Achilles Tendinitis

The Achilles tendon is the common tendon of the gastrocs and soleus muscles. The tendon twists as it descends, rotating laterally. The twisting produces a concentration of stress in the tendon above the insertion where rotating is most pronounced. The Achilles tendon is subject to various forces which may compound stress through the twisting tendon at its point of least blood flow. Common symptoms:

• Thickened tendon, oedema, sore to touch ,posterior heel pain on first few steps in the morning and at the start or after finishing exercise

Predisposing Factors:

• Excessive training loads (overuse injury)

• Hill running: up or down excessively steep hills

• More explosive movements: jumps or push-offs

• Resuming too quickly after a lay-off

• Biomechanical factors of the foot and leg: unequal leg length, misshapen heel or foot

• Excessive foot pronation

• Tight gastrocs and soleus

• Poor footwear and high heels

Stretching:

• Simple gastroc/soleus 3 x 3 x 10sec then ice. Walk with a slight heel raise (both shoes)

• Gastroc/soleus stretch 3 x 3 x 20 sec

• Dip stretches 3 x 3 x 30 sec and progress to 60 sec

Ankle injuries:

•  Lateral ligament strains are most common.

• The medial deltoid ligament is much stronger than the lateral ligament. Therefore, inversion ankle injuries are more common then eversion injuries.

• Peroneal muscles may also be injured as they resist ankle inversion

Stretching:

•  Passive and gentle range of motion (ROM) all planes of action 3 x 3 min

• Gradually increase all active ROM in all planes of movement as pain and movement limits allow

• Proprioception restoration is very important for ankle injuries. Stretching and strengthening should cover restoring a full ROM and strength in all planes of movement of the ankle (i.e. inversion, eversion, plantar and dorsi flexion.

On initial return to full activity the ankle should be taped for extra support.