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Achilles Tendonitis

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Dr. Rick Swartzburg,D.C.
Author of
1backpain.com, bursitis.org, probiotic.org and memoryfoammattress.org



Tendonitis.net Quick tip:
Stretching can help relax and lengthen a tendon, but never stretch the painful and inflamed area, as this can worsen the tendonitis.  Instead, stretch the more pliable muscle around the tendon.

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Achilles Tendonitis

How Achilles Tendonitis Occurs

The Achilles tendon named after the Greek mythological character, Achilles, is the largest and strongest Tendon in the human body.  This Tendon is one of the many reasons why we are able to walk upright.  The Achilles tendon attaches the Calcaneus(heel bone) to the Soleus-gastrocnemius complex (calf muscles).  This incredibly tough, fibrous tendon transfers the energy of the calf muscle to the force that allows you to push your foot off of the ground.  Taking a single step forward begins at the calf muscles.  The calf muscles react to nerves, connected to the brain, that tell the muscles to contract.  When the muscle contracts it places tension on the Tendon.  The Achilles tendon transfers the tension to top of the heel bone.  The tension causes the heel bone to be pulled upward.  When the heel bone is pulled upward it creates the force needed to push the foot off the ground.  Aside from the tendon pulling on the Calcaneus (heel bone), there are many other factors which contribute to our ability to walk.  The foot needs to be stabilized laterally to keep it from rolling side to side during the process of taking a step forward.   

Achilles Tendonitis is a condition that occurs primarily because of an overuse of the area.  After Tendonitis sets in, the Achilles tendon then becomes tight and painful.  The normal gait cycle requires the ankle to move a total of 30 degrees.  The constant movement of walking results in constant lengthening and shortening of the tendon.  This constant movement can cause inflammation and micro-trauma to the area.  The extreme shear forces placed on the insertion point of the tendon is typically what causes Achilles Tendonitis.  The insertion point is where the tendon attaches to the Calcaneus (heel bone).  The point at which the tendon connects to the heel bone is where the maximum shear force is found.  The tendon does have the ability to stretch a small amount, but because the tendon is so dense and fiborous is does not stretch much.  When the calf muscles are tight and tense, the tendon will be under more strain than normal.  If the calf muscle is loose, the muscles stretch further taking stress off of the tendon.  Under a microscope, an Achilles Tendon should be white, glistening and firm.  An Achilles Tendon that is plagued by Achilles Tendinitis is typically dull, slightly brownish in color and much softer than normal. 

The Achilles tendonís origin connects the top of the calf muscle to the tendon that attaches to the Tibia (leg bone).  The tendons and the calf muscles work like a hammock.  The weight of a person laying in the hammock would pull on the support straps (Tendons), which would cause the force of the personís weight to be transferred into force.  The tendons and calf muscles in the lower part of the leg work in exactly the same way.  The muscles contract and place force on the back of the heel bone which pulls the foot downward allowing the person to push their foot off the ground.  The tendons act like the support straps of the hammock, but the tendons have very little give.  The hammock, itself, needs to be very elastic so it can support the weight of the person laying in it.  When a person has muscles that are very tight, the muscle does not have enough give to allow the full range of motion.  Just like a hammock that is stretched to far, the support straps (tendons) will be strained and can even tear.  When a person has muscles that are loose and flexible, the hammock has the ability to support much more weight and is less likely to tear.   

As mentioned previously, Achilles Tendonitis is primarily due to a person having very tight calf muscles during movement of the area.  When the calf muscles are tight they do not react to tension correctly.  A tight calf muscle places a great deal of strain and stress directly on the Achilles Tendon.  The muscles should act as a shock absorber for the tendon, but if the muscle is very tight the shock will not be absorbed. 

Tight muscles can occur for many reasons.  Stretching before any physical activity is always recommended.  A person that stays physically active all the time will generally have muscles that are flexible and not as tight as someone who is not physically active.  If a person exercises and stretches daily, they will not be as prone to Tendonitis.

 

Achilles Tendonitis Symptoms

Symptoms can vary from an achy pain and stiffness to the insertion of the Achilles tendon to the heel bone (calcaneus), to a burning that surrounds the whole joint around the inflamed thick tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.  This is especially true if your sheets are pushing down on your toes and thereby driving your foot into what is termed plantar flexion (downward flexed foot), as this will shorten the tendon all night. 

 

Achilles Tendonitis Treatment

With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks following the initial injury.  This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together.  Scar tissue will continue to form past six weeks in some cases and as long as a year in severe cases.  After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating Achilles tendonitis is to support and protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.   

This can be done topically if a pain reliever has the ability to penetrate the skin barrier and contains anti-inflammatory agents. A topical formula that contains natural menthol will not only relieve pain, but dilate the blood vessels. This allows for relief of the tendonitis, without causing any stiffening of the tissue.  MSM, also known as Methyl Sulfonyl Methane is a natural supplement that is getting a lot of attention due to its role in tissue healing at a cellular level.  It is a natural organic sulfur that comes from rain fall and is found naturally in the human body.  It has been shown to have anti-inflammatory effects on the tissues.  See all about Glucosamine and MSM for more information this supplement.  Ice can relieve inflammation, but will constrict the blood vessels and further stiffen the tendon.  Cortisone injections can reduce inflammation, but unfortunately are very caustic and can cause a weakening of the tendon structure and a create more scar tissue.  Dr. Swartzburg, our site editor,  worked in conjunction with our sponsor, Relief-Mart, to develop a spray for Tendonitis called Therapain Plus.  It has all natural pain relievers plus 14,000mg of MSM and Glucosamine.

After the scar tissue has begun to accumulate, it will be important to perform procedures which help break down the scar tissue in the achilles tendon tissue, so as to let the tendon and muscle regain it's normal flexibility and lessen the chance of further injury.  While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages.  Therefore, other methods that can be performed by your healthcare provider, such as ultrasound and massage, may be safely used to accomplish this early on in the injury. Ultrasound uses sound waves that vibrate a such a fast level, that it cannot be felt with normal use.  Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down.  Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissues by transporting them with the sound waves.  Light stretches may also be performed if they do not cause any further irritation to the area.  Once the heavy inflammation has passed, the stretches can become more vigorous and by design really stretch the calf muscle, therefore helping to slacken the Achillies tendon (see proper Achilles stretch below)  

 

  Achilles/Calf Stretch (courtesy of www.1backpain.com)


Start with stretching the right Gastrocnemius portion of the right calf area. While standing, place your right leg in front of you and your left foot directly behind you.  Place the toes of your right forefoot up against a door or other flat wall surface, keeping your heel down to the floor.  Lean your upper body forward to place a stretch on the back of the calf.   Do the exact opposite to achieve a stretch of the left calf area.  Hold each stretch for a minimum of 30 seconds.  Any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the calf area of the leg, without aggravating your condition.

Achilles Tendonitis Prevention

Prevention of this condition requires stretching the calf muscle on a regular basis and thereby lengthening the tendon connection. This will allow less pulling and tractioning on the tendon attachment to the bone. When tendonitis does occur, it is important to treat it immediately, and thereby prevent it from reaching a stage that is more severe. 

 

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