Achilles Tendonitis - Michael Irvine (Paladin Biokineticists)

The Achilles tendon is the largest and strongest tendon in the human body. It is a tough band of fibrous tissue which inserts onto the calcaneus of the foot. The Achilles tendon is the common tendon to the gastrocnemius and soleus calf muscles. When these muscles are contracted, the Achilles tendon pulls on the calcaneus causing plantar flexion of the ankle. This is a common movement which makes walking, running, jumping and standing on toes possible. The Achilles tendon is said to withstand forces up to seven times one’s body weight, showing how much force the Achilles tendon is made to withstand during sporting activities.

Achilles Tendinitis is a condition which involves the inflammation of the tendon surrounding the ankle joint. Tendinitis within the heel complex is either due to a single cause, or may involve a variety of mechanisms. Although the Achilles tendon is an extremely strong structure and able to withstand large forces placed on it, it is still vulnerable to injury. This is due to a large amount of tension placed on it, as well as tendons having a limited amount of blood supply.

Achilles tendinitis is an inflammatory condition which involves the degeneration of the Achilles tendon. This is a result of micro tears which have developed within the structure which directly causes instability and a decrease in the tendons tensile strength.

There are two types of Achilles tendinitis:

• Acute Achilles Tendinitis

This is usually the result of abrupt or sudden onset, with the individual experiencing moderate pain 2 – 3 cm proximal to the tendons insertion on the heel. The pain is pinpoint tenderness and pain will increase when palpated.

• Chronic Achilles Tendinitis

This is generally an injury which occurs from overuse. Chronic Achilles Tendinitis exhibits a similar pain to Acute Achilles Tendinitis except the pain is usually at the insertion of the Achilles tendon. This injury generally occurs from repetitive micro trauma to the tendon and if left untreated, it could progress to an Achilles Tendon Rupture.

Aetiology:

It has been highly speculated that runners are more susceptible to Achilles tendinitis due to the repetitive micro trauma. This micro trauma is produced by:

1.       Eccentric Loading of fatigued muscles

2.       Excess pronation which produces a whipping action of the Achilles tendon

Therefore, all Achilles tendon injuries tend to be a result of either structural or dynamic disturbances of the lower leg. The main cause of Achilles tendon complex is due to overuse/overtraining.

Causes:

•     Overuse/changes in training
•     Ageing
•     Biomechanical faults (Pronation)
•     Tight calf muscles
•      Lack of ankle instability
•     Inappropriate show wear (resulting in biomechanical faults)

Signs and Symptoms:

Unless acute Achilles tendonitis, symptoms tend to develop gradually and become worse over time.

•         Local and tender pain in Achilles which tends to increase with specific activities
•     Crepitus (Grating or crackling sensation within the tendon upon movement)
•      Redness/swelling around the area
•      Affected tendon may appear thicker
•      Stiffness in tendon in morning which gets better with movement
•      Pain experienced with active or passive stretching
•      Reduced flexibility
•      Weakness and pain when standing on toes

Exercise as treatment:

Due to the Achilles tendinitis being an overuse injury, it is important to reduce activities that place strain on the Achilles tendon. Research has found that there are passive as well as active methods which can be prescribed to treat Achilles tendinitis. Aggressive stretching of the Achilles tendon complex should be implemented and incorporated into the training program to loosen the calf muscles and relieve the tendon of some of the tension placed on it. Exercises can be done to improve one’s biomechanical faults such as pronation which can help reduce the strain on the Achilles tendon.

Joint Laxity... Are you bent out of shape? - Nicole Robson (Paladin Biokineticists)

Ligaments connect bone to bone and therefore play an important role in joint stability. When ligaments are lax, there is less stability and the ligaments are termed “loose.” When this affects more than one joint in the body it is termed hypermobility and is often the cause of chronic pain. Causes are either genetic or as a result of an injury (torn ligament). Individuals with lax ligaments are more pre-disposed to injury and resultant joint degeneration with increasing age.

Common symptoms include

•  pain and stiffness in the joints and muscles
• clicking joints
• pre-disposition to dislocation.
• fatigue (extreme tiredness)
• recurrent injuries – such as sprains

Exercise is a great way to help manage pain and create stability around the joints. As a biokineticsist we can determine which joints are more hypermobile than others and therefore can determine which muscles are compensating. It is important to have specific exercise prescribed so that strength can develop and assist with stabilisation. It is also important to learn what normal range of motion is for each joint, in order to avoid hyperextension.

It is important to concentrate on both isometric and concentric strengthening exercises. In isometric exercise, the joint doesn't actually move, but the muscles around it are contracting. This enables the joint to remain stable whist gaining strength. With concentric exercises, muscles shorten as they contract (i.e. when you lift a weight in a bicep curl).

Emphasis should focus on the most susceptible joints such as your shoulders, elbows, knees and ankles. Core strengthening surrounding joints in your lower back, pelvis and hips is also of vital importance. A strong core assists with overall stability and therefore less chance of injury.