Achilles Tears and Tendinitis Injuries: Understanding, Preventing, and Rehabilitating

Achilles Tears and Tendinitis Injuries: Understanding, Preventing, and Rehabilitating

This weekend I competed in a pickleball tournament. I passed the ball to my opponent and he took a lunge forward. A terrible look suddenly crossed his face and he froze in horror. He reported that he felt a pop in the back of his leg and felt like someone had hit him with a bat in the back of his leg. My opponent had torn his achilles tendon. Achilles tendon injuries, including tears and tendinitis, can be incredibly painful and debilitating. Whether you’re a seasoned athlete, a weekend warrior, or just an active individual, these injuries can disrupt your daily life and athletic pursuits. In this article, we will delve into the causes of Achilles tendon injuries, explore effective prevention strategies, and discuss the crucial role of physical therapy in rehabilitating these injuries.

Understanding Achilles Tears and Tendinitis

Before we dive into prevention and rehabilitation, it’s essential to understand the two primary Achilles tendon injuries: tears and tendinitis.

1. Achilles Tears:
   • Achilles tendon tears can range from partial to complete ruptures of the tendon. These injuries often result from sudden and forceful movements, such as jumping or sprinting. They can be extremely painful and may even require surgical intervention.
   • Common causes of Achilles tears include:
     • Overexertion during physical activities and sports
     • Poor conditioning before exercise
     • Aging, as the tendon naturally weakens with time, making it more susceptible to injury
     • Body Mass Index (BMI) >  30 kg/m²  (Alegre et at 2021)
     • Sex. A recent study found that 83% of those with Achilles ruptures are men (Alegre et at 2021)
     • Previous tendon injuries, which increase the risk of future tears
     • Prolonged use of corticosteroids, fluoroquinolone antibiotics, and oral bisphosphonates (Shamrock et al 2023)
   • Symptoms of an Achilles tear may include sudden pain, swelling, and difficulty pointing your toes or pushing off your foot.
2. Achilles Tendinitis:
   • Achilles tendonitis is an inflammation of the Achilles tendon, often resulting from overuse, repetitive stress, or improper training techniques. Unlike tears, tendinitis doesn’t involve a complete rupture but can still be incredibly painful and limit your activity.
   • Common causes of Achilles tendinitis include:
     • Excessive running, walking, or jumping
     • Sudden increases in activity levels or training intensity
     • Prior history of lower limb tendinopathy or fracture
     • Use of fluroquinolone antibiotics
     • Moderate alcohol use
     • Training in cold weather
     • Decreased isokinetic plantar flexor strength (Malliaras 2022)
   • Symptoms of Achilles tendinitis include pain and stiffness in the tendon, particularly during the first few steps in the morning or after prolonged periods of inactivity.

Preventing Achilles Tears and Tendinitis

Preventing Achilles tendon injuries is far more desirable than having to deal with the pain and recovery process. Here are some essential tips to reduce your risk of these injuries:

1. Proper Footwear:
   • Invest in well-fitting athletic shoes that provide adequate arch support and cushioning. The right shoes can make a significant difference in reducing the strain on your Achilles tendon.
2. Gradual Progression:
   • Whether you’re starting a new exercise program or increasing your training intensity, gradual progression is key. Avoid sudden and significant changes in your activity level to give your body time to adapt and strengthen.
3. Warm-Up and Stretching:
   • Before any physical activity, ensure you warm up properly. Dynamic stretching and gentle range-of-motion exercises can prepare your muscles and tendons for more intense movement.
4. Strengthening Exercises:
   • Incorporate exercises that specifically target the calf muscles and Achilles tendon. Strengthening these areas can help reduce the risk of injury. Exercises like calf raises and eccentric heel drops are particularly effective.
   • Posterior kinetic chain strengthening beyond the gastrocnemius-soleus complex. This includes strengthening the hamstrings and gluteal muscles (Von Rickenbach et al 2021).
5. Cross-Training:
   • Vary your physical activities to prevent overuse of the Achilles tendon. Alternating between different sports or exercise routines can help reduce the repetitive strain on the tendon.
6. Balance Training:
   • Increases your body’s awareness of where you are in space.
7. Listen to Your Body:
   • Pay attention to any signs of discomfort or pain in your Achilles tendon. If you experience persistent discomfort, it’s essential to rest and seek medical attention if necessary.

The Role of Physical Therapy in Rehabilitation

Achilles tendon injuries can be challenging to recover from, but physical therapy plays a crucial role in the rehabilitation process. Here’s how physical therapy can help:

1. Pain Management:
   • Achilles injuries can be extremely painful. Physical therapists use various techniques, such as ultrasound and manual therapy, to manage pain and reduce inflammation.
2. Restoring Range of Motion:
   • After an Achilles injury, your range of motion may be limited. Physical therapists work on gentle stretching and mobility exercises to gradually restore the natural movement of your ankle and calf.
3. Strengthening Exercises:
   • Strengthening exercises are a fundamental component of Achilles tendon rehabilitation. Physical therapists design specific exercises to target the calf muscles and Achilles tendon. Eccentric exercises, where the muscle lengthens under tension, are particularly beneficial in rebuilding strength.
4. Gait Analysis:
   • Walking and running mechanics play a significant role in Achilles tendon health. Physical therapists can analyze your gait and make necessary corrections to reduce stress on the tendon.
5. Biomechanical Assessment:
   • If your Achilles injury resulted from poor foot biomechanics, physical therapists can assess your feet and recommend appropriate orthotics or shoe modifications to prevent future problems.
6. Neuromuscular Re-Education:
   • Learning how to move efficiently and distribute forces evenly can be crucial in preventing reinjury. Physical therapists help you retrain your body to move safely and avoid putting excessive strain on the Achilles tendon.
7. Home Exercise Programs:
   • Physical therapists provide you with a personalized home exercise program that complements your in-clinic sessions. Consistent, at-home exercises are essential for long-term recovery.
8. Gradual Return to Activity:
   • Your physical therapist will guide you through a carefully structured return to your desired physical activities, ensuring you don’t rush back to full intensity, which could increase the risk of reinjury.
9. Education:
   • Understanding your injury, the rehabilitation process, and preventive measures is crucial. Physical therapists educate you about your condition and how to care for your Achilles tendon in the long term.

Conclusion

Achilles tears and tendinitis injuries can be painful and frustrating, but with proper prevention and rehabilitation strategies, you can regain your mobility and return to your active lifestyle. Taking care of your Achilles tendon through appropriate footwear, gradual progression, and proper technique can significantly reduce your risk of injury. In case of an injury, working with a skilled physical therapist is invaluable in your journey to recovery. With their guidance, you can rebuild strength, restore mobility, and develop strategies to protect your Achilles tendon in the future. Remember, prevention is the best medicine, but when injuries do occur, there’s hope for a full recovery with the right care and dedication.

Citations

Alegre B, Seijas R, Alvarez P, Pérez A. The Achilles Tendon Rupture in Basketball: Systematic Review of the Present Literature. Surg J (N Y). 2021;07(03):e265-e270. doi:10.1055/s-0041-1733988.

Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother. 2022;68(4):221-237. ISSN 1836-9553. doi:10.1016/j.jphys.2022.09.010.

Shamrock AG, Dreyer MA, Varacallo M. Achilles Tendon Rupture. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430844/

Von Rickenbach, Kristian J. MD, MS^1,2; Borgstrom, Haylee MD^1,2,3; Tenforde, Adam MD^1,2; Borg-Stein, Joanne MD^1,2; McInnis, Kelly C. DO^1,2,3. Achilles Tendinopathy: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports 20(6):p 327-334, June 2021. | DOI: 10.1249/JSR.0000000000000855