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1st Jun

2009

Achilles tendon pain

One of the most common overuse problems seen is Achilles tendon pain, correctly referred to as Achilles tendinopathy (often called Achilles tendinitis). This is in particular common in runners and jumpers.

OVERUSE THE MOST COMMON CAUSE

Although partial and complete tendon tears are common, the most typical cause of pain in the Achilles tendon is overuse, where the amount of loading-strain on the tendon exceeds its tolerance. People susceptible to developing this are those who suddenly increase their exercise intensity or running mileage, those who are deconditioned prior to starting sports participation or running, runners with faulty mechanics (e.g. a bouncy running style), or those with pre-existing wear and tear in the tendon from previous trauma or sports participation.

TWO TYPES OF ACHILLES TENDON PAIN

The two kinds of Achilles tendon pain seen are the mid-portion tendon pain, and the insertional pain at the tendon attachment onto the heel. The former usually occurs in an area of relative avascularity, i.e. there is a “watershed” area of poor blood circulation in this region, 2″-4″ up from the heel bone. The insertional type involves the complex transition from tendon tissue to bone. Although both types are treatable, the mid-portion type of Achilles tendon pain usually responds quicker and better to conservative rehabilitation, including physical therapy rehabilitation. However, this is also the region of the tendon which is the most prone to complete ruptures, which are best treated by surgical repair, followed by rehabilitation.

REHABILITATION EXERCISE EFFECTIVE

While Achilles tendon rehabilitation exercise can be very effective, it is also important to initially reduce the strain on the tendon, by avoiding painful running or jumping, and by gradually resuming and progressing such activities as the tendon gets better. Early on, a heel lift inside of the shoe can also help to decrease stretch and therefore strain on the tendon. One form of rehabilitation exercise which has been found to be especially effective for mid-portion Achilles tendon pain is lengthening, or eccentric contractions of the calf muscles. There are a number of ways to do that, but the simplest way is to go up on toes and slowly drop the heel down, at first on both legs, and after some time on one leg, progressed to off a step, and even with weights in arms or on the back. A particular protocol must be followed, to get maximal effect, and to prevent worsening of the condition. Insertional tendon pain does not respond as well to this form of training, and therefore we would use a different and lower intensity approach for these problems.

With best wishes for a healthy summer,

Gunnar

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