Achilles Tendonitis and Achilles Tendon Injury, By: Brad Walker

Prevention and Treatment Strategies for Achilles Injury

Part 3
In part 1, we took a look at exactly what an Achilles injury is. We had a look at the muscles and tendons that make up the Achilles; what happens when an Achilles injury occurs; and the major causes and risk factors that contribute to Achilles injury. If you missed part 1 or you'd like to go back and refresh your memory, you can do so by visiting http://www.thestretchinghandbook.com/archives/achilles-tendonitis-pt1.html.

In part 2, we outlined a detailed strategy for the complete treatment and rehabilitation of Achilles tendonitis. Firstly, we reviewed the importance of the immediate treatment (the first 48 to 72 hours), and then we outline the ongoing treatment necessary for a full recovery. If you missed part 2 or you'd like to go back and refresh your memory, you can do so by visiting http://www.thestretchinghandbook.com/archives/achilles-tendonitis-pt2.html..

In this issue we're going to outline a detailed strategy for the complete rehabilitation of the Achilles tendon. We'll look at the rehabilitation and conditioning exercises needed to get your Achilles back to 100%.

By now, you've come over 80% of the way. You may even feel that your Achilles is fully recovered. Your treatment so far may have stopped the swelling and bleeding, and it may have reduced the amount of scar tissue in the Achilles and calf muscles. But there is still one more important thing to do.

The last 20% can be the most crucial to your complete recovery. If you've ever suffered from a sporting injury in the past, you'll know how annoying it is to think you're recovered, and then out-of-the-blue, you're injured again and back to where you started. It can be one of the most frustrating and heart-breaking cycles an athlete, or anyone else for that matter, can go through.

Active Rehabilitation
Most people will refer to this phase of your recovery as the active rehabilitation phase, because during this phase you will be responsible for the rehabilitation process. You will be doing the exercises and activities required to speed up your full recovery.

The aim of this phase of your rehabilitation will be to regain all the fitness components that were lost because of the injury. Regaining your flexibility, strength, power, muscular endurance, balance, and co-ordination will be the primary focus. Without this phase of your rehabilitation there is no hope of completely and permanently making a full recovery.

The first point to make clear is how important it is to keep active. Often, the advice from doctors and similar medical personnel will simply be; rest. This can be one of the worst things you can do. Without some form of activity the injured area will not receive the blood flow it requires for recovery. An active circulation will provide both the oxygen and nutrients needed for the injury to heal.

Warning!
Never, never, never do any activity that hurts your Achilles. Of course you may feel some discomfort, but never push yourself to the point where you're feeling pain. Be very careful with any activity you do. Pain is the warning sign; don't ignore it.

1. Range of Motion
Regaining a full range of motion of your Achilles and ankle joint is the first priority in this phase of the rehabilitation process. A full range of motion is extremely important, as it lays the foundation for more intense and challenging exercises later in the active rehabilitation process.

As you work through the initial stages of recovery and your Achilles begins to heal, start to introduce some very gentle movements. First bending and straightening your ankle, then as you get more comfortable with this simple movement, start to incorporate some rotation exercises. Turn your ankle from side to side, and rotate clockwise and anti-clockwise.

When you feel comfortable with these range of motion exercises and can perform them relatively pain free, it's time to move onto the next phase of the active rehabilitation process.

2. Stretch and Strengthen
Now it's time to add some intensity to the range of motion exercises. The aim here is to gradually re-introduce some strength back into the injured muscles, ligaments and tendons.

When attempting to increase the strength of your Achilles, be sure to approach this in a gradual, systematic way of lightly over-loading the muscles and tendons. Be careful not to over-do this type of training. Patience is required.

An effective and relatively safe way to start is to begin with isometric exercises. These are exercise where the ankle joint itself does not move, yet force is applied and the calf muscles and Achilles are contracted.

For example: imagine sitting in a chair while facing a wall and then placing the ball of your foot against the wall. In this position you can push against the wall with your foot and at the same time keep your ankle joint from moving. The muscles contract but the ankle joint does not move. This is an isometric exercise.

The above example can be used to strengthen the Achilles and ankle joint in all directions. Pushing your foot to the left or right against something immoveable, and pushing down (as above) and pulling up.

It's also important at this stage to introduce some gentle stretching exercise. These will help to further increase your range of motion and prepare your Achilles for more strenuous activity to come. While working on increasing the flexibility of your Achilles, it's also important to increase the flexibility of the muscle groups around the injured area. These include the calf muscles, and the anterior muscles of your shin.

3. Balance and Proprioception
This phase of the rehabilitation process is often overlooked and is one of the main reasons why old injuries keep re-occurring. Once you feel some strength returning to your Achilles it's time to incorporate some balancing drills and exercises.

When muscles and tendons are torn, nerves are also damaged. These nerves send vital information to the brain about the specific position and location of the Achilles tendon and ankle joint in relation to the rest of your body.

Without this information the muscles, tendons and ligaments are constantly second-guessing the position of the Achilles and ankle joint. This lack of awareness about the position of the lower leg can lead to a re-occurrence of the same injury long after you thought it had completely healed.

Balancing exercises are important to help re-train the damaged nerves around your lower leg and ankle joint. Start with simple balancing exercises like walking along a straight line, or balancing on a beam. Progress to one-leg exercises like balancing on one foot, and then try the same exercises with your eyes closed.

When you're comfortable with the above activities, try some of the more advanced exercises like wobble or rocker boards, swiss balls, stability cushions and foam rollers.

4. Plyometrics and Sports Specific Exercises
This last part of the rehabilitation process will aim to return your Achilles to a pre-injury state. By the end of this process your Achilles should be as strong, if not stronger, than it was before you injured it.

This is the time to incorporate some dynamic or explosive exercises to really strengthen up your Achilles tendon and improve your proprioception. Start by working through all the exercises you did above, but with more intensity.

For example, if you were using light isometric exercises to help strengthen your Achilles and calf muscles, start to apply more force, or start to use some weighted exercises.

From here, gradually incorporate some more intense exercises. Exercises that relate specifically to your chosen sport are a good place to start. Things like skill drills and training exercises are a great way to gauge your fitness level and the strength of your Achilles and lower leg.

To put the finishing touches on your Achilles recovery, I always like to do a few plyometric drills. Plyometric exercises are explosive exercises that both lengthen and contract a muscle at the same time. These are called eccentric muscle contractions and involve activities like jumping, hoping, skipping and bounding.

These activities are quite intense, so remember to always start off easy and gradually apply more and more force. Don't get too excited and over-do-it, you've come too far to do something silly and re-injure your Achilles.

Conclusion
These last three issues of The Stretching & Sports Injury Newsletter have been a very detailed account of the correct treatment of an Achilles tendon injury. If followed correctly, they'll give you the best chance of a full and complete recovery. Good luck!