Injury clinic: Achilles tendonitis

Premier League physio Dave Appanah tells you how to spot this painful tendon injury, treat it, avoid it and get back out on the pitch

Where's the pain?
Achilles tendonitis affects the tendon, which connects your calf muscles to your heel bone. It’s the thickest tendon in the human body. If you have the condition you’ll feel stiffness and pain in the affected area first thing in the morning. This discomfort will subside after you’ve got up and walked around, but it will be temporary. Once you’re stationary the pain will return and often be worse. In more advanced cases the tendon will be swollen and tender. Continuing to train with an Achilles tendinopathy may lead to it rupturing.

Why me?
It can be triggered by boots that don’t fit properly, a change in training load or playing on different surfaces i.e. 3G. More commonly it is due poor biomechanics, which can result in an overload and repeated micro trauma to the tendon. It is also associated with poor flexibility at the calf, which may be due to poor mobility and strength at the hip.

More after the break

What you need to do
No two Achilles injuries are the same. However, some basic management can be applied to all cases. Rest from the activities that aggravate the tendon, ice the area to reduce swelling and avoid any footwear that rubs. There’s an old runner’s trick that can help – cut out the back out of your trainers and boots or add heal raises. Trainers normally have these built in, but football boots are flat. Stretching both the gastrocnemius and soleus muscles, which form the calf, will help. If the injury is chronic you need to start performing eccentric exercises. This will prompt an active contraction of the muscle, while simultaneously lengthening it, encouraging the tendon to repair itself.

When can I play again?
Depends on how long you’ve had symptoms. If dealt with early and appropriately it should only be a matter of weeks. If you have a long-term problem you need a thorough biomechanical assessment with a treadmill gait analysis.

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