Achilles tendonitis (tendinopathy) is characterized by pain and stiffness in the Achilles tendon (the structure that connects your calf muscles to your heel) that increases after a resting period or as your activity increases throughout the day. There is often a bump or hardness present with Achilles tendonitis, which can be found along the base of the tendon at the back of your heel. There are two types of achilles tendonitis, insertional, and non-insertional. Non-insertional tendonitis tends to occur with younger and more active people, whereas insertional tendonitis can occur in a person of any age or activity level.
Achilles tendonitis is also referred to as achilles tendinopathy, which is a more general term for a problem with a tendon. The ending “-itis” technically means inflammation, and not all cases of achilles tendinopathy involve inflammation. An emerging term for non-inflammatory achilles tendonopathy is Achilles tendinosis. The ending of the word, “-osis” doesn’t mean inflammation, it basically means a degenerative response. And that’s exactly what it is. If you would look under a microscope, you would see that the individual fibers of the Achilles tendon actually have become degenerated. With this degenerative response, adhesions are actually laid down within the tendon, and those adhesions are the cause of a lot of pain, and they actually restrict motion. The adhesions also impact your proprioception, your body’s sense of where you are in 3D space. Your proprioceptive sense is thrown off if you have an injury to a tendon.
Symptoms of achilles tendonitis:
-Tenderness along the calf or back of the heel
-Thickening of the achilles tendon
-Increasing pain with increasing activity
-Increased pain following a long rest period (overnight)
-Swelling of the achilles tendon
-Calf stretching may increase the pain
Causes of achilles tendonitis:
Other than an acute injury, there are several other causes of Achilles tendonitis.
-Too much/too soon (increasing mileage)
-Tight calf muscles (gastrocnemius or soleus)
-Tight hamstring or glute muscles
-Weakness in hip or glute that affects biomechanics of the foot/ankle
*A bone spur is usually the result of achilles tendonitis, rather than the cause. According to Wolff’s Law, a force exerted on a bone (by a muscles or tendon) causes that bone to remodel. When the calf muscles are overworking and pulling too hard on the calcaneus (heel bone), a bone spur may develop. Many people assume that the bone spur is the cause of pain, however it is usually more accurate to note that the bone spur is a result of the problem. Every once in awhile, a bone spur forms for other reasons, and it can be a cause of pain in the achilles.
Treatment of achilles tendonitis:
So what needs to happen if there are adhesions in a muscle? Well, ice is not going to help, it’s not going to make an adhesion go away. Ice might give you a little bit of pain relief, but it’s not going to address the adhesion. The same thing applies to stretching, you’re going to get some overall benefit from the stretching, but you’re not going to actually get rid of the adhesion. It’s analogous to having a knot in the middle of a rope… if it’s just a regular rope clear of knots and you pull on the two ends, you’re going to get some stretch out of it. But if there’s a knot in the middle of it, yes, you might get a little bit of overall stretch, but you’re just tightening up the knot in the middle, and that knot in the middle, that’s the adhesion. Other solutions like anti-inflammatories, again, those are not actually going to reduce the adhesion.
The most efficient treatment method to reduce the adhesion is a non-invasive, non-surgical, physical technique such as Active Release Techniques. This technique will be performed on the achilles tendon itself, as well as on any offending muscles in the area such as the gastrocnemius, soleus, and deep calf muscles. Addressing the calf muscles is one piece of the puzzle, but to look more closely, there is usually a reason the calf muscles are so tight on one side of the body. Most people have two legs, and most people only come in with Achilles tendonitis on one side. So what’s going on with that? Oftentimes there’s either a weakness in the hip or the glute, or there’s an adhesion in one of the glute muscles and what happens when there’s adhesions in the glute muscles is that it actually throws off the biomechanics all the way down the chain, so that when you get to the ankle and the Achilles tendon, you feel pain in your heel.
To fully treat Achilles tendonitis or tendinosis, your chiropractor will check all the muscles and all the joints in the area, and check to see what needs to be adjusted, what needs to have soft tissue work done, what needs to be rehabilitated (Is there something that’s not strong? Is there something that’s not stable?) They will look at the whole picture and put together a plan and get you back to the activities that you want to be doing. If you have any questions about achilles tendonitis, please give us a call at (510) 465-2342.