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We are here to help you resolve your soft-tissue injuries and
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Injuries to the Achilles Tendon
By Dr. Brian Abelson DC. Calgary, Alberta,
Canada
In this article…
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Injuries to the Achilles Tendon Causes of Achilles Tendon Injuries Always Consider the Kinetic Chain The
Need for a Specific Diagnosis Treating Injuries to the Achilles Tendon with ART |
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Athletes suffer from
three common types of injury to the Achilles Tendon:
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About the Achilles Tendon
The Achilles tendon is the strongest and largest tendon in the body. It is extremely vulnerable to injury due to its limited blood supply and the numerous forces to which it is subjected.
The Achilles tendon is known as a co-joined
tendon. This tendon directly joins into
Gastrocnemius and the Soleus muscle (calf muscles). The Achilles tendon transmits the force of the calf muscles
(Gastrocnemius and Soleus) to produce the push-off during walking, running, and
jumping.
The area of the tendon (approximately 2 to 6 cm above its insertion into the Calcaneus) has the poorest blood supply, and therefore heals the most slowly. This makes it extremely susceptible to injury.
Causes of Achilles Tendon Injuries
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In triatheletes, the
most common cause of injuries to the Achilles tendon is overpronation,
inflexibility, or lack of strength.
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Always Consider the Kinetic Chain
Any restrictions in the kinetic chain of the Achilles tendon, either above or below the tendon, can affect the functioning of the Achilles tendon. Such structures would include:
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1. Hamstring muscles - The upper portion of the gastrocnemius (superficial calf muscles) are in contact with biceps femoris, semitendinosus, and semimembranosis (three sections of the hamstrings). 2. Plantaris muscle - This muscle inserts into the middle one third of the posterior calcaneal surface (heel bone), just on the inside of the Achilles Tendon. 3. Popliteus muscle - This muscle is involved in medial knee rotation. When it is restricted, it may cause increased stress on the lower extremities. 4. Flexor Hallicus Longus, Flexor Hallicus Brevis, and the Tibialis Anterior, muscles. These muscles are involved in cases of increased pronation and hyperpronation. |
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The Injury Process
Hyperpronation,
muscle restrictions, or lack of flexibility
of the Achilles tendon creates increased stress, internal pressure, or a
state of friction that leads to inflammation.
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Hyper-pronation Inflexibility Decreased Strength Decreased Performance Major Injury |
Chronic irritation to
the Achilles tendon leads to small tears within the tendon, making the tendon
susceptible to further injury and causing a build-up of scar tissue within
the tendon. Once the inflammatory condition has started, even the simple task of just standing can put considerable internal pressure on the Achilles Tendon. This constant internal pressure limits circulation to the tissue resulting in decreased delivery of oxygen to soft-tissues. Decreased oxygen causes several biochemical changes that result in the formation of yet more adhesions within the Achilles Tendon. This in turn creates more restrictions, inflammation, and swelling. The body responds to inflammation by laying down additional scar tissue (cross fibers across the tissue) in an attempt to stabilize the affected area. This scar tissue:
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Copyright Dr. Mike Leahy
Ineffective Treatments
We have seen numerous case of Achilles Tendonitis that were needlessly prolonged or that became chronic problems due to the application of ineffective treatments. Improper treatment of an Achilles Tendon injury can lead to major problems.
Cross friction massage often irritates this
area, increasing the time required for recovery rather than reducing recovery
times.
Additional problems often arise when a
therapist uses direct, heavy pressure and tension over the Achilles Tendon.
Steroid injections should be avoided whenever
possible. Research has shown the
steroid injections cause an increase in the incidence of rupture of the
Achilles tendon.
At the very least, many of these treatments have drastically decreased the Triatheletes level of performance.
The Need for a Specific Diagnosis
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It is extremely important to be as specific as possible when identifying the soft-tissue structures involved with this condition. Different athletes may present with identical pain patterns at the Achilles tendon, yet they may have completely different structures that are impairing motion or causing the injury. Before treatment takes place, an extremely specific examination and diagnosis must be performed. It is important to look past the initial point of pain and identify all the other structures that are involved in the kinetic chain. |
Treating Injuries to the
Achilles Tendon with
ART
Active Release Technique (ART®) is very successful at treating this type of injury since it removes restrictive adhesions between both the superficial and deep tissue structures along the entire kinetic chain.
Trained ART practitioners perform a biomechanical analysis of athletes to determine where the restrictions are located along the entire kinetic chain. ART treatments are specific and based upon the individual needs of each athlete. It is not a cookbook approach to treating a non-specific diagnosis.
For example:
If the fascial tissue anterior to the
tendon is restricted (which commonly occurs in this condition), ART procedures
can be used to release the adhesions.
Other structures in the kinetic chain
are similarly treated.
ART® finds the specific tissues that are restricted and physically works them back to its normal texture, tension, and length by using various hand positions and soft-tissue manipulation methods. While breaking up the adhesions can be uncomfortable at times, it is important to reproduce the symptoms.
Effective treatment of the Achilles tendon, or of any soft-tissue injury, requires an alteration in tissue structure that breaks up the restrictive cross-fiber adhesions and restores normal function to the affected soft-tissue areas. When executed properly, this process substantially decreases healing time, treats the root cause of the injury, and improves athletic performance.
With ART we often see immediate improvement after treating the involved structures.
Post Treatment Exercises
Strengthening
the Calf muscle and the entire related kinetic chain is extremely important in
order to ensure that injuries to the Achilles Tendon do not return.
Strengthening
exercises are only effective if they are executed after the adhesions
within the soft-tissue have been released.
Attempts to strengthen muscles bound by adhesions often cause the
structure to become more restricted, which in turn causes additional tension
within the soft-tissue.
Research has shown that using eccentric contractions (lengthening of the muscle during contraction) is one of the most effective types of strengthening exercises for the calf muscles. This concept can be applied to the entire kinetic chain.
In addition to the strengthening component, stretching, and
balance exercises continue to be key components in correcting the problem to
ensure that the problem does not reoccur.
Kinetic Health Performance
Care
Perform at your best.
Dr. Brian Abelson
DC, ART
Dr. Brian Abelson is
Clinical Director of Kinetic Health® . Dr. Abelson is a native
Calgarian who graduated from Palmer College of Chiropractic West with an award
for clinical excellence, holds a Level 3 Active Release Certification, and is
an ART Assistant Instructor. He is also
the author of the award winning website: www.drabelson.com and www.activerelease.ca .
Author: Dr. Brian Abelson
Editor: Kamali Abelson, Rowan Tree Books Ltd.
Edgemont Chiropractic Clinic
Bay #10, 34 Edgedale Drive N.W.
Calgary, Alberta, T3A-2R4
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Disclaimer This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition.Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsible for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility. All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment. The information provided by or linked to on this site may or may not reflect the opinions of Dr. Brian Abelson. It does not represent the opinions of the Alberta Chiropractic Association or other affiliated associations. |