When a muscle is overstretched, asked to contract hard against a sudden load, or overused, injury can occur to the muscle, the area where the tendon attaches to the muscle or to the tendon itself. Small tears in the muscle fibers or the fibers of the tendon that connect the muscle belly to nearby bone are called a strain. An achilles tendon strain involves the tendon that connects the gastrocnemius and soleus muscles of the calf with the heel bone. The soleus muscle is responsible for pointing the foot such as when you press on the gas pedal of a car. The gastrocnemius muscle also points the foot but because it crosses the knee and the ankle joints, it also assists with bending the knee.

Tendons are inelastic meaning they do not stretch easily. They transmit forces between the muscles and the bones and are generally very strong but can be injured. Tendon injuries can happen when a sudden high load is placed across the tendon or if it is overstretched or overworked. Runners, sprinters and jumping athletes can strain their achilles tendon suddenly or after a period of overuse such as when they ramp up a training cycle too quickly. When caused by overuse and left untreated, a strain can turn into tendonitis.

WHAT DOES AN ACHILLES TENDON STRAIN FEEL LIKE?

Symptoms of an achilles tendon strain can be felt along the length of the achilles tendon, just below the muscle belly of the calf and above the heel bone. It may also be felt where the tendon attaches at the back of the heel bone. A mild strain can cause pain along the tendon when the calf is contracted or lengthened. For example, you may notice pain when you push off during walking or running or when you set the heel down when getting out of bed or up from a chair.

If the strain is moderate in severity, you may also notice some localized stiffness in the calf or ankle, tenderness, and swelling. You may also observe that the calf muscle feels weaker than usual. If the strain is severe, the muscle belly or tendon can tear completely causing the range of motion in the knee or ankle to be either significantly reduced because of guarding or excessive because the torn muscle or tendon is no longer limiting it.

If you decide to work with a physical therapist to help correct your achilles tendon issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY INTERVENTIONS FOR ACHILLES TENDON STRAIN

Early/acute phase (first 5-7 days):

• Protect the achilles tendon to allow healing to begin
• Use bracing, taping, immobilization or assistive devices as needed to normalize your walk and minimize painful motions
• Consider ice, ultrasound or other modalities to manage inflammation and promote healing
• Passive range of motion that is pain-free may be used to prevent stiffness, maintain range of motion and reduce pain
• Exercising nearby but uninjured areas of the body is helpful

Middle/subacute phase (7-21 days or so after injury)

• Introduce active range of motion
• Wean off assistive devices, bracing, taping, etc.
• Begin submaximal exercise to lightly load the muscle and promote good fiber alignment in the tendon
• Begin very light stretching as needed
• Apply gentle soft tissue mobilization to promote healing, reduce pain and mobilize edema

Late/chronic phase (21 days to many months)

• Begin loading the muscle more intensively while monitoring for signs of acute regression including lasting soreness or inflammation
• Increase the load on resistance training
• Increase stretching and mobility
• Incorporate more dynamic weight-bearing exercises
• Begin exercises to improve tendon stiffness to help prevent future injuries
• Perform work and sport-specific drills to prepare for return to activity