of the Achilles Tendon
soleus, gastrocnemius, and plantaris muscles form a common tendon, the tendo
calcaneus (Achilles tendon), which
attaches medially to the posterior surface of the calcaneus.
Tendinitis and Tendinosis
Achilles tendinitis develops due to inflammation, strain, or
repetitive trauma to the Achilles
tendon. This occurs usually due to a repetitive activity. Symptoms are also
associated with recreational activities like running, tennis and basketball.
is left untreated, it can develop into Achilles
tendinosis, due to a degenerative change in the tendon from repetitive
majority of achilles tendon overuse
injuries occur in middle aged, athletic males. Runners with overly pronated feet
may be at greater risk for developing achilles
tendinosis. The increased pronation may put additional stress on the tendon,
therefore, placing it at greater risk for injury.
Muscle Action and Rehab
Eccentric muscle action is a lengthening muscle contraction. The
muscle fiber (sarcomeres) crossbridges are at their maximal overlap at the
beginning of the contraction, therefore, the eccentric
contraction generates more tension than both concentric and isometric
has been proposed that possible explanations for the positive effects of eccentric
training on tendinitis might be either an effect of stretching, with a
lengthening of the muscle-tendon unit, and consequently less strain during ankle
joint motion, or hypertrophy and increased tensile strength in the
tendon."(Alfredson, Pietila, Jonsson, Lorentzon, p.365) It is this concept
that may explain the possible remodeling effect of the tendon due to the eccentric
Guidelines for Runners
ice after exercise
small heel lift in shoe
for two weeks after the aggravating activity
stretching regimen for gastrocnemius and soleus complex
eccentric exercise program 7-10
days after pain has subsided
eccentric thera-band exercises
3 sets of 10, progressing to 3 sets of 15.
with toes pointed, giving resistance through the thera-band, slowly allow
your foot into dorsiflexion.
Perform a toe
raise on a 4-6 inch box or step with both legs. Once on your toes, lift the
uninvolved leg and lower yourself slowly into dorsiflexion.
speed, number of sets, and amount of weight as tolerated.
Warm up and
cool down before exercise
5-10 min. warm
3x30 sec. calf
Protocol for Severe Conditions
running all together
the ankle for 2-6 weeks depending on the severity of the inflammation
immobilization when non tender to palpation
non-tender to palpation:
stretching 2-3x daily
anti-inflammatory if not contra-indicated
painless progression of activities
- Eccentric exercises
to rest if symptoms return