Achilles Tendon Rehabilitation and Return to Run

In order to understand the injury, it is important to understand what is involved. The achilles tendon is a fibrous tissue (limited stretch) which as all tendons do links a muscle to bone. In the instance of the achilles, it links a few muscles to bone. The gastrocnemius and the soleus muscles join to form one band of tissue.

This tissue forms the achilles tendon and attaches onto the calcaneus (heel bone). At the attachment a small fluid filled sac, kind of like a car airbag sits to stop compression of the tendon against the bone.  These small fluid filled sacs are innervated (have a nerve supply) which means they can also signal pain. Being the largest and strongest tendon in the human body doesn’t stop the achilles tendon from being affected by overload whilst running.

During running the calf complex will contract and pull the heel upwards, forcing the toes downwards (plantar flexion). This is one of the most important movements for force creation in running. When the toes or foot is in a plantar flexed position it allows us to propel forward. 

However, although the toughest and strongest tendon in the body, it is hampered by its limited blood supply. The reduced blood flow slows the normal adaptation process that the whole body goes under. This mixed with the high loads placed on it during running make it susceptible to injury. It is one of the most common running injuries. The injury is even more common in masters running.