Achilles Tendon

Only someone who has had an Achilles tendon tear or Achilles tendonitis can relate to how weak one feels from an injury to this all important mythological structure that is very real in the minds of CrossFitters of all ages.  Most young CrossFitters have only read stories about Achilles heels, but as we get older which seems to be a recurrent theme in 321GoMD, the tendon does not have the same elasticity and forgiveness that it used to have and we can get into trouble before we even know we are there.

Looking at the anatomy of the heel it is amazing that this little cord of a structure not bigger than a sailor’s rope is responsible for popping us up in the air for double unders, lifting us 30 inches onto a box, or starting our explosion during the triple extension of the snatch.


(notice Rich’s ankles during his snatch and the plantarflexion that occurs or heels up-toes down).

The tendon starts in a muscle known as the gastrocnemius or calf muscle, which is made up of two halves- a medial and lateral. There is also a deeper muscle known as the soleus which not a lot of people know about. The gastroc and the soleus blend together into a tendon which connects the muscle to the heel bone or calcaneus. So you can see from the picture looking from the side where the toes are pointing forward when you contract your calf or shorten that muscle belly, the heel gets pulled on and the foot plantarflexes.

What are some things that can happen to the Achilles calf complex.  One can get a calf strain which is a tear of the muscle belly of the calf. It has nothing to do with an Achilles tear as the tendon is not involved. The tenderness is purely in the muscle belly but some people freak out and think they have ruptured their Achilles. These will get better without significant intervention and typically take rest, sometimes a boot to help walk, and then PT to get moving and strengthening to feel better.

Most commonly I see Achilles tendonitis which is overuse of the tendon from someone say box jumping 100 times when they have never done it before. Running is notorious for Achilles tendonitis when the tendon has not been primed for the distance, intensity or hills that people decide to try.  Just like anything in life you need to prepare for battle. Because you feel good one day, deciding to run 6 miles extra is a recipe for pain. Your body does not like surprises and will let you know if you keep it up.  Again don’t get me wrong I am all for a great workout and huge PRs and faster times etc., but we have to be smart about it. CrossFit should not be about,” Let’s go do Murph because that is insane”. It should be about getting in shape and being fit enough to do Murph so that you can do Elizabeth 2 days later.

Here is a good summary of Achilles tendonitis from the American Academy of Orthopedic Surgeons, with proper stretching and treatment options.

Achilles tendon tears are fairly common and can be seen in 35-55 year olds most often.  They occur as the result of a sudden eccentric or lengthening contraction in the muscle and tendon.  You can tear midsubstance or pull a piece of bone off. Box jumps can be the culprit as you are landing on your feet stretching out the tendon and then contracting again as the tendon elongates. People will say they felt as if someone hit them a baseball bat in the back of the leg. People will often turn around to see what hit them from behind. There will be pain swelling and a palpable divot in the tendon. There is something called a Thompson test where you squeeze your calf and if the tendon is intact, the foot will plantarflex. If there is no connection, squeezing the calf will do nothing to the foot. Repair of the tendon can take 4-6 months to recover from after a lot of patience as well as physical and mental therapy.

Tear with 2 separate edges

MRI with gap at arrow

Repair coming together with sutures in each end soon to be tied together

What can you do to prevent it, if you have pain. Think about your activity level and modify. Stretching is extremely important in maintaining flexibility and decreasing stiffness of tendon. The runner’s stretch as seen below is important first with the knee flexed to work on the soleus.  The gastrocnemius crosses the knee joint and stretches with the knee straight. I would recommend people start on very low boxes or weights for jumps and get used to the explosion in the calf that occurs with landing and jumping. Gradually you can then start to ramp up to bigger heights and not let your calf muscle become your Achilles’ heel.

runners-stretch

 

3 Comments

  1. go to my website for patient resources and PT protocols, orthopedicsne.com

  2. Do you have a post achilles tendon surgery protocol as you do for the shoulder?

  3. This column is awesome. I feel like it was written just for me, a Crossfitter. Thanks for doing this!

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

About 321GOMD Blog

This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If the reader or any other per­son has a med­ical con­cern, he or she should con­sult with an appropriately-licensed physi­cian or other health care worker.

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