Injuries to the Achilles tendon is one of the most common injuries experienced among athletes, especially runners and soccer players. Statistics show that roughly 24% of athletes develop pain in the Achilles. It’s also an injury that can linger for long periods of time, if left untreated. One recent study found that 63% of soccer players with Achilles tendinopathy still had symptoms 2 years after onset. With the high prevalence of injury to the Achilles tendon and potential for long-term recovery, prevention is key. Below we will discuss its common causes, symptoms, treatment and most importantly, prevention.
What is the Achilles Tendon?
The Achilles tendon connects the calf muscles (the gastrocnemius and soleus) to the heel bone. It is one of the strongest tendons in the body, but it is also highly vulnerable to injury, given the high amounts of tension put on it. Injury to the tendon can include a strain, partial tear, or full rupture.
Some common factors that can cause an injury to the Achilles tendon are:
- Poor footwear;
- Repetitive overuse, especially in sports that require running and or jumping;
- Repetitive overstretching;
- Training errors;
- Abnormal Biomechanics
An injury to the Achilles can be acute i.e., due to a kick to the back of the leg, or chronic as a result of repetitive irritation over time. It usually has a gradual onset starting with stiffness after activity; although, as the injury progresses, the stiffness becomes painful either during or after activity. It will become tender to touch with possible redness and swelling around the tendon. You may also notice thickening of the tendon or a nodule around the painful area. It will usually hurt when you go up onto your toes or stretch the muscles. As the injury worsens, daily activities such as walking and climbing stairs will also be limited and painful.
What does treatment entail?
Initially one of the main focuses of treatment is decreasing the pain, which can be achieved through manual therapy, taping and heel lifts. The other focus is promoting healing with modalities such as laser, which has excellent research support that it speeds up recovery time. Exercise is also one of the best ways to promote tissue repair. Research has shown that eccentric calf muscle training can decrease pain, as well as improve function and a quick return to sport following an Achilles injury. Finally, in order to get rid of the injury and prevent it from re-occurring, the cause of the injury must be addressed. Training errors, poor biomechanics and equipment issues such as footwear may need to be changed.
What can you do right now to prevent an Achilles injury?
- Examine what you’re putting on your feet. Are your shoes/cleats too tight, too loose or held together by a thread? Shoes that don’t fit well or support your feet can alter your biomechanics, which puts more stress on the Achilles.
- Look at yourself in the mirror barefoot. Are your feet flat on the ground, do you look bowlegged, do you have super-high arches? If you can’t tell what you’re looking for, have your biomechanics checked out by a Sheddon therapist. Abnormal biomechanics and deformities in the foot (even something that seems minor), can put the foot at an angle that creates extra stress on the Achilles tendon. Therapists at Sheddon Physio are trained in gait assessment and will watch what your feet and lower leg are doing while you stand, walk and run. Findings may indicate specific exercises and manual therapy to correct the abnormalities.
- Are your calves super tight and/or weak? Muscle imbalances in the lower body can put strain on the Achilles, leading to a higher chance of injury. An exercise program that specifically addresses your imbalances may help prevent future injuries.
- Do you rush to your game and run onto the field without properly warming up? An improper or lack of warm-up is one of the easiest ways to injure the Achilles. Take 5-10 minutes before games to warm up properly. Check out the FIFA11 warm-up program here.
- Have you recently increased your intensity, frequency, distance or speed in training? Too rapid an increase in any of the above without adequate rest days could put extra strain on the body and lead to overuse injuries in the Achilles. Working with a coach, trainer or therapist could help prevent over-training.
- Have you started doing more training that involves stairs, hills and/or jumping? All of the above activities put an extra load on the Achilles tendon and should be introduced into a training program with adequate rest and proper scheduling.
So, you now know how to keep your Achilles healthy and injury free, but what about the rest of your body? During this time of year, soccer players usually aren’t training as much, so take advantage of the extra time you have now to address any nagging injuries. Research has shown that injuries to muscles and tendons roughly take 6-10 weeks for full recovery, if treated at the initial onset of symptoms. However, if you do what most people do and wait until the symptoms get really bad (in hopes that it will go away on its own), recovery could take 3-6 months. Getting your injuries fixed now may ensure that you’re healthy and pain-free for outdoor season.
Are you injury-free but out of shape? Aside from their technical skills, soccer players require speed, agility, endurance and strength. Spending the winter months hibernating indoors on the couch could set you up for injury by the time warm weather and the outdoor season come around. Research has shown that preseason conditioning significantly decreases overall soccer injuries. Preseason conditioning should focus on any muscle imbalances and weaknesses, as well as general and functional strengthening, speed, agility, interval training, and plyometrics. Not sure where to start? Talk to one of the therapists at Sheddon Physio and they can get you started on a program.