Tuesday, 28 June 2011

The Care and Prevention of Achilles Tendon Injuries Part 2


A detailed history, and examination by an appropriately qualified health professional, will allow a diagnosis to be made. An ultrasound or MRI scan can confirm the diagnosis.

Other causes of symptoms in the area, such as those referred from the lumbar spine and local infection, should be excluded.




Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries.


It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints.

Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.

Footwear and training advice

I have found that, when track athletes (particularly sprinters), run over-distance repetitions (for example, 300m) as part of their training, the Achilles is subject to great forces, as the athlete tires and their heel drops further during each ground contact. This can be counteracted by purchasing a pair of middle-distance-type spike shoes that have a protective heel wedge. This reduces the strain on the tendon, as the shoe's heel offers greater protection, and is not subject to overstretching when fatigue is present. I also advocate that any running below 90% of maximum speed is performed in trainers and preferably on a stable grass surface.

Very often sports people wait until their sports footwear (trainers/boots/spike) are well beyond the state at which they provide adequate protection and support before replacing them. Then, after an injury has occurred, they are advised by a physiotherapist and/or coach to buy a new pair. Trust me, it is cheaper to buy sports footwear regularly and stay healthy, than to pay for physiotherapy treatment (and buy the necessary footwear).


Ice therapy is an effective form of pain relief. Observe the PRICE protocol:






This can relieve the symptoms of a painful swollen Achilles tendon. Using ice packs for a period of 20 minutes every two hours can help with the swelling and pain, but pain relieving medication may also be required.

It may be necessary, in severe cases, to rest from high-impact activities for up to three months. This is because the collagen tissue, which the body produces to repair the damaged Achilles tendon tissue, can take three months to lay down.

Non-impact training, such as pool work, can maintain fitness during this period, and other body parts can be exercised with weights or other exercises. A physiotherapist may gently mobilise the soft tissue by providing controlled stress to help the tendon adapt and gain tensile strength.

Published research has suggested that recovery is promoted by using a very gradually progressed strengthening programme for the Achilles tendon and calf muscles under the supervision of a sports specialist/therapist/Physiotherapist. This strengthening programme uses eccentric muscle work, which means that the muscle is lengthening while contracting. Maximum tension is generated in the muscle and tendon during eccentric contractions.


It is important that an appropriately qualified therapist looks at the players'/athletes' overall body alignment to detect if the injury has been caused by a biomechanical problem. Over pronation can place excessive strain on the Achilles and lead to Achilles tendinopathy. An orthotic insert may be required but, in many cases, biomechanical problems are caused by stiffness in the joints. The therapist can mobilise them, which, if normal range of movement is attained and maintained, can often eradicate the problem.

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