Achilles tendonitis is the recurring plague of many of our sports-people patients. If it doesn’t prevent them from perusing their sport entirely, the often chronic nature of this condition slows their progression and blights their performance.
What is Achilles tendonopathy?
This body part got it’s name from the Greek legend of Achilles, who’s only weakness was to be found at the bottom of his calf. The correct anatomical name for this tendon is the Calcaneal tendon, connecting the calf muscles on the back of the lower leg to heel bone, and then to the plantar fascia at the sole of the foot. If we think of all these tissues as one continuous sheet, it is much easier to understand the reasons that pain occurs in the first place.
Tendons are thick fibrous tissue with poor circulation, which connect muscle to bone. The term tendinopathy is best used because tendonitis implies an active inflammatory response – and sometimes our patients don’t present with that. Quite frequently we see Achilles tendons which have been chronically aggravated, and are visibly thick with scar tissue.
Tendinopathy then refers to any dysfunction of the tendon that causes pain.
Why does it happen?
Any one of the interlinking parts of the anatomy we talked about before can put stress on to the Achilles tendon. Tight calves can pull on the tendon, poor footwear can stress the plantar fascia and pull on the tendon, and any misuse of the ankle joint can cause undue biomechanical load to be put onto the Achilles tendon. Just like Greek Achilles, it’s a vulnerable part of our anatomy.
Thinking as an osteopath, the function of the knee, hip, lower back, and the whole of the opposite leg are also very important to assess in patients presenting in clinic with Achilles tendinopathy.
How can it be sorted?
A full osteopathic assessment of your biomechanics may be able to identify the causative factor in your tendinopathy. Once the root cause has been found, these are some of the common treatment techniques I like to implement with my patients in the clinic.
- Eccentric heel-drop calf stretches
Standing with your toes on a small step, lift onto your toes. Squeeze you calves as tight as you can for 10-15 seconds. Lower your heels off the back of the step, lower than your toes, very slowly and carefully. Do not bounce in this stretch, as it is deep and your tendon is already vulnerable. Hold the stretch for 20-30 seconds. Repeat 3 times.
I’ve been using sports tape in clinic for 3 years, but RockTape is by far my preferred brand. I use the tape from the sole of the foot, all the way to the top of the calf, with extra horizontal pieces to reinforce areas of particular stress.
- Gluteal strengthening techniques
Sometimes Achilles tendinopathy is the by-product of a rotated leg posture. I encourage patients to lengthen and strengthen their hips to make sure the foot is landing as correctly as possible in their gait (that’s walking and running!)