Physical Therapy for Achilles Tendonitis

The Achilles tendon is the largest and strongest tendon in the body that allows you to run, jump, and stand on the balls of your feet. Achilles tendonitis is an inflammation of the tendon, often due to chronic overuse, that leads to swelling, pain, and irritation. Physical therapy is the most common treatment for Achilles tendonitis, decreasing pain, strengthening the affected area safely, improving mobility and flexibility, and allowing patients to return to daily activities and sports in a timely manner.
What is the Achilles Tendon?The Achilles tendon is the largest, strongest tendon in the body that connects the calf muscles to the heel bone. The Achilles tendon is used to jump, walk, run, and stand on the balls of the feet. When a person pushes off the ground, force is transmitted down the calf muscles through the Achilles tendon to the foot to allow a person to run or jump; when landing, the Achilles tendon helps to control the ankle’s position when the foot comes back to the ground. It can withstand a high amount of stress from running and jumping, but is prone to irritation, overuse, and degeneration.
What is Achilles Tendonitis? Achilles tendonitis is a common condition that occurs when the Achilles tendon becomes irritated and inflamed due to repetitive stress on the tendon or a sudden increase in the amount of or intensity of exercise that places too much stress on the Achilles tendon. Achilles tendonitis can occur within the tendon itself or at the point where the tendon attaches to the heel bone.
 There are two types of Achilles tendonitis:

1. Non-insertional Achilles tendonitis: the fibers in the middle portion of the tendon begin to break down and degenerate with tiny tears in the fibers. This causes swelling and thickening of the tendon and is common in younger, active athletes and people.
2. Insertional Achilles tendonitis: pain occurs at the lower portion of the tendon where it attaches to the heel bone. It occurs most often after years of overuse, particularly in long distance runners.

Achilles tendonitis results in swelling, pain, and irritation of the tendon and can limit the individual’s ability to walk, jump, and run.  If a sudden “pop” is heard in the back of the calf or heel, rupture or tearing of the Achilles tendon may have occurred, often requiring surgery and rehabilitation.
 Symptoms of Achilles Tendonitis include:

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens during activity
• Severe pain the day after exercising
• Thickening of the tendon
• Development of a bone spur (with insertional tendonitis)
• Swelling present continually and gets worse during the day with activity

There are several factors that contribute to developing Achilles tendonitis, which include calf muscle tightness and weakness, abnormal foot structure and mechanics, improper footwear for activities, obesity, and a sudden change and increase in intensity in exercise or sports training. Achilles tendonitis is more common in runners.
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Physical Therapy for Achilles Tendonitis Physical therapy is the first line approach to managing Achilles tendonitis. Physical therapy can decrease pain and swelling of the Achilles tendon, strengthen the affected area, improve mobility and flexibility, and help patients return to their daily activities and sports safely and gradually. The physical therapist completes a thorough evaluation of the heel, calf, and ankle and assesses foot posture, strength, flexibility, and movement, including functional movements (such as standing, walking, stepping on stairs, heel raises, and squatting).
Physical therapy treatment for Achilles tendonitis includes:

• Stretching and flexibility exercises to help the tendon heal without shortening the tendon or causing long-term pain
• Individualized exercise program with progressive strengthening exercises to regain tensile strength of the tendon
  • Use of eccentric exercises to reduce pain and improve function of the tendon
  • Lower-extremity resistance program used to correct weakness-associated movement dysfunction that contributed to pain and irritation of tendon
• Use of ice and ultrasound heat modalities to manage pain and swelling
• Manual therapy soft tissue mobilizations to improve mobility and range of motion to help ankle, knee, hip, and foot move properly
• Taping to decrease strain on tendon
• Education on external factors contributing to tendonitis, including inappropriate footwear or over-training
• Foot orthotics to reduce pain and address ankle and foot mechanics when running
• Functional training to transition from strengthening exercises to daily activities and sports to relearn how to complete these actions safely  

Achilles tendonitis is a common condition causing irritation and loss of full function of the Achilles tendon, affecting your ability to walk, run, and jump. Don’t wait to address your Achilles tendon pain. Come see us at Zenergy  so that we can help you return to your sport and activities without pain and stronger than before!