AFX Technical Paper www.AFXonline.com www.facebook.com/AFXonline www.twitter.com/AFXonline Achilles Tendonitis Prevention Achilles tendonitis is a painful condition in which the Achilles tendon is strained and inflamed (i.e. swollen) (see image below). The Achilles tendon attaches the calf muscle (gastrocnemius and soleus) to the heel bone (calcaneus). When the calf muscle contracts, tension is placed on the Achilles tendon, and your toes move away from your shin. Because of this function, the Achilles tendon is vital in the push-off phase of activities such as walking, running, and jumping. Did you know that the Achilles tendon is the thickest and strongest tendon in the human body and is capable of withstanding forces greater than 1000 pounds without tearing? (American Orthopedic Foot and Ankle Society) However, forces up to 12 times body weight can sometimes be placed on the Achilles tendon during a sprint or push-off (Noto, 2011), while overtraining can lead to a weakening of the tendon, either of which can result in small tears in the tendon. If ongoing stress is placed on the tendon without adequate rest, the body is unable to repair the injured tissue, and significant inflammation and pain can result. Pain is typically experienced either at the attachment point (insertion) at the back of the heel, or in the mid-portion of the tendon (approximately 1.5 inches above the heel). The Achilles tendon does not have good blood supply, so this injury can be slow to heal. Achilles tendonitis is common in “weekend warriors” (i.e. those who are less conditioned and participate in athletics only on weekends or infrequently). Sports that require a lot of running, jumping and change of direction, such as long-distance running, football, basketball and tennis, have the greatest prevalence of Achilles injuries. It is estimated that Achilles tendonitis accounts for approximately 11% of all running injuries, and undue strain results in over 230,000 Achilles tendon injuries per year in the U.S. alone (Noto, 2011). Causes Achilles tendonitis usually develops after sudden changes in activity or training level, use of inappropriate footwear (e.g. inadequate heel cushioning), or training on uneven or hard surfaces, especially if other risk factors such as tight calf muscles or over-pronation (i.e. flattening of the arch) are present. As people age, tendons become less flexible and therefore more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis. Potential causes of Achilles tendonitis include the following : • Overtraining; • Increased intensity, duration, or frequency of activity; Source: University of Maryland Medical Center
Achilles Tendonitis Prevention Achilles tendonitis is a painful condition in which the Achilles tendon is strained and inflamed (i.e. swollen) (see image below). The Achilles tendon attaches the calf muscle (gastrocnemius and soleus) to the heel bone (calcaneus). When the calf muscle contracts, tension is placed on the Achilles tendon, and your toes move away from your shin. Because of this function, the Achilles tendon is vital in the push-off phase of activities such as walking, running, and jumping. Did you know that the Achilles tendon is the thickest and strongest tendon in the human body and is capable of withstanding forces greater than 1000 pounds without tearing? (American Orthopedic Foot and Ankle Society) However, forces up to 12 times body weight can sometimes be placed on the Achilles tendon during a sprint or push-off (Noto, 2011), while overtraining can lead to a weakening of the tendon, either of which can result in small tears in the tendon. If ongoing stress is placed on the tendon without adequate rest, the body is unable to repair the injured tissue, and significant inflammation and pain can result. Pain is typically experienced either at the attachment point (insertion) at the back of the heel, or in the mid-portion of the tendon (approximately 1.5 inches
above the heel). The Achilles tendon does not have good blood supply, so this injury can be slow to heal. Achilles tendonitis is common in “weekend warriors” (i.e. those who are less conditioned and participate in athletics only on weekends or infrequently). Sports that require a lot of running, jumping and change of direction, such as long-distance running, football, basketball and tennis, have the greatest prevalence of Achilles injuries. It is estimated that Achilles tendonitis accounts for approximately 11% of all running injuries, and undue strain results in over 230,000 Achilles tendon injuries per year in the U.S. alone (Noto, 2011).
Causes
Achilles tendonitis usually develops after sudden changes in activity or training level, use of inappropriate footwear (e.g. inadequate heel cushioning), or training on uneven or hard surfaces, especially if other risk factors such as tight calf muscles or over-pronation (i.e. flattening of the arch) are present. As people age, tendons become less flexible and therefore more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis. Potential causes of Achilles tendonitis include the following :
• Overtraining; • Increased intensity, duration, or frequency of activity;
• Intense return to training after an absence or a layoff; • A traumatic force applied to the tendon, through a sudden, explosive movement such as a
sprint start or a jump in basketball; • Improper warm-up and/or stretching prior to activity; • Lack of calf muscle flexibility, strength, or muscular
endurance; • Lack of intrinsic foot muscle strength or muscular endurance; • Over-pronation – in which the underside of the foot rotates
inward; • Flat feet or high-arched feet. • Sudden addition of hill training and speed work; • Uneven or hard training surfaces; • Excessive hill or stair climbing; • Inadequate heel cushioning in shoes; • Excessive heel cushioning (e.g. air-cushioned heels); • Inflexible shoes; • Prolonged walking in high-heeled shoes (heels greater than 2” in height), which can result in
shortening of the calf muscle and increased tightness in the Achilles tendon; Prevention Strengthen the calf muscles of the lower legs, the ankle inverter muscles, and the intrinsic muscles of the feet (see AFX Achilles Tendonitis Prevention Program). Include full range of motion exercise and eccentric loading, and increase the resistance consistently and gradually to optimally strengthen these muscles. Also strengthen the dorsiflexor muscles on the front of the shin so that you have balanced strength between the plantar flexors and dorsiflexors.
Warm up before stretching or exercising. Spend a minimum of ten minutes warming up. Warm up examples include: walking slowly at the beginning of a long or fast walk, slow cross court movements and volleys prior to playing tennis, a brisk walk before jogging, jogging before running, lifting lighter weights before lifting weights, etc.
Stretch between warming up and exercising, and then again after exercising. Stretch the hamstrings and calf muscles. Tightness in the hamstring can lead to increased stress on the Achilles tendon. Also, stretch the toe flexor muscles under the arch of the foot. Stretch gently and slowly. Hold each stretch for approximately 30 seconds, until a sense of muscle relaxation occurs.
Ensure adequate rest and recovery. After an intense exercise session involving the lower leg muscles, allow at least 48 hours recovery.
Increase your running distance and your speed gradually. Ensure that increments in distance or speed are no greater than 10% per week.
Reduce intensity of exercise after a lay-off. If you are returning to training after a lay-off, start at a lower intensity level and gradually increase to allow your muscles a chance to adapt.
Reduce amount of training on uneven or hard training surfaces. If your sport or activity is performed on an uneven or hard surface, avoid training on these types of surfaces for extended periods of time to minimize the risk of muscle fatigue and potential injury.
Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming, on a daily basis.
If you perform aerobic and strengthening exercises on the same day, do the aerobic exercises first. If leg strengthening exercises are done before aerobic activity, the Achilles tendons may end up taking up more of the load during the aerobic activity due to leg muscle fatigue, which will increase the risk of Achilles injury.
Wear appropriate dress shoes and sports shoes. Avoid wearing high-heeled shoes (heel height greater than 2 inches) and ensure that training shoes have a well-cushioned heel (avoid air cushioning) and good flexibility. In cases where flat feet or over-pronation cannot be corrected with foot and ankle strengthening, arch supports/orthotics or anti-pronation shoes may be required to reduce stress on the Achilles tendon. In these cases, consult with a qualified practitioner.
Do not ignore pain. If your Achilles tendon is hurting while you are training, do not ignore it. The pain is an indication that damage has occurred, and appropriate treatment including rest is essential. Continued training and stress on the Achilles tendon could lead to further injury and, in some cases, may cause the tendon to rupture.
How AFX helps To decrease the risk of Achilles tendonitis, AFX can be used to strengthen the ankle plantar flexors (calf muscles), ankle inverters, and the intrinsic muscles of the feet through a full range of motion using eccentric loading, while full range of motion stretching of the calf muscles and Achilles tendon in a non-weight bearing position will help to enhance flexibility. Strengthening the ankle dorsiflexors (muscles on the front of the shin) will help to balance the calf muscles, to prevent conditions such as shin splints (i.e. anterior tibialis tendonitis) from occurring.
Summary The AFX has been designed for full range of motion strengthening and stretching of all the muscles that are utilized in the foot and lower leg, so that risk of injury is minimized. The foot support is designed not to slip, and by moving the handles into different positions, you can increase resistance, or vary the direction of loading for more effective strengthening or stretching. Equally important, however, is that AFX is incredibly easy to use - 10 minutes a foot, three times a week, and a person can be confident that she/he is significantly improving their foot and ankle strength. ~ By Rick Hall Rick is the Principal Scientist for Progressive Health Innovations, and co-inventor of the AFX. Rick has a M.Sc. in Biomechanics, and has conducted research in athletic performance enhancement, exercise physiology, and injury prevention for over 20 years. He is a member of the International Foot and Ankle Biomechanics Community, and is also a reviewer for the Journal of Biomechanics.
American Orthopedic Foot and Ankle Society. Achilles tendonitis. Available from: http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Achilles-Tendonitis.aspx
Noto, D (2011) Research shows PRP’s ability to repair tendons. Available from: http://blog.spineandjointcenter.com/research-shows-prps-ability-to-repair-tendons/ University of Maryland Medical Center (2008). Inflamed Achilles tendon. Available from: http://www.umm.edu/imagepages/8612.htm
