How Is Your Achilles?
Physical TherapyHave Achilles Pain?
Achilles Tendinosis in Elite Runners
by Stephanie Penny, PT, DPT, a physical therapist with Lakeshore Sports Physical Therapy, PC.
Dr. Penny may be reached at sp@lakeshoresportspt.com.
Elite runners alternate between intensive physical training and recovery to improve performance. However, many runners fail to maintain a balance between intensity of training and appropriate recovery, resulting in a breakdown in tissue reparative mechanisms and eventually leading to overuse injuries. Historically, these injuries have been referred to as “tendinitis,” a word that points to inflammation the cause of the problem. While true inflammation of a tendon occurs after traumatic injury, research has demonstrated that most non-traumatic overuse injuries are degenerative in nature. Since the body’s healing process relies on a series of events heralded by the arrival of inflammatory cells, many overuse injuries do not benefit from the body’s normal healing process and result in a progressive, degenerative process.
For elite runners, injury to the Achilles tendon is a common experience with an annual incidence of 7% to 9% in top level runners. One study of runners found that the odds of developing Achilles problems were 10 times greater in runners than in age-adjusted controls. Risk factors for developing Achilles tendonosis include excessive mileage, sudden increases in intensity, inadequate warm-up and stretching, and muscle imbalances. Mechanically, Achilles tendonosis is most commonly precipitated by excessive foot motion, shortened calf muscles and weakness in the gastrocnemius-soleus (calf) muscle.
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In running, the gastrocnemius-soleus musculature controls the transition of the lower leg over the foot and ankle after initial contact, requiring significant eccentric muscle control and shock absorption. If the gastrocnemius-soleus is not conditioned to handle the forces of running, the Achilles tendon can be overloaded and strained. Traditionally, conservative rehabilitation for Achilles tendon pain was rest, ice and non-steroidal anti-inflammatory medications (NSAIDS). However, this treatment did not address the root causes of the problem and more current rehabilitation now incorporates eccentric strengthening to assist strengthening the muscle and improving the health of the tendon. Eccentric strengthening exercises load a muscle during the lengthening phase of a movement, such as holding a weight in your handing with the elbow bent and lowering it slowly to straighten the arm. Physical therapists incorporate eccentric strengthening in rehabilitation programs for Achilles tendinosis, but many are also starting to utilize additional techniques to assist with collagen regeneration and healing. Augmented Soft Tissue Mobilization or ASTYM is a soft tissue mobilization technique that applies acrylic tools to the healing tissue to stimulate the body’s natural healing response, resulting in the resorption and remodeling of scar tissue and the regeneration of degenerative tendons. This effective therapy incorporates a customized program of stretching and exercise, which positively influences the alignment of the newly developed collagen. You can visit www.astym.com for more information or to locate an ASTYM provider near you. |