The Achilles tendon, also known as the calcaneal tendon, is a large strip of fibrous tissue located at the posterior side of the ankle. It attaches the strong calf muscles to the heel bone (calcaneus). Achilles tendon is the largest tendon in the body. Upon contraction of the calf muscles, the Achilles tendon gets tightened and allows the heel to be pulled up. This enables a person to stand on tiptoe and point the foot. Achilles tendon helps in various functions such as walking, running, and jumping. Achilles tendon rupture is a condition where there is a complete or a partial tear in the tendon commonly occurring around 2 inches above the heel bone. A total rupture occurs more frequently than a partial one. Activities such as pushing off forcefully from the toes such as while starting a race also causes the tendon to rupture.
Partial rupture of the Achilles tendon commonly occurs in those athletes who are involved in high impact activities such as running, jumping etc. The tendon does not get torn completely, but there is an incomplete tear. Formation of scar tissue in that region causes inflammation of the tendon. The athlete is usually not aware of the rupture at the time of the rupture, but later feels the pain when the tendon has cooled down.[1]
Symptoms of Partial Rupture of Achilles Tendon[2]
- Acute, sharp pain in the region of Achilles tendon. The athlete may not feel pain at the time of the rupture, but may feel the pain after the tendon has cooled down.
- Upon exercising, sharp pain may be felt which recedes after the warm up and starts again later.
- Morning stiffness in the region of Achilles tendon.
- Swelling may be present.
Treatment of Partial Rupture of Achilles Tendon[3]
- Cold Therapy or R.I.C.E. (Rest, Ice, Compress, and Elevate) should be applied during the acute phase (usually 24 to 48 hours).
- Patient should consult a sports injury specialist.
- Thompson’s test can be done to confirm a complete rupture of the tendon.
- Taping can be done for support.
- Ultrasound therapy can be done.
- Anti-inflammatory medications such as ibuprofen and naproxen help in pain, swelling and inflammation.
- The leg may be put in a brace or a plaster cast to allow healing without the surgery.
- After complete healing, physical therapy should be started to prevent stiffness and to improve range of motion.
- Surgery may be required in severe cases.
Stretching Exercises for Partial Rupture of Achilles Tendon[4]
It is important that patient seek medical advice before starting any of these stretching exercises.
Gastrocnemius Muscle Stretch
- Stand with the legs spread apart.
- The heel of the back leg should be positioned on the floor with the knee straight.
- The front knee should be bent forwards along with leaning forwards and pushing against a wall if necessary.
- This stretch should be held for 10 seconds.
- Repeat three to five times for three times a day.
- Increase the duration of the stretch gradually (up to 45 seconds).
Soleus Muscle Stretch
The same method as above should be followed but the stretching leg should be flexed at the knee. This excludes Gastrocnemius muscle attaching above the knee from the stretch and will stretch the soleus muscle present down the leg. Hold for 20 to 30 seconds and repeat 5 times daily.
Stretching on a Step
- Stand on the border of a step with the heel hanging and stretch.
- A gentle stretch can be felt. Hold this position for minimum 15 seconds.
- Do not over-do this stretch.
Calf Raise
This exercise helps in strengthening the calf muscles (Gastrocnemius and Soleus).
- Stand with the feet firmly on the floor. The feet should be kept shoulder width apart. You can hold onto something as you are doing this stretch.
- Raise yourself onto the tip toes as high as you can.
- Slowly lower the heels back to the starting position.
- Initially try to do for 3 sets of 10 and increase gradually.
- This exercise can be made difficult by doing it on single leg.
- This can also be done on a step so that the heels are hanging down below the level of the step.
Sports Massage for Partial Rupture of Achilles Tendon[5]
Sports massage helps immensely in rehabilitation from Achilles tendon rupture. It helps in improving blood circulation to the injured area, helps in relaxing the muscles and makes them more flexible. It also helps in reducing swelling and preventing accumulation of adhesions.
Sports Massage Techniques
Patient should seek medical advice before starting any massage or exercise.
The first and foremost equipment which is required for a massage is a lubricant. This enables smooth gliding of hands during massage. For this purpose, massage oils can be used or simple baby oil will also suffice. Care should be taken not to use too much oil, as it will cause lack of control during massage. Apart from a lubricant, the other equipment needed is a firm and flat surface to lie upon during massage.
- Effleurage: This technique is used to initiate massage and for even oil application. It also helps in warming up the tissues in order to prepare them for deep massages. Light strokes should be applied using the hand from above the heel to the knee. The direction should always be upwards towards the heart, because this is the direction of the blood flow. Doing it the opposite way causes vein damage. After these strokes are done, the hands should be brought down the outside of the leg while keeping them firmly on the skin without too much pressure. This whole movement should be repeated using gentle stroking techniques and covering as much area of the leg as possible. This technique should be repeated for 5 minutes while slowly increasing pressure on the up strokes.
- Transverse Mobilization: In this technique, consecutive transverse pressure is applied using the first finger of one hand and the thumb of the other hand. This technique stretches the tendon transversely one way and the other way. It helps in increasing the mobility and flexibility of the tendon. Excessive oil usage must be avoided as it makes this technique difficult to perform.
- Stripping The Achilles tendon: Continuous pressure is applied along the entire length of the tendon.
- Cross Frictions: Mild pressure is applied in a transverse direction to the Achilles tendon using the first two fingers. Excess oil makes this technique difficult.
- Circular Frictions: Pressure is applied in a circular direction by keeping a finger on both the sides of the Achilles tendon. The tendon should be felt beneath the fingers. This massage may not be comfortable, but it should not be painful such that it results in the athlete stiffening their muscles.
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