March 17th, 2008
Learn about ten commonly advised solutions you can discuss with clients suffering from acute or chronic Achilles tendonitis. Also, find out two specific sports massage techniques that can help repair this potentially crippling condition.
by Nicole Cutler, L.Ac.
Want to earn continuing education credit for this article? Learn more.
As the largest and most vulnerable tendon in the body, the Achilles tendon joins the gastrocnemius and soleus muscles of the lower leg to the calcaneus. Accounting for 11 percent of all running injuries, inflammation of this tendon is appropriately named Achilles tendonitis. Although the slow healing time for Achilles tendonitis is due to scant localized vasculature, bodyworkers can play a key role in restoring this tendon to its pre-injured state.
Providing the power in the push-off phase of the gait cycle, the Achilles tendon can become inflamed when the gastrocnemius is stressed. Although this tendon is strong, its lack of flexibility can easily lead to inflammation, tear or rupture. Achilles tendonitis can be acute or chronic. Signs of an inflamed Achilles tendon include:
- Tendon pain during exercise. Achilles pain gradually comes on with prolonged exercise and typically dissipates with rest.
- Swelling over the Achilles tendon.
- Redness over the skin.
- Sometimes, a creaking can be felt when pressing the fingers into the tendon while moving the foot.
Often more difficult to treat, chronic Achilles tendonitis may follow if the tendon is not treated properly or allowed to fully heal. When this problem becomes chronic, the pain typically disappears after a warm up, yet returns once the person stops training. If the Achilles is repeatedly stressed, the injury worsens until it is impossible to run. In addition to the symptoms of acute Achilles tendonitis, additional signs of a chronic problem include:
- Pain and stiffness in the Achilles tendon in the morning. This pain may be described as diffuse along the tendon rather than specific.
- There may nodules or lumps in the Achilles tendon, particularly 2 cm above the heel.
- Pain in the tendon when walking up a hill or up stairs.
An injury typically occurring from overuse, Achilles tendonitis usually comes on gradually. Ignoring the early warning signs of Achilles pain causes the symptoms to increase until activity is too painful to continue. In general, the more fatigued the calf muscles are, the more stressed the Achilles tendon, and the higher likelihood of tendonitis developing. The most commonly reported causes of Achilles tendonitis include:
- Overuse – Excessive activity before adequate warm-up causes most overuse injuries.
- Running Up Hills – Running up hills causes the Achilles tendon to stretch more than normal on every stride, which fatigues the tendon sooner than normal.
- Overpronation – Overly pronating the foot increases the strain placed on the Achilles tendon. As the foot rolls in and flattens, the lower leg rotates inwards causing a twisting motion. This twist puts an additional strain on the Achilles.
- Tight or Weak – A tightness or weakness in the calf musculature easily leads to fatigue. Once the gastrocnemius fatigues, it tightens and shortens, thus putting additional strain on the Achilles.
10 Solutions for Achilles Tendonitis
For best results, a sore or achy Achilles tendon responds best to immediate attention and rest. Left untreated, Achilles tendonitis could cause persistent pain or cause the tendon to rupture. A ruptured Achilles tendon may require surgery to correct the damage. Ten commonly advised solutions for treating Achilles tendonitis include:
- Resting the calf muscles.
- Applying cold therapy or ice to minimize inflammation.
- Wearing a heel pad to raise the heel, thus taking some of the strain off the Achilles tendon.
- Wearing arch support insoles or orthotics to prevent overpronation and improve foot biomechanics.
- Taking anti-inflammatory medication.
- Taping the back of the leg to support the Achilles.
- Applying a plaster cast for more severe cases.
- Applying ultrasound treatment to encourage the tendon to heal.
- Administering sports massage to the lower extremities.
- Strengthening the calf muscle to help reduce the stress on the Achilles tendon. Toe raises, balancing on the toes and wall stretching are useful exercises.
Whenever discussing approaches to Achilles tendonitis with clients, always emphasize avoiding excessive stretching. Taking this action has the potential to aggravate an already stressed Achilles.
Two sports massage techniques put bodyworkers on the top of the list for Achilles tendonitis treatment: transverse friction massage and strain-counterstrain techniques.
Transverse friction massage is a massage technique that is often used for tendonitis. The massage strokes of transverse friction massage are deep and applied directly to the affected area, perpendicular to the direction of the tendon. When done properly, transverse friction massage can help reduce pain, improve blood flow to the surrounding area, and prevent or reduce the formation of scar tissue and adhesions in the connective tissue.
Another sports massage technique, applying strain-counterstrain on the calf muscles can unload the excessive stress these tightened or weakened muscles place on the Achilles. As published in the September 2006 edition of The Journal of the American Osteopathic Association, researchers found that applying strain-counterstrain techniques on the soleus of those with Achilles tendonitis produced a 23.1 percent decrease in localized stress. The investigators noted a similarly significant response when strain-counterstrain was applied to the lateral and medial heads of the gastrocnemius.
While early and persistent attention to this injury often results in a full recovery, making sure the original cause of the tendonitis is addressed is the only way to prevent its recurrence. In addition to tackling the reason for Achilles pain, most practitioners recommend some combination of the above ten solutions to help an inflamed Achilles heal. A massage therapist using strain-counterstrain and transverse friction massage techniques can play an important role in the timely healing of an inflamed Achilles tendon – and can even help prevent this injury from turning into a hard-to-treat chronic case of tendonitis.
Earn continuing education credit for this article contained in our Common Sports Injuries series. Click here to enroll.
Howell JN, et al., Stretch reflex and Hoffmann reflex responses to osteopathic manipulative treatment in subjects with Achilles tendonitis, The Journal of the American Osteopathic Association, September 2006.
http://altmedicine.about.com, Natural Remedies for Tendonitis, Cathy Wong, About, Inc., 2008.
http://sportsmedicine.about.com, Achilles Tendonitis, Elizabeth Quinn, About, Inc., 2008.
www.mayoclinic.com, Achilles Tendinitis, Mayo Foundation for Medical Education and Research, 2008.
www.sportsinjuryclinic.net, Achilles Tendonitis, Sports Injury Clinic, 2008.
Like this massage article? Sign up today for our free e-newsletter! You'll receive high-quality, original articles designed specifically for the massage professional right to your email. Plus tips and important updates to help build your massage practice.