Achilles Tendon For further information contact injury Sports Medicine Australia www.sma.org.au  www.smartplay.com.au A guide to prevention References and management For a full list of references, contact Sports Medicine Australia. Acknowledgements Sports Medicine Australia wishes to thank the sports medicine practitioners and SMA state branches who provided expert feedback in the development of this fact sheet. Images are courtesy of www.istockphoto.com ALWAYS CONSULT A TRAINED PROFESSIONAL The information in this resource is general in nature and is only intended to provide a summary of the subject matter covered. It is not a substitute for medical advice and you should always consult a trained professional practising in the area of sports medicine in relation to any injury. You use or rely on information in this resource at your own risk and no party involved in the production of this resource accepts any responsibility for the information contained within it or your use of that information.

© Papercut 719/2010 weaken thetendon.weaken ofmicrotears dueto aseries most likely (tendinosis) that doesnotinvolve inflammation andis ofinjury this type as Achilles Tendinitis. However, research hasfound that Until recently Achilles Tendinopathy wasreferred to treatmentprovided options. further research hasrevealed valuableinformation thathas to apoor understanding ofitscause;however recent thepasttreatment optionshaveIn beenlimited due peopleandrecreational athletes.condition insports Achilles Tendinopathy isachronic, yet common

Anatomy to push off during walking andrunning. walking to pushoff during thelegmusclesto thefootconnects andgives theability attaching to thecalcaneus(heelbone). The Achilles tendon soleus (calf muscles),runningdown thebackoflower leg ankle. The ofthegastrocnemius tendon isanextension and The Achilles tendon isalarge tendon atthebackof Soleus Achilles Tendon Gastrocnemius Risk may thetendon weaken to andcontribute ruptures. illness ormedications, antibiotics, suchassteroids orcertain intheirspare time. Less insports commonly,participating warriors’‘weekend people –typically, middle-aged Achilles tendon ruptures are seenin mostoften to thetendon canalsoresult fromAn injury fallingortripping. of running, canoverstretch thetendon andcauseatear. Forceful jumpingorpivoting, orsudden accelerations occurs whenthetendon isstretched beyond itscapacity. An Achilles tear tendon that rupture isacomplete orpartial • • • • • • • • • Achilles, including: of causeswhichmay result inexcessive loadingonthe Achilles Tendinopathy canbedueto oneoranumber Peritendinitis andRetrocalcaneal Bursitis. include lesscommoninjuries of thetendon. Other are Achilles Tendinopathy, orrupturing andtearing oftheAchillesThe mostcommoninjuries tendon two Inadequate warm up, warm Inadequate stretching andcooldown. Decreased jointrangeofmotion(e.g. joint). stiffankle weak calfmuscles). Poor (e.g. muscleflexibility tightcalfmuscles, (seasonal). Change ofsurface Running onhard oruneven surfaces. Excessive pronation (force onachillestendon increases). Wearing footwear. inadequate orincorrect A decreaseactivity. timebetween inrecovery of activity. A suddenincrease intheintensity, andduration frequency

Prevention • • • • • • • • • Undertaking training prior to competitionto trainingprior ensure Undertaking Warming up, stretching andcoolingdown. secure structure. to assistincreating amoreStrapping andtapingtheankle Achilles tendon. technique toUsing correct limitexcessive stress onthe Wearing appropriate shoesfor theactivity. commencing RICER. immediately and discontinuing theactivity paindoesoccur,Avoiding thatcausepain.If activities or trainingsessions. Allowing workouts timebetween adequate recovery Gradually increasing anddurationoftraining. theintensity sessions to maintainmusclestrength andflexibility. Participating inregular strengthening and stretching readiness to play. Signs and symptoms or kick inthebackofleg. or kick loss ofstrength and movement. to ahit The painislikened Tendinopathy, acomplete rupture causespainandsudden rupture. tear presents similarsymptoms asa While apartial tear orcompletely An Achilles tendon canpartially Achilles tendoninjuries to severity. Achilles Tendinopathy isgraded from 1–4according • • • • Achilles Tendinopathy (Extreme) 4 (Severe) 3 (Moderate) 2 (Mild) 1 Grade sluggishness intheleg. Decreased strength andmovement; afeeling of up withuse. Stiffness thatmay diminishasthe tendon warms Swelling. area may (tenderness bemore noticeableinthemorning). to severeMild intheAchilles painandtenderness tendon

(pain worsening orprogressing). Pain activities everyday during in volume ofactivity. Pain causingadecrease withactivity pain gradually arun. lessensduring Pain before running, andafter Pain runningonly. after Description

Rehabilitation and return to play Immediate management no alcohol, norunningoractivity, andnomassage. This will The NoHARMprotocol shouldalsobeapplied–noheat, the joint. The aim isto reduce thebleedinganddamagewithin referral. RICEprotocol shouldbefollowed for 48–72hours. of theRICERprotocol –rest, ice, compression, and elevation consists The immediate treatment ofany tissueinjury soft load on the weakened Achillesload ontheweakened tendon. aheelraiseortapingmay beusedto reduce activity the shouldbegradual. to activity Return When returning to medicineprofessional.sports ofa These willbecompleted underthesupervision rehabilitation followed by astrengthening program. theAchillesimmobilisation period willrequire intense in aplaster castfor upto nineweeks. Following this surgically. followed isoften Surgery by immobilisation A completely ruptured Achilles tendon repaired ismostoften prescribed to reduce pain. medicationmay alsobe Anti-inflammatory and orthotics. include ultrasound, mobilisation,stretching, massage sports issevere. treatment may Other also beusediftheinjury off theinjury. Taping,even aheelraiseor aplaster castmay The useofcrutches may berecommended weight to keep enable itto copewithincreased loadbefore return to activity. may beprescribed to gradually strengthen thetendon to Once painhassettledaprogram ofrehabilitation exercises advice ontreatment required. andto provide oftheinjury possible to theextent determine medicineprofessional A sports shouldbeseenassoon weeks to monthsofrest for thetendon to slowly repair itself. Achilles Tendinopathy thatiscausingsymptoms canrequire some instances. maystress alsoberequired onthetendon. Surgery in techniques andfootwear to reduceand changesinsports Treatment includesrest, painrelief, stretching exercises, ensure decreased bleedingandswelling intheinjured area.