---

Achilles Tendonitis

Overuse injuries are estimated to account for up to one-half of all athletic injuries. Though the Achilles tendon is the strongest in the human body, it takes a high magnitude of stress which makes it susceptible to overuse injuries. The Achilles tendon has been shown to account for 18% of running injuries and 4% of visits to sports medicine clinics. A recent finding showed male to female injury ratios range from 2:1 to 12:1.

TERMINOLOGY

Tendinopathy – Term used to describe pain, swelling and impaired performance in a tendon.
Tendonitis – Inflammation of the tendon has been confirmed.
Tendinosis – Degeneration of the tendon has been confirmed and may lead to a tendon rupture.

DO YOU FEEL ANY OF THE FOLLOWING?

Pain or tenderness between the heel and lower calf that occurs when:

• running
• stair-climbing
• jumping
• walking on the toes
• pointing the toes down
• taking your first few steps after getting out of bed or after sitting awhile
• beginning a new activity or workout

If so, you may have Achilles tendonitis. This tendon attaches the calf muscles (gastrocnemius and soleus) to the heel and is responsible for pointing the foot downward. It also helps in jumping, sprinting, using stairs and standing on your toes.

Achilles tendonitis is often brought on by:

• Excessive running or jumping
• Inadequate warm-up and/or stretching
• Activity on unfamiliar surfaces
• A sudden increase in the intensity of a workout or sports activity
• Faulty foot mechanics or training technique (such as wearing poorly supportive shoes with flat feet)
• Aging (leads to increased tendon stiffness and decreased ability to withstand repetitive stress)
• Leg-length differences

TO RELIEVE PAIN AND SPEED RECOVERY

Unless your Achilles pain is severe or you're unable to walk, you can try the following:

• Rest from all activities that cause pain, especially running and jumping
• Ice 2-3 times per day. Ice in a plastic bag can be placed over the Achilles tendon for 20 minutes at a time OR a frozen cup of water can be used to massage the inflamed area for 5 minutes
• Aspirin or Ibuprofen
  - To reduce pain: take per product’s guidelines
  - Important: Stop taking if stomach upset or bloody stools occur.
• Shoes refer to “Footwear” handout for tips on choosing proper shoes

STRETCH - to reduce tension along the Achilles tendon

Technique: Warm up with a brisk walk, slow jog or cycling until you start to sweat. Stretch to a gentle pull and hold without bouncing for 20-30 seconds.
Frequency: Do 4-8 repetitions/day, 5-7 days per week.

STRENGTHEN - the calf muscles and Achilles tendon to prevent injury.

Technique: Perform exercises after stretching. Start by strengthening the calf muscles, then after 3-4 weeks, try the Achilles strengthening.
Frequency: Do 3 sets of 10 repetitions, 3-4 days per week.

**Recommendation: Begin stretches and exercises listed here (only if pain-free) until your appointment with the physical therapist or athletic trainer.

References:

Magnussen, R. A; Dunn, W. & Thompson, B. A. “Nonoperative Treatment of Midportion Achilles Tendinopathy: A Systematic Review,” Clinical Journal of Sport Medicine; 2009; Vol. 19(1); p54-64
Hess, G. W. “Achilles Tendon Rupture: A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention,” Foot & Ankle Specialist; 2010; Vol. 3(1); p29-32
Arya, S. & Kulig, K. “Tendinopathy Alters Mechanical and Material Properties of the Achilles Tendon,” Journal of Applied Physiology; 2010; Vol. 108; p670-675.