Today I am continuing on with the second part of the Injury and Exercise Report on Achilles tendon exercises.

If you missed it, in part 1 I focused on Achilles Tendonitis and Exercise.

What is the Strength of the Achilles tendon?

What do the figures say?

How strong is the Achilles tendon?

The strength of tendons is related to their thickness and collagen content. Tendons with more collagen type I fibers, are more adept to withstand larger loads.

Research indicates that an adult healthy Achilles tendon is capable of enduring about 9 kilonewtons when running (Maffuli et al., 2004). This figure corresponds to about 12.5 times the body weight. When running on your toes, as much as 4 kilonewtons are loaded to the tendon. Maffuli and his team indicated that the Achilles tendon can support a load of about 2.6 kilonewtons during walking and 1 kilonewton during cycling.

How big of a Problem is Achilles Tendinitis?

In the past 30 years, the incidence of Achilles tendinitis has significantly increased. Its escalating incidence is attributed to a greater number of individuals who engage in recreational and competitive sporting activities. In fact, at this time, 10% of Americans are involved in some kind of activity that requires recreational running and other jumping activities, for longer periods of time than in the earlier generations (Hargrove & McLean, 2009).

The exact data are not known, but there are reports indicating the incidence of Achilles tendinopathy in the population.

Hargrove and McLean estimated that Achilles tendinopathy affects between 7 and 18% of club runners.

In the United States, more than 200,000 patients are treated each year for Achilles tendinitis and tendinosis.

What Increases the Risk of Achilles Tendinitis?

Achilles tendinitis is commonly associated with athletes, especially runners. It was estimated that this injury has a 7 to 18% incidence among club runners. The figure is not so surprising knowing that the Achilles tendon loads about eight times your body weight during running.

Its incidence is also on the rise in individuals involved with raquet sports, track and field, volleyball and soccer. The number of Achilles tendinitis cases among ballet dancers has also become a growing concern.

Achilles tendinitis is by no means limited to athletes. Almost one-third of patients with the diagnosis did not even participate in any form of vigorous physical activity. This condition has also been seen in people who live a sedentary lifestyle.

Age is possibly one of the most significant factors associated with Achilles tendinitis. It more commonly occurs in older and more sedentary athletes than in younger and well-conditioned athletes.

In addition to repetitive microtrauma, this condition is significantly influenced by the declining number of tough collagen fibers as you age. As an result, the Achilles tendon becomes more susceptible to injury.

One problem with Achilles tendon damage is that healing may be slower than the usual due to the limited supply of blood. The problem turns from bad to worse as you age since an Achilles tendon injury does not usually heal appropriately when physiological changes related to aging set in. If the athlete is poorly conditioned, overfatigued or insufficiently prepared, the risk further increases.

As an interesting side note, rupture of the biceps tendon is strongly linked to smoking. However, no study has adequately proven that smoking is related to Achilles tendon rupture. In spite of the lack of evidence, smoking should be avoided. Its chemical components can inhibit or slow down the process of tissue healing, which can certainly worsen the tendon damage.

What Causes Achilles Tendinitis?

The exact root cause of Achilles tendinitis is not fully understood. Although more information is needed to fill in the gaps, initial findings suggest that Achilles tendinitis is associated with overuse, improper training, aging of the tendon, gait abnormalities due to structural deformities, or improper footwear (Dubin, 2005).

As a main starting point, an injury involving the Achilles tendon occurs when the force applied to the tendon exceeds its ability to withstand the load. It may occur in a single episode or more frequently, over a period of time, such as repetitive microtrauma.

Certain activities and improper body mechanics may also weaken, tire or tighten the supporting muscles in the lower extremity, such as the gastrocnemius, quadriceps and hamstrings. When they tire out, trauma is most likely to occur. When the strength of calf muscles is maintained, the Achilles tendon sustains its ability to endure the load.

Excessive outward turning of the foot increases the tendency to walk on the inner border of the foot. This places a great amount of stress on calf muscles and Achilles tendon.

Trauma is also caused by premature increase of the intensity, duration and frequency of an exercise program.

Also, training on improper surfaces increases the risk of its occurrence. The foot has to have a stable ground contact to efficiently absorb the shock and transfer the load evenly to the supporting structures.

Your footwear may also increase the risk of Achilles tendinitis. Frequent wearing of high heels shortens the tendon and calf muscles,  leading to Achilles tendinitis and high heel pain.

Signs and Symptoms of Achilles Tendinitis

Achilles tendinitis may be acute or chronic. Acute tendinitis is mainly manifested by signs and symptoms of inflammation. You may experience localized or burning pain in the Achilles tendon area or around the back of the ankle, specifically from the calf to the heel during or after an activity. During the earliest stages of the injury, the pain and tenderness are usually resolved within 24 hours with conservative treatment. Activities and exercise are not usually disrupted.

When acute Achilles tendinitis is inappropriately managed or untreated, chronic tendinitis ensues. This condition is more difficult to treat, necessitating more aggressive interventions to resolve the symptoms. Pain continues to be the major complaint. The onset of pain may occur all throughout an activity, with decreased activity or at rest. A great number of patients with this condition complain of increased severity of pain in the morning. Unresolved by conservative treatment, pain in the Achilles tendon may begin to interfere with your speed and overall performance. It may get so severe that you may be unable to tolerate your usual training session, especially if it involves walking up hill or up the stairs. Activities of daily living become intolerable as it further goes into progression.

Individuals with chronic tendinitis report a sensation of fullness or the development of nodules at the back of the leg, about 2 to 4 centimeters above the heel. This occurrence signals tendinosis, which involves degenerative changes in the Achilles tendon. Creaking sounds upon movement of the ankle joint or upon pressing the tendon with your fingers may be noted.

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I got an e-mail from a fitness professional that was looking for some suggestions on Achilles tendonitis.

She was off to Italy for a few weeks and had to do a lot of walking and did not want Achilles tendonitis to slow her down.

Great question, the catch was, she wanted suggestions other than stretching, icing and massage.

Hmmmm?

Here you go Janice.

Three Tips to a Happy Achilles Tendon while Walking in Italy

#1 – Little Bit of Olive Oil and Candle Light

I saw a massage therapist once and she recommended if I wanted to do self massage, to use a little olive oil.

My parents are Croatian and they love olive oil. They go threw about 1 liter a week.

Yes, just my mom and dad.

Yes, 1 liter.

While growing up, they never taught me to massage with olive oil. If you are going to Europe, it maybe and interesting thing to try. I know the olive oil is amazing in Italy.

Let me get to my point, self massage is huge. It would be nice to have access, time and the funds to get a massage every day for your achilles tendon. For most of us, it is not possible. If you have Achilles tendon issues, I recommend self massaging your calf (Gastrocnemius). I recommend you spend one to two minutes massaging different parts of the calf looking for sensitive areas and using the self massage to help with the circulation to those sensitive areas.

The self massage is based on what I learned in Bill Huhn’s Understanding Trigger Points to Overcome Pain course.

#2 – Shoe Burning Party

Your shoes maybe part of the problem. If you plan to do a lot a walking in a day and your Achilles tendon is bugging you, you may want to add a little heel lift under the shoe insole.

When I was hiking across the USA, I did this with a piece of cardboard. It was low tech, cheap and did the trick. Another idea to change your shoe insoles so you have more of a heel lift. This will decrease the load and stretch on the Achilles tendon.

#3 – GET OFF YOUR FEET!!!!!!!!

I learned this when I was hiking for 5 months. When I was not hiking, I was sitting. Doing a half marathon a day hiking was a challenge but adding to the stress on my Achilles tendon by standing when I did not need to, put even greater stress on it.

If your Achilles tendon is bugging you, do less standing. Get off your feet and sit down on a bench, chair, the ground, on a rock or a hoarse.

If you or any of your clients have ankle and foot issues, I go threw an extensive list of exercises to help overcome the most common ankle & foot injuries in the Exercise Rehabilitation of the Ankle & Foot course.

I think that it is.

Have a great day.

Rick Kaselj