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Achilles Tendon Pain

Understanding The Potential Contributing Factors For Achilles Tendinitis
Achilles tendinitis is a chronic inflammatory condition that can be a major cause of pain and disability.21,22 Between 7 and 9 percent of all professional athletes in sports that require running or jumping get a diagnosis of Achilles tendinopathy.21

Immediately after the foot strikes the ground, the foot rolls into pronation and the knee begins to flex, causing obligatory internal rotatory forces to the tibia.23,24 As the body passes over the foot during midstance, the foot rolls into supination and the knee begins to extend in preparation for takeoff, causing external rotatory forces to the tibia. In individuals who overpronate, the foot is still pronating after knee extension has begun. This will result in the external tibial rotation generated by knee extension conflicting with the exaggerated internal rotation produced by prolonged pronation. The motion of the hindfoot going from a supinated to a pronated position and then back during the running gait cycle creates a “whipping” action on the Achilles tendon. This creates shear forces across the Achilles tendon, placing particularly high eccentric stresses on the medial side of the tendon.24,25

Other factors to consider are muscle tightness and weakness, muscle imbalance and leg length discrepancy. Tight triceps surae and hamstring muscle groups may cause compensatory motions at the ankle that may cause tensile forces to not be absorbed or disturbed appropriately.25 Leg length discrepancy alters normal gait patterns and changes the directional load of stress on the tendon. Muscle weakness or imbalance will prevent successful force distribution and may require excessive forces to be dissipated by the Achilles tendon. Extrinsic risk factors, outside of skeletal anatomy, primarily deal with errors in individual training including a sudden increase in training mileage or intensity, a change of terrain, an increase in interval training or a solitary, intense run.24,25

Key Pointers On Physical Rehabilitation For The Achilles
One should evaluate the hamstring and calf musculature, or recommend evaluation to determine any imbalances and weaknesses. When these imbalances and weaknesses are combined with technical flaws during movement, this causes overload on the Achilles. Utilizing strength exercises and technique drills, a physical therapist can help address hamstring and calf muscle imbalances and weaknesses that may contribute to the tendonitis. The physical therapist can monitor the load and intensity, and make adjustments based on the player’s progress.26 Hip strength exercises are also necessary in order to provide a comprehensive treatment program.

References

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