Another must read article in our Injury/Prevention Education Series from Dr. Marc Bochner, including: why the Achilles tendon is one of the most commonly injured tendons, how to recognize early signs of injury and treat properly.
Injury to the Achilles tendon can either happen suddenly, as in a rupture,or can occur gradually, as with tendinosis, which is the usual case in running. In the sudden injury scenario, recreational athletes often injure an already tightened or weakened calf when it is suddenly stretched or contracted past its normal limits, causing the tear. Although tears can occur in endurance athletes, the common scenario for a tear is a middle-aged person who has gradually lost flexibility and developed adhesions in the calf muscles and around the tendon, probably from years of sitting without regular stretching, and who goes out and plays tennis or softball for the first time in months or years. He or she then stresses muscles and tendons past their current limits, and a tear occurs. So even though the injury may seem sudden, the predisposing factor of decreased calf flexibility was probably present for some time. Likewise, in running and other endurance sports, a loss of calf flexibility and calf muscle/tendon adhesions are also to blame for cases of tendinosis.
To prevent overuse injury to the Achilles, addressing the factors leading to tightness and possible scar tissue formation is necessary. Muscle tightness can be a major factor, and two areas are often the culprit: one is the calf, or back of the leg, as mentioned above, and the other is the adductor, or inner thigh muscles. Regular stretching and strengthening of these muscles (exercises described below) will help preserve normal foot motion and prevent overpronation. This is important to prevent, because overpronation, which is the ankle bone “rolling inward” at a greater than normal amount or speed, can overstretch the Achilles. Overstretching causes the tendonosis by stressing the tendon and causing the tendon microtears and adhesions (the scar tissue). Tight calf muscles can cause a compensatory overpronation, to make up for the lack of leg bend at the ankle by flattening the arch more than normal. Likewise, tightness in the adductors can lead to the thigh moving inward while running, which then can cause our foot to turn outward, pronating excessively to compensate and keep us moving forward. Overpronation can also exist without any muscle tightness or imbalances, and lead to injury in the same way. Orthotics will correct the overpronation. Calf weakness can also be a factor, as lack of strength will cause overstretching of the Achilles. Finally, training errors, such as doing too much speed work or rapidly increasing training volume, can be causative. So can wearing worn out shoes, which can cause overstretching and tightness which will lead to injury. Unfortunately, often a runner often will only learn about these preventative measures once injured. The good news is that with proper treatment, even the worst cases can be resolved; however the earlier treatment starts, the better.
Continue to learn about treatment…