Issue link: https://www.massageandbodyworkdigital.com/i/72103
ACHILLES TENDON INJURIES If you injured your Achilles tendon, it would be almost impossible for you to sneak out of your house on tiptoe—the pain would be too great. Hiking, running, dancing, or doing physical labor, like construction work, would make you equally miserable. The Achilles is one of the biggest and strongest tendons in the body. It begins at the back of the calcaneus and extends up the middle of the calf. It connects the lateral and medial gastrocnemius and soleus muscles to the heel, and controls the actions of pushing off in walking, running, and rising onto the balls of the feet. Without the Achilles tendon, you literally could not walk. ONE TENDON, MANY TYPES OF INJURIES The Achilles tendon can be injured in many different places, and in many different ways. The body of the tendon has four different surfaces—anterior (front), posterior (back), and medial and lateral (sides). A person can injure the tendon in any of these places—and it's possible to injure it in multiple places at once. Most Achilles injuries are in the body of the tendon, 2–3 inches superior to the calcaneous. In addition, injury can occur where the tendon attaches to the superior posterior aspect of the calcaneus—this is sometimes referred to as dancers' heel. Injury can also occur at the aponeurosis (flat Achilles tendon and feet are in good alignment, your weight is evenly distributed throughout the Achilles tendon as you perform these tasks. If there is a misalignment in one of these body parts, however, the majority of your weight falls onto either the medial or lateral aspect of the tendon, causing a constant strain—an injury waiting to happen. One common alignment issue Sobota: Atlas der Anatomie des Mensche @ Elsevier GmbH, Urban & Fischer Verlag Munich bands of fibrous connective tissue) on the medial and lateral aspects of the calcaneous. Finally, injury can occur at the musculotendinous junction where the tendon joins the gastrocnemius muscle or the soleus. (This last scenario is the least common.) The sensation caused by an Achilles injury may range from a mild, occasional ache to a severe throbbing pain, depending on how many of the tendon fibers have been affected. When the strain is mild, there is minimal scar tissue formation, and therefore mild pain. In severe injuries, involving repeated micro- tears of the tendon fibers and extreme inflammation, the development of adhesive scar tissue causes severe, persistent pain. If the pain becomes chronic, tendinosis can develop, causing the fibers to atrophy and the pain to become more difficult to treat. HOW AND WHY THE TENDON GETS INJURED Whenever you walk, run, or stand on tiptoe, the Achilles tendon is called upon to work. If your pelvis, knees, is excessive pronation of the feet, causing more weight to fall on the medial portion of the Achilles. While the medial part gets overworked, the lateral part gets underworked and therefore weakens. Another possible source of imbalance is weakness in the one of the four quadrants of the low leg. Only when the stirrup muscles, peroneus/fibularis muscles, tibialis anterior and posterior muscles, and calf muscles have balanced strength will weight be transmitted properly into the foot and therefore the tendon. Improper stretching of the calf muscles (stretching that is too aggressive or too prolonged) can also cause an injury, as can overuse. Runners, athletes, and dancers frequently strain the Achilles tendon by jumping up and down on the balls of their feet or by just working out for many hours at a time. INJURY VERIFICATION Before treating a client for an Achilles tendon injury, make sure the person has seen a physician. There may be other issues, such as gout or another underlying medical condition, causing the person's pain. TEST 1 To test for this injury, have the client stand barefoot and rise high onto the balls of the feet. The person may have to do this several times on both feet before the tendon feels pain or discomfort. If no pain is felt, earn CE hours at your convenience: abmp's online education center, www.abmp.com 97