The achilles tendon is the biggest tendon in the human body and injury to this tendon can be quite debilitating for most people. It’s no wonder that when referring to a person’s weak quality, people often use the term ‘achilles heel’.
complexity in treating issues with achilles tendon can be overwhelming so we
always advocate for prevention rather than treatment. This blog outlines what
we believe are the best ways to avoid an achilles tendon injury. Before getting
to this, here are some interesting facts on achilles tendon injuries:
- The incidence of achilles tendon ruptures in
the general population is 5-10 per 100,000 but this is increasing overall.
- Competitive athletes have a lifetime
incidence of achilles tendinopathy of 24 percent, with 18 percent sustained by athletes
younger than 45 years.
- Achilles tendinopathy is common in runners.
The incidence rate may be as high as 40-50%.
- The tendon gets weaker with age leading to
increased risk of tendon rupture later in life.
- The risk factors for rupture are multi-factorial.
This can include medical conditions such as autoimmune diseases, renal
insufficiency and disorders of collagen; the type of activity you do (more
common in runners).
- A normal tendon has a safety factor of 10.
This refers to the strength and ability to withstand load. The higher a safety
factor, the less chance of rupturing that tendon. The achilles tendon has a
safety factor of 3.
facts above demonstrate the need for better self-management. This leads into
our tips. Here are our tips on what we believe is crucial to prevention of
achilles is the tendon for the calf muscles which are the gastrocnemius (outer)
and soleus (inner) muscles. Decreased flexibility in these muscles has been
linked to increased risk for achilles tendon injuries. Poor flexibility
particularly in the soleus muscle, leads to reduced shock absorption when
running which leads eventually to achilles overload/injury. We recommend
the following to help improve calf flexibility:
- Daily stretching – Stretching
daily for 30-45 seconds and doing this a minimum of three times a day is great
regime. The following photo shows how to stretch the gastrocnemius and soleus.
- Daily mobility –
mobility is a very important factor for injury prevention. It involves putting
the joint into positions to increase movement that the joint. To increase
mobility, stand in a calf stretch position and bend the knee, you should feel a
stretch in the back of the calf. Repeatedly bend and straighten the knee in
this position. You should find that your mobility at the ankle increases.
- Self Trigger point releasing – Tight
calves generally have many knots or ‘trigger points’. A great way to relieve
trigger points is to press the knotted areas of the muscle firmly on a ball or
an object such as a foam roller and hold the pressure for a minute at a time.
- Heat – Applying
heat to a muscle is a great way of increasing blood supply to the muscle
promoting improved flexibility.
Motion has massage balls, foam rollers, and heat packs available for purchase
in the clinic.
is very simple: when training for something, always gradually increase
your training load to prevent overload. The key word here is gradually. It pays
to write out a detailed training plan at the beginning, which outlines the
weeks leading up to an activity or event. Sudden changes to training regimes
such as changing terrain, drastically increasing distance or speed, decreasing
rest periods, or changing footwear can cause unnecessary stress on the achilles
which eventually leads to injury.
Check Your Footwear
wear is a big factor because old, overworn shoes can cause overload on the
achilles leading to injury. Overworn shoes tend to lose important properties
such as shock absorption, which can increase the stress on the achilles with
impact. It is recommended by physiotherapists to change footwear yearly
especially shoes that are worn and used daily. We also recommend seeing a
podiatrist to do a proper analysis of your foot biomechanics to determine the
appropriate type of footwear.
Regular Calf Strengthening:
achilles is the tendon the calf is directly attached to. Therefore,
strengthening the calf leads to a stronger achilles tendon, which is less prone
are some nice calf exercises to help strengthen:
Double Leg Calf Raise: Raise
your heels from the ground so that you are standing on your tiptoes. Hold this
for 5-10 seconds then slowly lower to the ground. You can progress this
exercise to single leg and further increase it to a longer hold
Double Leg Calf Raise over a step: Raise
your heels from a step so that you are standing on your tiptoes. Hold for 5-10
seconds then slowly lower past the step until you feel a stretch in the calf.
Likewise in the first exercise, this exercise can be progressed to single leg
and then by adding weight.
Leg Double Leg Calf Raise: stand
in front of wall/chair and hold for support. Bend the knees and flex your hips
so that you’re nearly at 90 degrees of knee flexion. While keeping the knees
bent, raise the heels from the ground until you are on your tiptoes. Hold this
for 5-10 seconds then slowly lower to the ground.
Raise Wall Sit: Lay
against a wall/sturdy surface and squat down so that your knees are 90 degrees.
Raise your heels from the ground and stay on your tiptoes. Hold this position
for 5-10 seconds then repeat.
exercises can be progressed by adding light weights. For a proper
calf-strengthening regime, it is best to come see us physiotherapists at
gluteal muscles are at the top of the lower limb kinetic chain and they are
essentially the powerhouse of the lower limb. This means that their strength
greatly influences the stability and function of all the muscles and joints in
the lower limb. The glutes are lateral rotators of femur, which means that when
active, they pull the entire lower limb into the proper alignment which lessens
the stress on the achilles. Here are common glute strengthening exercises that
we highly recommend:
by lying on your back with knees bent and feet flat on the ground. Lift your
bottom of the bed and squeeze your buttocks. Hold for 5 seconds before
in side lying with legs bent. Keeping the ankles together, lift your top knee
from the bottom knee and squeeze through the buttocks. Hold for 5 seconds before
Walking with resistance bands: Start
by standing in a mini squat position with a theraband/resistance band around
your knees. Step sideways towards one direction for 10 steps before stepping
the opposite direction for also 10 steps. As you step out, you should feel the
These five tips are great ways to help with prevention of achilles injuries. For more information, or if you currently have an achilles injury, come and see our friendly team at Pivotal Motion Physiotherapy and Podiatry to help you out. Give us a call now to see how we can help you get the most out of your movement!
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