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Chronic achilles tendinitis: What to do about it?

Many of our patients are dealing with ailments over the years of enjoying life. One of the more common problems that are presented is Achilles tendinitis. This diagnosis is very limiting and annoying to a person that wants to remain active in their sport or activity. The greatest problem with this tendon is the ability to rest it. Anytime there is an injury, proper care and rest are paramount to allow healing to occur. Now, this does not mean become a couch potato for the next few weeks, but it does mean you should alter your a

ctivities to allow the healing process to occur.


How does it occur?


There can be many causes of tendinitis, but most commonly it is a sign of overuse. The body is resilient. It can handle a lot of stress and damage bouncing back again and again. It is when the body reaches its limit, that is its healing limit is when the damage starts to accumulate. Patients will tell me that they have been doing the same activity all their life with no problems, but now they are not able to do the activity they love the most. I usually will explain that this because the body’s ability to handle the stress from the activity has decreased with the awful word "age". We are no longer the body we were when we were a teenager. Teens can get away with a lot of not so smart activity and usually have no reminders of it the next day.


The indications that you may be dealing with tendinitis are simple. Pain or swelling in the region of the t

endon. Usually, the pain is worse with activity but can decrease when you have warmed up enough. This is when the invitation to continue on with overtraining is tolerated by the body but will let you know after you have done it. Usually, after the activity stiffness and pain are felt at a greater level for a while and then will return to the normal level of irritation until the cycle is repeated again.


The cause of achilles tendonitis is not as easy to define. There can be many culprits to the same problem that may need the assistance of a professional i.e. Physical Therapist to diagnose the cause. Some of the common findings that I encounter are:


1. Tightness. Tightness. Tightness. This tightness can be anywhere in the leg, foot or even back. These stresses are problematic by overloading the posterior chain of muscles and wreaking havoc on the Achilles. A huge market has been developed around this one limitation. Foam roller, muscle sticks stretching devices are just a few tools that are commonly used for tightness in the legs. Usually, these techniques are not too popular because of the pain that is associated with them during but if you can suffer through it, usually the outcomes are worthwhile. Oddly enough, stretching will give some relief but is short-lived at best, the neurological system takes over and increases the tightness within steps of stretching. Currently, getting a tissue prep program, followed by a dynamic warm-up seems to be the ticket for proper body prep.


2. Joint limitations. Anything from the knee not fully extending to the hip not getting into full extension when you walk. These are examples of the joint altering mechanics of the leg which in the end affects the achilles. I commonly will examine both legs to ensure all joints are moving well when the Achilles is acting up. Most commonly, there will be a joint close to the tendon that is not functioning but there could be tightness in the pelvis or back that could also cause increased stress on the tendon.


3. Previous injury. When we are born, we are usually born perfectly. Cartilage is brilliantly white and shiny with no flaws. Tendons are formed in perfect alignment with no restrictions. Muscles are developed with no limitations of length or tightness. As our bodies grow and develop we start using them and pushing the limits. Scrapes on the knees, possible broken bone here and there but overall the body is brilliant at putting things back together. It is just not like what it was originally. For instance, when we have that big scar on the knee from falling off a bike early on in life. Our healing rates and potential are at its best but as you can see with the visual reminder of the scar, it was not perfect. The scar is functional and serves a purpose but it is not as good as the original. These injuries can lead to alterations in the motion and function of a joint.


4. Poor strength: Imbalances in any joint can cause havoc on the body. There can be direct correlations to weakness present in the anterior thigh and the rotators of the hip-related to a higher incidence of Achilles injury. When these muscle groups do not work right there is excessive stress on the tendon due to altered positioning of the leg when loading.


5. Doing stuff you should not be doing: We all have those moments we wish we could take back due to the wisdom that came from the stupidity that we went through. As adventurous souls, we all tend to push our bodies beyond their limits and function. Sometimes we can get away with it but most other times we are reminded that our bodies were not ready for that specific stress.


If you are experiencing an increase of heel pain or Achilles pain you are welcome to contact us to set up a visit to help you trying to achieve an injury-free life!



About the author,


Rajesh is a Physical Therapist, who is passionate about health and wellness. He is interested in all aspects of general well being including fitness, nutrition and mindfulness. He continues to learn and grow from the profession he loves.


If this article is helpful to you or you would like to get more information, please do not hesitate to contact me at khemrajphysicaltherapy@gmail.com


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