Stride Strong PT’s Achilles Injury Treatment Formula
• Decrease inflammation of the tendon without stressing the structure, while improving soft tissue mobility to decrease strain.
• Modalities such as kineseotaping and iontophoresis with dexamethosone to decrease inflammation and pain.
• Video Gait Analysis to determine offending part of the gait cycle contributing to cause of Achilles tendintis.
Achilles tendinitis can be a very crippling issue for runners – simply because the pain is enough to discourage loading of the foot. This type of foot injury can also be a tricky condition to treat because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.
What causes it?
The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of landing. This is what is called an “eccentric load”. Excessive eccentric loading – either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture – could very well be the cause of a runner’s achilles injury. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.
The different types of tendinitis
Midsubstance tendinitis – usually presents with pain at the middle of the achilles tendon, or to either side of it. (See the achilles tendon colored red in the illustration) Midsubstance tendinitis is the easier type of tendinitis to treat because the tendon here has a higher proportion of muscle fibers and collagen. Manual therapy and eccentric stretches can help stimulate recovery rapidly.
Insertional tendinitis – the pain congregates more around the heel, where the achilles tendon flares out and attaches to the heel bone. Look for pain on either side of the foot (but not on the bottom of the heel – this could be from plantar fasciitis instead). Insertional tendinitis frequently requires a longer recovery period. ASTYM works well for this region, as well avoidance of the heel sinking past neutral position (also known has “ankle dorsiflexion”). In stubborn cases, prolotherapy or accupuncture has shown success.
How to treat it?
– Physical therapy is the first and most useful defense for achilles tendonitis because of the two presentations outlined above. Treatments for the two types are quite different in approach. Midsubstance tendinitis responds well to stretching, whereas insertional tendnitis tends to be aggravated more by it. Depend on your trusted physical therapist to differentiate between the two and follow their guidelines on exercises and running modifications.
– Alter your gait mechanics. Running gait patterns that show excessive “sinking postures” tend to point to the source of achilles tendon problems. Altering your gait in the midstance phase of the cycle can reduce the load on the tendon dramatically and thereby reduce pain. Rely on your running physical therapist for proper guidance on altering your gait the right way. Stride Strong’s Portland Running Clinic gait analysis can identify and fix potential issues before pain sets in.
– Icing at the onset of acute achilles pain (i.e. when the achilles injury is fresh and new) would help control the inflammation. Your next step should be to call our number for an appointment.
By Alice Holland, DPT.
Alice’s Google + page.
Doctor of Physical Therapy, Director at Stride Strong Physical Therapy