Take Care of Your Achilles Tendons

It was the fateful weak spot of an otherwise-invulnerable Hellenic warrior. And it’s been sidelining athletes, dancers, and plain ordinary people ever since.

The Achilles tendon connects your calf to the back of your heel, transmitting the forces of running, walking, jumping, and pointing your foot.

If you run, you’re vulnerable to problems of the Achilles tendon, especially if you’re over forty. But other athletes are at risk too. And even if you’re sedentary you’re not immune. The tendon can be weakened by under-use as much as by over-use.

The type of injury can vary: your Achilles tendon (or the sheath around it) can be degenerated, inflamed, or torn outright. The injury location varies, too. It can occur in the mid-calf (where the tendon arises from the gastroc and soleus muscles), at the attachment to the heel bone, or at a vulnerable zone just above the heel where the blood supply is most limited.

If you have a complete tear of the Achilles tendon, you’re in trouble. You’ll have a hard time walking and you may even need surgery to reattach the two ends.

Fortunately, most Achilles injuries are less severe.

The common Achilles problems are primarily due to degeneration of the tendon from overuse or misuse. Add to the mix possible inflammation of the sheath around the tendon, along with micro-tears in the tendon itself, and you’ve characterized the majority of Achilles tendon problems.

Often these problems are called Achilles tendonitis.  But technically, since there’s rarely inflammation involved, more precise diagnostic terms would be Achilles tendonosis or Achilles tendinopathy.

Achilles “tendonitis” treatment

Your ideal treatment plan requires four components:

1. Resolve inflammation (if there is any)

Many overuse injuries don’t actually involve an inflammatory process, but sometimes the sheath around the Achilles tendon can become inflamed. (The tendon itself is a less likely site of inflammation.)

Ice is nice.

And there are those who swallow anti-inflammatory pills like ibuprofen, aspirin, or naproxen (NSAIDs).  A more benign “nutritional” alternative to NSAIDs that works for some people is the use of digestive enzymes.  Proteolytic enzymes that break down proteins in your diet will also break down the inflammatory chemicals in your swollen tissues.

Combine the proteolytic enzymes with anti-inflammatory herbs such as curcumin, and you’ve got a potent all-natural treatment strategy. (Contact me for information about the specific products I recommend.)

2. Blast your fibroblasts

Fibroblasts are the cells that manufacture the structural protein of the tendon – collagen. When you’re injured, you need your fibroblasts to speed up their production line.  The best way to do this is to mechanically stimulate them with manual therapy such as friction massage or myofascial therapy.

Gentle stretching and eccentric strengthening help too.  Here’s your basic eccentric strengthening exercise:

Stand on both feet and rise up onto your toes. Then, lift your “good” foot off the ground and slowly lower your weight using the muscles of the injured side. Repeat up to 20 times.

CAUTION: The exercise as described may not be appropriate for everyone. If you have a serious injury, it might be too challenging. If the alignment of your feet is off, you could also be doing more harm than good. And for some people, this exercise isn’t challenging enough. Contact me for more information about your specific situation.

3. Correct structural problems

• Get the joints of your feet checked (by a doctor of chiropractic) to see if altered motion of the joints is adding to your problem.
• You may also need shoe inserts: simple ones such as a slight heel lift or lateral wedge, or more complicated ones like custom foot orthotics.
• Have the joints of your pelvis and low back checked for alignment and joint play problems.
• You may need to stretch your calves, hamstrings, outer thigh, or other tight zones.

4. Get fit!

Once you’ve balanced your structure so that you’re not putting undue stress on the Achilles tendon, it’s time for a gradual return to your normal fitness routine.

Don’t let Achilles tendon injuries prevent you from enjoying a fit and active life. Institute some simple self-care measures and get professional help too as needed.

Dr. Lavine has been an innovator in the use of movement and touch to promote health since 1981. He practices in New York City and Princeton, NJ.