How to prevent Achilles tendon injuries

Here’s the paradox of the Achilles: It’s the largest and strongest tendon in the human body, but it’s also among the most vulnerable. The rope-like tendon connects the calf muscles, the gastrocnemius and the soleus, to the heel bone, and is responsible for pushing off when you walk, jump or run. “You can expose the tendons to forces that are as much as 12 times your body weight,” says Dr. Stephen M. Pribut, an expert in running-related injuries based in Washington, D.C.

When it comes to Achilles trouble, there are a few common culprits. Overuse from a sudden increase in training is the first red flag. So if you just hit the court for the first time in a few months, pay attention to any pain above your heels. Other risk factors are tight calf or hamstring muscles and ankles that pronate, or roll inward when you walk or run, which can put severe stress on the inside of the tendon. Finally, wearing shoes with too much cushioning in the back, causing heels to sink down, can also strain the Achilles.

How do you know if an ache in your Achilles is serious? “If the tendons feel tight or hurt when you get out of bed, but then the pain subsides as you walk around a bit, beware,” says Dr. Jeff Ross, a Houston-based fellow at the American College of Sports Medicine. You might also see or feel a bump on the Achilles, a sign of severe inflammation. Another warning sign: intense pain during warm-up that eases for a while, only to return when you stop playing. “If you ignore it, it will get worse,” Ross says.

Prevention before intervention
“If you’ve developed pain in your Achilles, and you’re playing every day, cut back to every other day,” Pribut says. He recommends ice massage after a workout and anti-inflammatories to ease discomfort. One big no-no: overdoing calf stretches. “It puts too much stress on the already sore tendon,” he says, adding that you should use caution and avoid overstretching, in particular on stair stretches. He recommends the wall stretch (see the illustration at top-right, and instructions here), which is best done after a gentle warm-up of brisk walking or jogging. One reason to focus on prevention: A weakened Achilles is vulnerable to a tear or rupture, which can sideline an athlete for months. “Years ago I ignored my own Achilles pain and eventually developed such a severe problem that I had an egg sized lump in the tendon,” says Ross, a veteran of 25 marathons. “I had to take a three-year hiatus from long-distance running.”

Outfitting your shoes with quarter-inch heel lifts (check amazon.com), firm wedges that elevate the heel, decreases the stretch and pull on the Achilles, allowing the tendons to rest. If the pain persists for more than four weeks, see your physician. He might recommend physical therapy, which can include ultrasound, electrical stimulation and massage. For those who haven’t had luck with these conservative treatments, there’s another option. In a study performed at the Feinberg School of Medicine at Northwestern University, 41 patients who hadn’t healed after six months of the treatments outlined above underwent sonographically guided Achilles tendon debridement, a procedure that breaks up scar tissue and encourages the body’s own repair process by causing bleeding within the tendon. According to Dr. Thomas Grant, the lead author of the study, 75–80 percent of athletes in the study reported their symptoms had either completely resolved or were markedly improved. But prevention is still the best medicine, so keep your Achilles fit by easing back into the game when you haven’t played and resting if you feel pain.

Since spending over $1,000 on MRI on both ankles, I can tell you from experience, don't let it get to the point I did.  I have so much scar tissue on my Achilles tendon's that I have holes in my socks where my Achilles tendon is on each ankle - Jason Summers of SETTA

Article on Tennis.com by Dana Sullivan