The Achilles tendon is the largest and strongest tendon in your body. Located in the back of your lower leg, it connects your leg muscles to your heel bone. This helps you put weight on your toes and push off of the ground whilst running. Achilles tendonitis is swelling or irritation of your player's Achilles tendon. This is usually found at the heel attachment point or where the tendon and muscle meet.

Mechanism of Injury
Achilles tendonitis involves inflammation and degeneration or rupture of your Achilles tendon. The stages of degeneration include:
Stage 1: Irritation or inflammation of the surrounding tissue around your Achilles tendon.
Stage 2: Inflammation or pain of the actual Achilles tendon (can be accompanied by a piercing sensation that occurs during activity).
Stage 3: The fibers in the tendon weaken and may snap or rupture.

Possible causes of Achilles Tendonitis:

• Added stress placed on your athlete's calf muscles and Achilles tendon during activities.
• Sudden increase in the intensity or frequency of exercise.
• Overuse: too much too soon, a basic cause of overuse injuries.
• Running up hills involves stretching your player's Achilles tendon more than normal on every stride. The tendon will fatigue sooner than usual so overuse can occur.
• Change of training shoes.
• Over-pronation (feet which roll in) can place an increased strain on his Achilles tendon. As the foot rolls in (flattens) the lower leg rotates inwards which twists the Achilles tendon placing twisting stresses along its length.

Signs and Symptoms

• Local tenderness just above where your player's tendon inserts into the heel bone.
• Early morning stiffness, painful walking and climbing stairs.
• Pain found on the tendon during activities. Achilles pain will gradually come on with prolonged exercise but will go away with rest.
• Her tendon appears thick and a “crunchy” feeling is felt when the tendon is actively moved through its range of motion.
• She can feel a bump sticking out of the heel (pump bump).
• Decreased ankle dorsiflexion (toes to your nose) with the knee straight.

On-Site Management
P.R.I.C.E.

PROTECT the area from further injury by using a heel pad to take pressure off the Achilles tendon.

REST: cutting back on the amount of training can be difficult, but key to recovery. Gradually return to any running or climbing stairs.

Your player should place ICE on the Achilles tendon for 10-20 minutes every 1.5 to 2 hours for the first 2 to 3 days or until the pain goes away.

COMPRESS the area by having a trainer or physiotherapist use an ace wrap. This helps decrease swelling and bleeding.

ELEVATION is important to encourage blood flow to the heart for healing.

Medical Referral.

A doctor may prescribe anti-inflammatory medication to help with pain and swelling. You and your player should seek out a medical referral to a physiotherapist for proper treatment and strengthening activities for return to play.

Rehabilitation.

Your athlete's Achilles tendon has a poor blood supply so it is slow to heal. A therapist can assist with a complete evaluation. A therapist may consider the following treatment:

• Identify the causes and prescribe orthotics or a change in specific training methods.
• Tape the back of the leg to support the tendon.
• Apply a plaster cast if it is really bad.
• Use ultrasound treatment.
• Apply sports massage techniques.
• Prescribe an Achilles tendon specific rehabilitation program.
• Some orthopedic specialists might give a steroid injection but an injection directly into the tendon is not recommended; this can increase the risk of a total rupture.

Return to Activity.

If your player looks after this injury early enough he should make a good recovery. It is important he rehabilitates the tendon properly after it has recovered or the injury will return. If he ignores the early warning signs and does not look after this injury then it may become chronic which is very difficult to treat. In general, the longer she has symptoms before she starts treatment, the longer it will take to rehabilitate. The following is a list of guidelines to follow when returning to activity.

• Work towards full range of motion in the affected Achilles tendon compared to the unaffected one.
• Work towards full strength of the affected Achilles tendon compared to the unaffected one.
• Work towards jogging straight ahead without pain or limping.

Prevention.

The best prevention is to stretch the Achilles tendon.

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