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Weak Legs Lead to Rupture

The Issue

Having witnessed two Achilles ruptures in person I’d gladly never see one again, if you have heard the spine tingling scream you know what I mean. One possible cause of a rupture is gradual decrease in tendon health which can be due to a tendonosis or a tendonopathy which are both terms for degeneration of the tendon. Achilles tendonosis is the acute version and arguably the wrong label as there is in fact no inflammation with tendon injuries, this is one of the reasons I believe they can be stubborn injuries to recover form. Achilles tendonopathy being the name for the chronic condition if you’ve had it for a while.

Achilles tendonopathy can start off as a mild discomfort in the Achilles area, the characterising symptoms of a chronic Achilles tendonopathy is an insidious onset of pain and dysfunction in the Achilles tendon. You may also note a lump on the tendon that is not on the other one, this is yet another sign it’s the Achilles that is the culprit of your pain. Achilles tendonopathy is normally secondary to repetitive use from your sport or that you are not getting enough rest for the amount and intensity with which you use it. This amount of rest or recovery needed will vary based on your level and sport. A sprinter for example will need to rest there Achilles more from their maximum efforts than a javelin thrower who would need to think more about their shoulder and back recovery. The pain and dysfunction in your Achilles may improve as the activity goes on and you warm up which can lead people to thinking the problem is only minor and it will just go away if you carry on as normal, or worse, just sit there and wait (atrophy; reduction in muscle mass due to inactivity).

This however is not true, if the degeneration continues to worsen the tendon as a unit will become weaker and therefore more prone to tears as there is literally less there to absorb the high level of forces sent through it. When we jump and run we send forces ranging from 2-7 times body mass through our legs, so for me that is from 170-595KG. Think of it like pulling an elastic band apart, when it’s whole and you pull on it the band snaps back. If you make a tiny cut it and pull it repeatedly the band will continue to snap back but will also make that cut in the band bigger, and the more force you pull the band with, or the faster you run, higher you jump or more weight you squat the more that tear will increase. Leading to the inevitable Achilles tendon!

If your Achilles tendonopathy has occurred following high amounts of exercise, you will need to adapt the level of activity you are doing. Further, because it is a degenerative condition, it needs stimulus and rest to get better. If it were a muscle tear the muscle would heal over time, but with degenerative conditions we need to manipulate the body to ‘generate’ again. Tendons notoriously don’t have good blood flow, which is where manual techniques such as cross fibre frictions, medical acupuncture and instrument assisted soft tissue mobilisation come into their own. Although they may seem aggressive techniques, they help to promote blood flow and thus spark healing in the area which will reverse the degeneration seen. Provided you follow the recommended exercise adaptation and rehabilitation exercise program they will get you back to your sport far quicker than sitting around waiting for it to get better by itself (if it ever will).

I however prefer to prevent injuries in the first place rather than fixing them once they have stopped me from playing the sports I love. Intrinsic factors are those that can be assessed with only you, such as strength and flexibility. Functional or extrinsic factors are not going to be included in this article. Signs that you are prone to Achilles tendonopathy are;

  1. Weak calves (gastrocnemius, soleus, tibialis posterior, peroneal group)

  2. Greater range of motion

I personally disagree that having greater range of motion will increase your risk of injury, I fall into the camp that is for greater flexibility, control of that flexibility (mobility) and strength through the entire range of motion. In fact i use the knee to wall test with every ankle injury client i get and this is one of the measures i use to make sure we stay on track. In order to get all of this we need to stretch and train muscles through their full range of motion. Simply put for the calf this means doing calf raises starting with the heel below the ankle bones (end range of dorsiflexion) and finishing on the balls of your feet (plantarflexion).

Problems occur when you do not train the entire range, such as not dropping the heel as far down as possible, when not pushing up onto the balls of your feet.

The Solution

The preventative measure is:

  1. Full range calf raises

  2. Calf stretches (plural!)

The calf raise:

Initially I would recommend starting with both feet and doing body weight only looking for high reps upwards of 20 as the muscle is designed to work ALL DAY, not much point training this muscle with a 1 rep max style of training.

Then add some weight to the movement and maintain the high rep count of 20+ and in all honesty if you struggle to do 20 I’d have concerns about you getting injured playing your sport.

Finally move onto the single leg variation and repeat, look for 20+ reps, although it will be harder on one leg. This for me is where you should be at if you play sport. If your legs can’t work in isolation the other one will be doing a lot more work to make up for it, other areas will become tight and lead to more issues. Strengthening your legs in isolation from the other is a sure fire way to maximise your performance and reduce the risk of injury.

The important thing with exercise is where you push with your foot, you want to make sure your ankle maintains a solid position and so we want the weight to be on the big toe and second toe and the cushioned ball of the foot area.

The stretches:

There are two major components in the calf, those that act over both the knee and the ankle, and those that act solely over the ankle. To make sure we stretch all of them we need stretches that cover both aspects.

Hold stretches for 30 seconds 3 times round

The first one: Gastrocnemius stretch (stretches muscles that act over the ankle and knee)

  1. Back leg being stretched

  2. keep back heel on the floor

  3. shift HIPS forward

The second one: Soleus stretch

  1. Front leg being stretched

  2. keep heel on floor

  3. bend knee

  4. shift KNEE forward

Nothing will bullet proof your Achilles tendon but getting up to 20+ reps single leg calf raises WITH full range of motion will go a long way to achieving that. I can’t stop you falling over however.

Till Next Time

Happy Training!

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