
As a physical therapist, I see all too many weekend warriors and seasoned athletes alike sidelined by injury to the Achilles tendon. This large tendon at the back of the ankle connects the calf muscles to the heel bone and plays a crucial role in walking, running, and jumping. When the Achilles tendon is overloaded or aggravated, it can lead to debilitating pain and dysfunction.
Understanding Achilles Tendon Injuries The two main types of Achilles injuries are tendinitis and tears. Achilles tendinitis is an overuse injury where the tendon becomes inflamed, often due to excessive hill running or jumping. A more serious injury is an Achilles tendon tear, which can be either a partial tear or a complete rupture of the tendon. These tears frequently occur with explosive, forceful movements like those involved in sports.

Why Achilles Injuries Happen There are several key reasons why the Achilles tendon is vulnerable to injury:
Repetitive Forces Activities like running, especially uphill or on uneven surfaces, place significant repetitive stress on the Achilles tendon over time which can lead to micro-tears and tendinitis.
Abrupt Increases in Load Suddenly ramping up the intensity, duration, or introducing new activities like hill running that place greater demands on the Achilles without proper progression sets it up for potential injury.
Muscle Tightness Having overly tight or stiff calf muscles places increased tension on the Achilles. Inadequate flexibility predisposes you to Achilles issues.
Poor Biomechanics Excessive pronation or rolling inward of the feet can create abnormal pulling forces on the Achilles. Problems higher up the kinetic chain such as limited ankle mobility or weak hip muscles can also contribute.
Footwear Worn out or improper shoes for your foot type could place excess stress on the Achilles. The same goes for spending too much time in shoes with an elevated heel.
Age As we get older, the Achilles tendon becomes more rigid and less vascular, making it more prone to degeneration and subsequent injury, especially for "weekend warriors".
Preventing Achilles Trouble While no single factor causes Achilles tendon problems, being aware of risk factors like those above can help minimize your risk. Fortunately, seeing a physical therapist at the first sign of Achilles pain can resolve inflammation and overuse injuries before they progress to tears. Physical therapy can also address any deficits in flexibility, strength, and biomechanics that predispose you to future Achilles issues.
Don't ignore that nagging Achilles pain - see a physical therapist promptly so you can keep moving towards your fitness goals. With proper management and addressing any modifiable risk factors, Achilles problems can often be avoided or overcome.
-Dr. Lilly Koh, PT, DPT, OCS, CSCS
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