The Achilles Tendon is made up of two major muscles and one insignificant muscle. The two muscles are the Soleus, which does not cross the knee and the Gastrocnemius which does cross the knee. The distinction is important because most people only stretch the Gastrocs (see the typical runners stretch with the knee straight). Very few people I treat regularly stretch their Soleus. The best way to do this is to be on the floor in a sprinters start and you will feel the stretch in back of the calf in the forward leg- this will be the Soleus that is stretching.
Sometime in middle age, around age 35 or so, I often see calf strains. The situation is typically one where the muscle is fatigued, and the person steps backwards, like on a tennis court or basketball court, and they feel like they have been hit or kicked in the back of the leg. Typically, it is the medial third of the Gastrocs that gets strained. this is a muscle/tendon junction injury and can be easily treated, with a good outcome for return to sport.
At other times, the tendon actually ruptures. This can be the same move that causes the muscle strain, but the injury is felt further down, and feels more like a gunshot to the leg. The rupture of the tendon is the last event following many more minor events that lead to the gradual thinning and weakening of the tendon.
A rupture such as this requires surgery for repair. Then the PT that follows the surgery needs to both restore ROM, and also balance as well as explosive strength.
For whatever reason, I have several Achilles tendon injuries in the clinic at the moment. Among my present population is an acute Gastroc strain, a very irritated and strained tendon, a recently ruptured and repaired tendon and a tendon that was repaired a long time ago. Each of these situations offers lessons for prevention and for recovery.
The medial third Gastroc strain illustrates the importance of both stretching and hydration. Not hydration in therms of how much water you drink, but hydration at a tissue level. More on this later. Pre-game stretching will help prevent this injury as will stopping when you have become fatigued before the injury stops you!
The pre-failure tendon illustrates the consequence of multiple injuries to the tendon that lead to a thinning of the tendon (called “necking” in the physiology text books). The progressive failure of a dense connective tissue goes through several stages before a rupture. One of the last stages before the rupture is this necking stage. If you grab your Achilles tendon and pinch it, and it hurts, then damage has occurred in the tendon to the dense connective tissues and you are on the way to further damage that might eventually lead to rupture.
The recently repaired tendon needs good rehab to stimulate the best and strongest possible repair. The rehab needs to take into consideration the repair characteristics of the scar that is growing. Then the strength needs to be restored. My patient with recently had a repair, for instance, cannot actively recruit the Soleus at the moment. This will pass, but we need to pay attention to the restoration of strength as well as to the other issue such as balance and ROM before we start thinking about activities like running and certainly before sprinting.
The post surgical tendon – a year or two out, reveals that not enough energy was spent in the rehabilitation cycle. The loss of power of the injured leg has left the leg in a state of sub-optimal performance ability. We now need to help this person build muscle mass and restore the Type II muscle mass especially.
I think that the best treatment for the Achilles Tendon is prevention of injury in the first place. So three things come to mind:
- Stretch the Gastrocs AND the Soleus
- Strengthen the two muscles as well. to strengthen the Gastrocs, do heel raises with a straight leg. To strengthen the Soleus do heel raises with your knees bent. You should do 40 continuous heel raises on both legs with both positions and then do 40 continuous on EACH leg.
- Use THE STICK to work the tissue regularly.
Finally, a word about water binding in the dense connective tissues. If you are middle aged, you need to take a supplement like COSAMIN DS or MOVE FREE that provides molecular support to the production of GLUCOSAMINOGLYCAN – a long mucopolyscharide that binds water in the connective tissues and makes it both more elastic and also tolerant of tensile forces.