Get Started Is Simple
One phone call it takes to schedule your appointment.

CALL US:

Or to ask questions and to see if our treatment approach is right for you, just send us a message below

© 2016 by White Bay P.T. Inc. Proudly created with Wix.com

Thanks for submitting!

BLOG

"Tons of Useful Information"

  • Lionel Pannunzio PT / SCS


Introduction


A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌an‌ ‌injury‌ ‌to‌ ‌the‌ ‌muscles‌ ‌in‌ ‌the‌ ‌calf‌ ‌area‌ ‌(the‌ ‌back‌ ‌of‌ ‌the‌ ‌lower‌ ‌leg‌ ‌below‌ ‌the‌ ‌knee).‌ ‌


Calf injuries are among the most common muscle injuries in the sports of Soccer. What makes this injury very tricky is its high rate of re-injury. If it is not treated right in first time, this muscle injury can linger for months preventing players from playing soccer .





Anatomy‌ ‌of‌ ‌the‌ ‌Injury‌ ‌

A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌an‌ ‌injury‌ ‌to‌ ‌the‌ ‌muscles‌ ‌in‌ ‌the‌ ‌calf‌ ‌area‌ ‌(the‌ ‌back‌ ‌of‌ ‌the‌ ‌lower‌ ‌leg‌ ‌below‌ ‌the‌ ‌knee).‌ ‌ The‌ ‌calf‌ ‌muscle‌ ‌is‌ ‌actually‌ ‌composed‌ ‌of‌ ‌up‌ ‌to‌ ‌9‌ ‌separate‌ ‌muscles,‌ ‌any‌ ‌of‌ ‌which‌ ‌can‌ ‌be‌ ‌injured‌ ‌individually‌ ‌or‌ ‌together.‌ ‌

The‌ ‌gastrocnemius,‌ ‌soleus,‌ ‌and‌ ‌plantaris‌ ‌muscles‌ ‌attach‌ ‌onto‌ ‌the‌ ‌heel‌ ‌bone,‌ ‌and‌ ‌work‌ ‌together‌ ‌to‌ ‌produce‌ ‌the‌ ‌downward‌ ‌motion‌ ‌of‌ ‌the‌ ‌foot.‌ ‌


The‌ ‌other‌ ‌6‌ ‌muscles‌ ‌cause‌ ‌knee,‌ ‌toe,‌ ‌and‌ ‌foot‌ ‌movements‌ ‌in‌ ‌different‌ ‌directions;‌ ‌these‌ ‌muscles‌ ‌are‌ ‌the‌ ‌popliteus,‌ ‌flexor‌ ‌digitorum‌ ‌longus,‌ ‌flexor‌ ‌hallucis‌ ‌longus,‌ ‌tibialis‌ ‌posterior,‌ ‌and‌ ‌the‌ ‌fibularis‌ ‌(or‌ ‌peroneal)‌ ‌longus‌ ‌and‌ ‌brevis.‌ ‌They‌ ‌extend‌ ‌from‌ ‌the‌ ‌lower‌ ‌leg‌ ‌bones‌ ‌around‌ ‌the‌ ‌sides‌ ‌of‌ ‌the‌ ‌ankle‌ ‌and‌ ‌attach‌ ‌to‌ ‌various‌ ‌parts‌ ‌of‌ ‌the‌ ‌foot‌ ‌and‌ ‌toes.‌ ‌

Calf‌ ‌strains‌ ‌are‌ ‌a‌ ‌well-known‌ ‌problem‌ ‌for‌ runners,‌ soccer‌ ‌and‌ ‌basketball‌ ‌players,‌ ‌ gymnasts,‌ ‌and‌ ‌dancers‌ ‌

A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌caused‌ ‌by‌ ‌overstretching‌ ‌or‌ ‌tearing‌ ‌any‌ ‌of‌ ‌the‌ ‌9‌ ‌muscles‌ ‌of‌ ‌the‌ ‌calf.‌ ‌

The‌ ‌muscles‌ ‌usually‌ ‌affected‌ ‌are‌ ‌Gastrocnemius‌ ‌or‌ ‌Plantaris‌ ‌


Calf‌ ‌Strains‌ Statistics‌

Although‌ ‌studies‌ ‌documenting‌ ‌the‌ ‌injury‌ ‌rates‌ ‌of‌ ‌calf‌ ‌muscle‌ ‌tears‌ ‌are‌ ‌no‌ ‌so‌ ‌great,‌ ‌a‌ ‌5-year‌ ‌study‌ ‌of‌ ‌European‌ ‌soccer‌ ‌players‌ ‌revealed‌ ‌that‌ ‌12%‌ ‌of‌ ‌the‌ ‌muscle‌ ‌injuries‌ ‌sustained,‌ ‌were‌ ‌injuries‌ ‌to‌ ‌the‌ ‌gastrocnemius‌ ‌muscle,‌ ‌and‌ ‌the‌ ‌gastrocnemius‌ ‌was‌ ‌categorized‌ ‌as‌ ‌one‌ ‌of‌ ‌the‌ ‌top‌ ‌five‌ ‌muscles‌ ‌injured.‌ ‌(Armfield‌ ‌D,‌ ‌et‌ ‌al.‌ ‌Sports-related‌ ‌muscle‌ ‌injury‌ ‌in‌ ‌the‌ ‌lower‌ ‌extremity.‌ ‌Clin‌ ‌Sports‌ ‌Med.‌ ‌2006;25:803–842.)‌



Causes and Symptoms

Calf strains can occur during hi-speed motions like running and jumping, or from any type of forceful or uncoordinated movement.

What happens is that the Calf is overstretched causing the tear or strain of the muscle fiber. This injury can be attributed or be related to

  • Poor running mechanics.

  • Improper warm-up.

  • Inappropriate training loads.

  • Lower back pathology or increased tightness in your posterior chain of muscles ( lower back, hamstrings and calf muscles )

  • Fatigue

  • Age Middle-aged or older patient, usually over the age of 40, often present with lower leg muscle injuries following strenuous exercises.

Symptoms



  • Sharp pain or weakness in the back of the lower leg.

  • A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.

  • A feeling of tightness or weakness in the calf area

  • Spasms (a gripping or severe tightening feeling in the calf muscle).

  • Sharp pain in the back of the lower leg, when trying to stretch or move the ankle or knee.

  • A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 calf strain).

  • Weakness in the calf when trying to walk, climb stairs, or stand.

  • Limping when walking.

  • Difficulty performing daily activities that require standing and walking.

  • An inability to run or jump on the affected leg.

  • Bruising: When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.




Common Calf Strains

A calf strain is caused by overstretching or tearing any of the 9 muscles of the calf.


The muscles usually affected in Soccer players are Gastronemius or Plantaris

1 . Gastronemious Strain

A medial Gastrocnemius strain is the most common cause of acute onset calf pain with the typical symptom described on previous post: pain in the inner part of the lower leg, swelling, bruising, inability to run or jump.

2. Plantaris Muscle Rupture

The plantaris muscle is a thin muscle that runs along the gastrocnemius muscle but is only a fraction of the size. When the plantaris muscle ruptures, often as a result of lunging forward, a sudden, snapping pain in the back of the leg is felt. Swelling and bruising in the back of the leg may occur, along with cramping of the calf muscle.

3. Soleus Muscle Strain

The soleus muscle is located below the gastrocnemius muscle in the calf. Straining of the soleus muscle is commonly a chronic injury that occurs less common in soccer and more frequently in long-distance runners. The pain is often reported as a deep soreness or tightness in the calf that can be reproduced when bending the knee and dorsi-flexing the ankle (pulling your toes back toward your shin) at the same time.








Types of Calf Strains and Healing Time





Calf Strains are graded according to the amount of muscle damage that has occurred:


Grade 1

A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.

Grade 2

A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.

Grade 3

A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible.



Time of Healing for Calf Strains

Depending on the severity of the injury, the healing time could be from 1-2 weeks to 1-2 months at times.


As usual with these muscular injuries, healing time does not mean rest. For the contrary, pushing the muscle to the limit of tolerance ( guided by mild pain or discomfort ) is the best path to create a strong and flexible scar tissue strong enough to tolerate the high demands of soccer. The calf muscles create a lot of power to sprint and jump.


Before return to play after a calf strain you must be sure that you have restored not only the range of motion of the ankle and knee, the strength of the Gastrocnemius and soleous but also you have training the injury to tolerate high speed running and jumping on the injured leg otherwise you are setting yourself up for a re-injury.





What to do if you suffer a calf strain?


Treatment



Physical‌ ‌therapists‌ ‌treat‌ ‌individuals‌ ‌with‌ ‌calf‌ ‌strains‌ ‌by‌ ‌reducing‌ ‌pain,‌ ‌restoring‌ ‌muscle‌ ‌strength‌ ‌and‌ ‌ flexibility,‌ ‌and‌ ‌increasing‌ ‌their‌ ‌recovery‌ ‌speed.‌ ‌


Acute Phase - Early Strengthening






Acute Phase (1st week aprox.): The goals of this phase is to control pain and inflammation and to start moving the injured fibers as tolerated.

Reduce Pain.

Including ice for 1st 1-2 days , also ultrasound, electricity, taping, heel lifts, and hands-on therapy.


Improve Motion.

Gentle Range of motion exercises as tolerated: I like Gastrocnemius activation with ankle pumps , first with the knee in flexion to relax the calf muscle and allow more ankle excursion and then with knee straight to challenge more the injured fibers inside the muscle.

Improve Strength.

Band resisted Calf exercises.

As soon as tolerated we start with resistance training using bands for plantar flexion and Gastrocnemius Strengthening.

Soleus Exercise: As soon as tolerated we start with resistance training using a light weight to resist this muscle contraction and promote healing.





Strengthening Phase




Strengthening Phase: The goals of this phase is to start loading the muscle and restoring the strength of these powerful muscles progressively My favorite exercises are:

Weight Bearing Isometrics Bilateral

Setup Begin in a standing upright position with your hands resting in front of you on a wall. Movement Slowly raise your heels off the ground and hold that position



Weight Bearing Isometrics Single Leg

Setup Begin in a standing upright position with your hands resting in front of you on a wall. Movement Bend one knee up to 90 degrees, then raise your other heel off the ground and hold that position


Gastrocnemius Resistance Training - Bilateral

Setup Begin standing at the edge of a step with your heels hanging off the edge. You may hold onto a stable object for support. Movement Raise up onto the balls of your feet, then slowly lower your heels down off the edge of the step and repeat.

Tip Make sure to maintain your balance during the exercise. Keep your movements slow and controlled. Use the following pace: 3 seconds to get to the top position, hold for 2 seconds, 3 seconds to return to starting position .




Soleus Strengthening






Another crucial component of the rehabilitation process after a calf strain is the Soleus Muscle, very important because of its function as the powerhouse of the calf musculature. Soccer requires repetitive sprints throughout the game.


The force generated by your body during these high intensity activities must be absorbed and dissipated by your muscles, joints and tendons .


A 2012 study measured the peak forces generated by your lower extremity muscles during running at different speeds. (Mechanics of the Human Hamstring Muscles during Sprinting. Schache AG1, Dorn TW, Blanch PD, Brown NA, Pandy MG. Med Sci Sports Exerc. 2012 Apr;44(4):647-58).


They found that the SOLEUS muscle works hard to make you run fast and to absorb your bodyweight at the same time. For example at 25 km/hr the Soleus is generating a force of 8.7 times your body weight while the gastrocnemius only 3.23 times your bodyweight. So it is more than clear that strengthening your Gastrocnemius only will only take you ⅓ of the road to your recovery and that Soleus strengthening is mandatory when recovering from a Calf Strain

Also from the same study we can infer that Soleus Strengthening should be part of every program to rehabilitate muscles injuries of any type in your lower extremities. So do yourself a big favor and start thinking 𝐒𝐎𝐋𝐄𝐔𝐒.



How to train the Soleus ?


Setup Begin standing on a small step or platform with your heels off the edge, holding onto a stable object for balance.


Movement Bend your knees, then raise both heels up, and then lower down slowly


Tip

Make sure to maintain your balance during the exercise. Keep your movements slow and controlled.

Use the following pace: 3 seconds to get to the top position, hold for 2 seconds at the top, 3 seconds to return to starting position.

In the video I show them using a weighted vest but you should start with your own body weight and progress to a vest or backpack once you can knock down 10-12 good quality repetitions.





Conclusion:


  • Calf muscles are very common in Soccer players.

  • Healing time depends on the severity on the injury but usually 3 to 6 weeks is a good estimate

  • Resting for 3-6 and returning to play will not help . You need to restore the size, strength and power of the calf musculature. Use the videos above as guidance for training

  • Be sure you work on Gastrocnemius strengthening

  • A good return-to-play training with field work is mandatory if you want to avoid another injury



Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:


Facebook Page

Google Plus Page

Instagram Page


where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”



If you want more information about soccer injuries we sure to take a look at our blog archives with plenty of useful information for soccer players




#westoncalfpain #calfstrain #calfpull #PulledMuscle #Soccerinjuries #Soccercalfinjury #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy



Introduction


Treatment of Achilles tendinopathy requires a comprehensive approach including pain control exercises, then strengthening followed by power and finally a well rounded return-to-play program to restore strength and function to this affected tendon.

In this blog, you will learn the main exercises we use with soccer player recovering from an Achilles Tendionpathy


Should I rest the Achilles or Loaded ?


Many soccer players may think that they need to ‘use’ the tendon ‘less’ in order to improve the pain and reduce the symptoms, so they rest or reduce the activity significantly and the pain usually gets better but here is the catch, once these players return to practice the pain comes back almost immediately

In our approach to Achilles Tendinopathy, the key is to fully rehabilitate the tendon by using the tendon more. More means progressive loading of the tendon to increase its resilience for the sport activity.


What are the best exercises for Achilles Tendinopathy?


Build plantar flexor capacity !!!! Do all types of calf raises

We discussed above that in Tendinopathies, loading the tendon is the way to improve this condition.

The goals is a progressive increase in loading the tendon through rehabilitation exercise that ultimately will include what is known as ‘heavy slow resistance’ work that typically is performed in a gym setting with appropriate resistance.


I like to see soccer players being able to do heavy gastrocnemius and soleus work in a gym (targets 1.5x body weight soleus seated calf raises & 0.3-0.4x body-weight standing calf raises aiming for 3x 8 reps with good control.


Of course even though the goal is to go heavy on the tendon, we cannot start with heavy stuff because it will most likely irritate the tendon and create more pain.


The logical progression for this exercises is to build up capacity with Isometrics first, then isotonics (full Range of movement) , then eccentrics (emphasis on the movement down of the calf raises ) and finally plyometric exercises with all types of jumps to challenge the super important and ultimate function of storage-release mechanism of the tendon )



Isometrics


Isometric contraction is a very powerful type of muscle activity in which the muscle contracts quite strong but there is no movement at the adjacent joint. Isometric exercises help with pain in the tendon as well as with the develop of force.

Isometric contractions are used early in the treatment process for these reasons.



Bilateral Calf Raises - Isometrics




Setup

Begin in a standing upright position with your hands resting in front of you on a wall.

Movement

Slowly raise your heels off the ground and hold that position. Start with 5 seconds and build it up until you can hold for 45 seconds . 5 repetitions and 3 sets are recommended .

As you get stronger you can add weight to this exercises with a vest or backpack



Unilateral Calf Raises - Isometrics



Setup

Begin in a standing upright position with your hands resting in front of you on a wall.

Movement

Raise your heels as high as you can then Bend one knee up to 90 degrees and hold the weight of your body on the opposite Foot raised , hold that position . Start with 5 seconds and build it up until you can hold for 45 seconds . 5 repetitions and 3 sets are recommended.



Isotonics Exercises


Once you are able to manage the Isometrics without a flare-up in pain or symptoms we start loading the tendon progressively in the full Range of motion available. Adding a step to the equation allows for more demand on the tendon fibers.

It is very important with these exercises below that you control the pace of the movement and go from one end of the movement to the other. This is how we will show the tendon where to align the newly formed fibers of collagen : “in line “ with the force which makes the tendon more resistant to the load.


Calf Raises on Step



Setup.

Begin standing at the edge of a step with your heels hanging off the edge. You may hold onto a stable object for support.

Movement.

Raise up onto the balls of your feet, then slowly lower your heels down off the edge of the step and repeat.

Tip.

Make sure to maintain your balance during the exercise. Keep your movements slow and controlled. Use the following pace: 3️ seconds to get to the top position, hold for 2️ seconds, 3 seconds to return to starting position. You can start with 3 sets of 5 repetitions and progress to 3 sets of 8 repetitions and finally to 3 sets of 10 repetitions as long as you can maintain the quality of the contraction.


Bent Knee Calf Raise on Step



Setup

Begin standing on a small step or platform with your heels off the edge, holding onto a stable object for balance.

Movement

Bend your knees, then raise both heels up, and lower them down slowly. Repeat these movements.

Tip

Make sure to keep your back straight and knees bent throughout the exercise. Keep your movements slow and controlled. Use the following pace: 3️ seconds to get to the top position, hold for 2️ seconds, 3 seconds to return to starting position. You can start with 3 sets of 5 repetitions and progress to 3 sets of 8 repetitions and finally to 3 sets of 10 repetitions as long as you can maintain the quality of the contraction.





Excellent… by doing calf raises Am I cured ? ….

The answer will be NO... YET....


Building plantar flexor capacity is just part of the treatment. Once you have more control of your calf muscles we need to reproduce the demands on the tendon. Tendons are like springs. Let’s say you are running and every step you take you absorb your own weight in the foot and then you push your body forward to continue running. This load absorption and release is the main function of the Achilles Tendon.






So in order to get completely better, strengthening only will not be enough and you need to reproduce and train this energy storage-release mechanism.

To recreate this, Therapists use what it is called Plyometrics exercises intended to simulate this function. Examples of Plyometrics are bilateral and unilateral leg jumps , quick calf raises , box jumps and other.

Plyometrics are high level exercises need to be done by a therapist to properly choose the right doses in order to avoid irritation of the tendon



Ankle Plyometrics - Double Leg and Single Leg Ballistic Heel Raises


Set Up

Stand up on the ball of your feet

Movement

Do Quick Rebounds mid amplitude

Then switch to one foot only and repeat mid amplitude heel raises

Sets of 10 reps


Load Management



When returning to the activity in this case playing soccer, you must do it gradually. Knowing exactly what brings out your symptoms will empower you to make the right adjustments for the healing process to take place.

Movements that create high loads and use the tendon as a spring (jumping or sprinting activities for example) increase cell signaling and can create the over-response that sparked the pain you are feeling. Therefore, start with walking and jogging session, followed by jogging only session, changes of speed (50-75-90 %), cuts 45-90-180 degrees, speed and agility drills, ball possession drills until you can practice a whole week without irritation of the tendon. If during the progression there is pain after the activity of the morning after it means the pain you’re experiencing is your tendon telling you it is not tolerating the loads you are placing on it. It is there for a reason. Listen to it.

For such cases, try changing one variable in your training program and see how your tendon responds. For example, if you currently train seven days a week, decrease the frequency by dropping one session. If you can’t sacrifice one day of training, you must make a change to either the amount of high intensity loads or the total volume of your training. Regardless of which variable you choose, only change one factor at a time and wait to see how your body responds (everyone will be slightly different so there is no golden rule).




Finally...Should I stretch Tendon Pain?

Despite what you may have learned elsewhere, we do not want to stretch an Achilles tendon injury!

No matter what form of tendinopathy you may be experiencing, stretching should not be a part of your rehabilitation program.

Remember that Insertional Achilles tendinopathy injuries occur due to high levels of compressive load to the tendon against the calcaneus bone. Stretching your calf muscles will only serve to add more compression (and lead to more pain) on the already injured area.

While there is less cause for concern for those dealing with a mid-tendon tendinopathy injury, research has not shown any benefits to stretching whatsoever.

Instead, if you do have limited ankle mobility or you feel tight in your calves, you can safely perform soft tissue mobilization to the calf muscles with a foam roller or massage stick. Foam rolling has been shown in research to improve ankle mobility without placing harmful compressive loads on the tend




Conclusion


  • Achilles Pain from Tendinopathy is very common in Soccer players (see statistics at https://www.ncbi.nlm.nih.gov/pubmed/23770660)

  • In this Tendinopathy there is an imbalance between the amount of load that the tendon in receiving and the tendon's capacity

  • Weakness in the calf musculature is the main reason for Achilles Tendinpathy.

  • Physical Therapy can help by building Calf Raise Capacity to improve the strength of the calf and reinforce the remaining of the healthy tendon.

  • A combination of Isometrics, Isotonics, Eccentrics and Plyometrics exercises is necessary for a safe and pain-free return to play process

  • Education in Load Management and a strategy to progressively load the tendon without (or minimal) irritation are also mandatory if you want to play pain-free



Do you have other questions about Achilles Tendinopathy?

Do you want to know if Physical Therapy can help your particular case ?



Give us a call at 754 244 2561 and we will help you answer these question and even we will schedule you a Free consultation


Visit www.wbsphysicaltherapy.com for more information

on how to talk to a Sports-Certified Specialist

and start getting better today...



#achillestendinopathy #achillespain #whitebayphysicaltherapy #calfpain #calfStrain #PulledMuscle #Soccerinjuries #Soccercalfinjury #westonsoccer #westoncalfpain #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston



Introduction


Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel.

It affects Soccer players of all ages. In this blog, you will learn the main causes of Achilles Pain, the different types of injures and guidelines for recovering from this condition



Incidence


A total of 27 clubs from 10 countries and 1743 players have been followed prospectively during 11 seasons between 2001 and 2012.

A total of 203 (2.5% of all injuries) Achilles tendon disorders were registered.

A majority (96%) of the disorders were tendinopathies

A higher injury rate was found during the preseason compared with the competitive season

The mean lay-off time for Achilles tendinopathies was 23±37days

Players with Achilles tendon disorders were significantly older than the rest of the cohort, with a mean age of 27.2±4 years vs 25.6±4.6 years

27% of all Achilles tendinopathies were reinjuries.

Recurrence is common after Achilles tendinopathies and the reinjury risk is higher after short recovery periods.

(source: Recurrence of Achilles tendon injuries in elite male football players is more common after early return to play: an 11-year follow-up of the UEFA Champions League injury study. Gajhede-Knudsen et al)





Anatomy of the Injury



Where is the problem?

Achilles Tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel.




What is a Tendinopathy?


The term “tendinopathy” refers to any problem with a tendon, either short- or long-term.

The Achilles tendon transmits force from the calf muscles down to the foot when a person pushes the foot off the ground (eg, runs or jumps), and helps control the position of the ankle when the foot touches back down on the ground (eg, lands).

Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function.

The condition can occur after a single incident (acute injury) or after repetitive irritation or "microtrauma" (chronic injury).

Most often, Achilles tendon pain is the result of repetitive trauma to the tendon that can result in chronic Achilles tendinopathy—a gradual breakdown of the tissue—and is most often treated with physical therapy. Please note that we don’t use the term tendonitis because “itis” means inflammation like in a acute ankle sprain. This is more a problem in the architecture of the tendon, a mechanical problem within the tendon and not an inflammatory process.

So in the tendinopathy there are mainly healthy fibers in conjunction with some “abnormal fibers”





Stages of the Achilles Tendinopathy


  • Normal Tendon

  • Reactive Tendinopathy: early stage of the tendinopathy, as a result of an excessive and rapid load. Thickening of the tendon. Painful . Reversible. Young -15-25 yrs

  • Tendon Disrepair: tendon unable to manage loads and architectural changes occur inside the tendon. Trying to repair . Less painful. Less reversible. Young Adult - 20-35 yrs

  • Degenerative Tendinopathy: Late stage of Tendinopathy, tendon gives up on healing. Degeneration of parts the tendon. Non-reversible. Older - 30-60 yrs

  • Reactive on Degenerative Tendinopathy: acute exacerbation of a Degenerative Tendon







Types of Achilles Tendinopathy

Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel (known as mid-portion Achilles tendinopathy), although it may also be present where the tendon meets the heel (known as insertional Achilles tendinopathy).






Causes of Achilles Tendinopathy


Achilles tendinopathy is linked to several different factors, including:

  • Calf muscle tightness

  • Calf muscle weakness

  • Abnormal foot structure

  • Abnormal foot mechanics

  • Improper footwear

  • A change in an exercise routine or sport activity

  • Obesity



Symptoms


With Achilles tendinopathy, you may experience:

  • Tenderness in the heel or higher up in the Achilles tendon with manually applied pressure

  • Pain and stiffness with walking, at its worst with the first several steps, especially worse in the morning upon stepping down from bed or after being sitting for +20-30 mins

  • Tightness in the calf

  • Swelling in the back of the ankle


The Pain cycle and the road to a Chronic pain


In the early stages of the Tendinopathy Achilles Pain typically warms up as the athlete starts to exercise, feels okay during exercise, then aches again following activity.

As time goes on, there is often less of a warm-up effect and the pain persists during exercise. Patients will often also complain of morning pain and stiffness which warms up over a few minutes. Tenderness and swelling are also common complaints.


That’s how this Tendinopathy becomes Chronic and from there it can last forever without proper treatment



How Physical Therapy can help me get better from Achilles Pain?


At White Bay Physical Therapy, we will review your medical history and complete a thorough examination of your heel, ankle, and calf. We will assess your foot posture, strength, flexibility, and movement. This process may include watching you stand in a relaxed stance, walk, squat, step onto a stair, or do a heel raise. The motion and strength in other parts of your leg also will be assessed.

We may also ask questions regarding your daily activities, exercise regimens, and footwear, to identify other contributing factors to your condition.

Imaging techniques, such as X-ray or MRI, are often not needed to diagnose Achilles tendinopathy. Although it is unlikely that your condition will ultimately require surgery, your physical therapist will consult with other medical professionals, such as an orthopedist, to determine the best plan of treatment for your specific condition if it does not respond to conservative care.



Treatment Guidelines


Seth O’Neil a physiotherapist from UK and one the Achilles Tendinopathy “Gurus” resumed the guidelines for treating Achilles Tendinopathy in 5 points


1. Reassurance

One of the common incorrect beliefs is that tendinopathy needs to be rested to get better. In actuality the tendon needs to be used ‘more’ but in the correct manner (ie loaded rehab exercises and progressive running)


2. De-threaten the condition

Many people can fear loading the tendon for concern of ‘tears’ or ‘rupture’. The therapist’s job is to show the tendon-pain-sufferer of the very high loads that tendons endure day to day (eg 4x Body-weight intra tendon loads with walking, 6x BW with running) so loading the tendon with just your body at the beginning it is not a high demand activity so you are safe to do it.


3. Educate on load management

The soccer player needs to appreciate that loading tendon correctly is the pathway forward, how to monitor increases in workload based on the pain response, the required time to allow tendon to adapt to loading, why ‘flare ups’ can be expected.

Build plantar flexor capacity: I like to see soccer players being able to do heavy gastrocnemius and soleus work in a gym (targets 1.5x body weight soleus seated calf raises & 0.3-0.4x body weight standing calf raises aiming for 3x 8reps with good control

Return to full practice : this must be staged & I normally suggest returning to practice progressively with days in between to rest



Conclusion


  • Achilles Pain from Tendinopathy is very common in Soccer players.

  • In this Tendinopathy there is an imbalance between the amount of load that the tendon in receiving and the tendon's capacity

  • Weakness in the calf musculature is the main reason for Achilles Tendinopathy.


Next post will be about what exercises you can do to self manage Achilles Pain, stay tuned.



Do you have other questions about Achilles Tendinopathy?

Do you want to know if Physical Therapy can help your particular case ?



Give us a call at 754 244 2561 and we will help you answer these question and even we will schedule you a Free consultation


Visit www.wbsphysicaltherapy.com for more information on how to talk to a Sports-Certified Specialist and start getting better



#achillestendinopathy #achillespain #whitebayphysicaltherapy #calfpain #calfStrain #PulledMuscle #Soccerinjuries #Soccercalfinjury #westonsoccer #westoncalfpain #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston