Achilles Tendinopathy – a causes approach

The tendon is under-used, over-used, degenerative, reactive, disrepair etc There is a huge volume of excellent research into tendon injury, pathology and repair, but very little in terms of the causes of these specific tendon related problems.

Lets take the Achilles tendon as an example. It has the tensile strength of roughly 1200 newtons (very strong), so why does it go wrong so often? Why does it occur unilaterally (vast majority)?
We need to look at the muscles that directly attach to the tendon, soleus and gastrocnemius primarily. What is their function? Is it just plantar-flexion and knee flexion?

All muscles in the body work in 3 dimensions during functional activities, such as gait. The calf group, and therefore the TA are no different. During gait, as the foot enters the ground the calcaneus will evert causing a lengthening in the frontal and transverse planes, followed by a lengthening in the sagittal plane with ankle dorsi-flexion. If we have too much pronation this may increase the stress on the Achilles tendon, conversely a lack of pronation and ankle dorsi-flexion may lead to excessive stress on particular parts of the Achilles.

If we look at the Achilles as the back leg in gait, we should see calcaneal inversion and ankle dorsi-flexion (supination). A common problem that I see is late pronation (pushing of a flat/unstable foot), which will increase the stress on the medial aspect of the tendon.

We must also remember that the actions of pronation and supination do not just involve the foot. The tibia will move in all 3 planes, followed by the femur and pelvis. Therefore we must look at the function of the gluteals and hamstrings. This does not mean assessing their concentric strength or length in a supine position, but the ability of the muscle to be eccentrically loaded in all 3 planes of motion and concentrically react.

If we just work on loading the tendon on a step with different reps and sets and rest periods we will probably be missing the causes of their irritation, and working only on the symptoms.
Assess the clients gait and any specific functions/activities that relate to their symptoms, then you will find the causes.

At momentum physio, we assess the individual and their needs to tailor their treatment and rehabilitation specific to their activity.

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