2. Increase flexibility and ankle range of motion.
As poor calf flexibility is one of the risk factors for Achilles tendinitis, common sense suggests patients with limited dorsiflexion, resulting from having short calves, would benefit from a calf-stretching programme, including soleus and gastrocnemius stretches. These stretches are used to reduce pain and improve the Achilles tendon function, increasing ankle dorsiflexion. Poor evidence supports this though.
Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning. There are many different ways to stretch your calves, but I will show you only some of them as I would need many posts to explain all the options you have. The best stretches are the stretches that work best for you. In any case the most important thing is to be aware that you stretch both gastrocnemius and soleus.
I am going to show you different stretches that can be performed in a static way or dynamic way. For the static way you have to hold the position and are advocated to be done after exercising and for the dynamic, don’t hold the position and do them in your warm up. Make sure that these stretches are pain free.
How to stretch your gastrocnemius muscle?
• Standing in front of a wall, in a wide stance position (one leg in front of the other), with the leg to be stretched at the back and your hands placed on the wall. Then lean forwards towards the wall, keeping the foot at the back flat on the ground. It is important not to bend the knee of the back leg.
• This stretch needs to be done no less than twice a day and holding the position 25-30 seconds, if you do it after exercising ( no running, remember that you have to rest from running). Otherwise, it should be done without holding the position ( dynamic stretch).
• Never do static stretches when your muscles are cold. So do not do static stretches first thing in the morning. This rule will be applied to all the stretches I mention on this blog.
How to stretch your soleus muscle?
This stretch is quite similar to the previous one. Same position as the previous stretch but now you have to bend your front knee while you lean forwards towards the wall. You have to try to touch the wall with your front knee, keeping your heel on the floor.
Again, you can do it dynamic or static (holding the position for 25-30 seconds) and repeat, at least, twice a day.
Stretches on a step
• Standing on a step on tiptoes and the heels off the back of the step. Lower your heels below the level of the step until you feel the stretch.
• Perform them with knees straight and then with the knees bent to make sure you stretch both gastrocnemius muscle and soleus muscle.
• You should be really careful to avoid worsening your injury, so hold on to a banister while you do this stretch.
• Do it with both legs at the same time and then with one leg at a time. And again, dynamic or static ( for 25-30 seconds) and repeat, at least twice a day.
- Manual therapy
Ankle mobilization is an important part of the treatment as, like I said in a previous post, the ankle range of motion is usually limited. The ankle has to be mobilized in all directions ( upwards, downwards, inwards, outwards and in diagonal or, in other words, dorsal flexion, plantar flexion, supination, pronation, inversion and eversion). It is essential to mobilize the bones of your foot as well as the bones of your knee, as indirectly it will make your ankle range of motion improve. Osteopathy treatment might be useful at this stage.
Deep massage will prevent adhesions forming within the tendon which would limit the ankle range of motion and, at the same time will allow you to improve your flexibility by relaxing the muscles and releasing possible trigger points (muscles knots). These points have to be released because it is really difficult to improve flexibility or strength in other ways.
Acupuncture and dry needles might be a good option as well to release the aforementioned points.
Achilles tendinitis part II finishes here. Click on Achilles tendinitis treatment part I to see the previous part of the treatment, Achilles tendinitis treatment part III and Achilles tendinitis treatment part IV to see the previous two parts.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.