Understanding Achilles Tendinitis

Understanding Achilles Tendinitis

According to Greek mythology, Achilles was a powerful hero whose main weakness was his heel. A tendon injury sounds like an incurable condition but when treated at the New York Dynamic Neuromuscular Rehabilitation of Manhattan in New York, this injury does not have to be your weakness.

The Achilles tendon can also be called the calcaneal tendon. This tendon is the strongest and largest tendon in the human body. Tendons are flexible and tough connective tissue bands that connect muscles and bones. Tendons can withstand tension and are capable of storing and releasing energy that is produced by the muscles like a spring. Tendons act as a force that absorbs buffers and limits muscle damage. The Achilles tendon particularly links the calf muscle and heel bone. This tendon allows the body to move up on its toes which is necessary for activities such as running, jumping and walking. The Achilles tendon coordinates with the heel while the calf muscle is flexing to allow proper movement.

Although the Achilles tendon is strong, it is susceptible to injury owing to the high tension it is subjected to and its limited access to blood. One of the common conditions affecting the Achilles tendon is Achilles tendinopathy. This term refers to two conditions: Achilles Tendinosis and Achilles Tendinitis. In many cases, tendon pain is caused by Tendinosis or small tears in the tissue surrounding the tendon. Achilles tendinitis is an inflammation affecting the tendon, but this condition is rarely the reason for tendon pain.

Tendon injuries either occur suddenly (acute) or worsen overtime (chronic). Achilles tendinopathy affects persons who are highly active like recreational exercisers and athletes but it also affects inactive persons. This condition can arise from repeated movements when engaging in activities or by overusing the tendon. The main sign of this injury is pain that may affect a person while they are active like while running or walking. Another symptom is swelling around the ankle. Individuals who suffer from this condition should act on it immediately to prevent fibrosis that causes the tendon to tighten and thicken permanently. The difference between Achilles tendinosis and Achilles tendinitis is hard to tell because pain begins when the chronic tendinosis begins.

Insertional Achilles tendinopathy causes approximately 25% of all conditions associated with Achillis. Some of the factors that cause this condition include hypertension, diabetes, genetic susceptibility, gout, failing to wear proper footwear and repetitive loading.

If you are suffering from a tendon injury, it is advisable to seek medical attention immediately. Without treating tendon injury, one may experience a burning feeling around the injured area and severe swelling. Early treatment is also more successful than treating tendon injury at the chronic stage. The doctor will assess the back of a patient’s leg to determine if their Achilles tendon has been affected. Where the diagnosis is unclear, the doctor may use MRI or ultrasonography. MRI also called Magnetic Resonance Imaging is a procedure that clearly shows the doctor the problematic parts of the body. Ultrasound also called sonography refers to ultrasound imaging. This procedure involves using sound waves to obtain images of the internal parts of the body without using non invasive procedures. This treatment gives the doctor a better visual of the inside of the foot, when it is being used to diagnose problems with the Achilles tendon.

There are several treatment options for tendinopathy. Physical therapy may be used alongside most treatments. Electric Shock Wave Therapy (ESWT) is a non invasive procedure that is highly effective in the treatment of tendinopathy. ESWT combined with eccentric exercises has led to a huge improvement in patients compared to eccentric exercises alone. Each treatment plan is unique and different depending on the patient’s biology. The treatment of tendinopathy can be aimed at relieving symptoms and may include instructing the patient to refrain from activities that may have led to the injury.

Patients may be required to refrain from the offending physical activity for a period of one week to several months. The patient may also have to take a break from sports and activities that may have the same effect as the offending activity. However, the patient may continue engaging in exercises that have no adverse effect on the Achilles tendon like swimming and upper body exercises. It is worth noting that for a full recovery, patients should avoid using the affected tendon.

Another treatment option for tendinopathy which may be used together with other treatments is ice therapy. This treatment is effective in reducing swelling and pain. It also helps to reduce the injury on the tendon. An ice pack (wrapped in a towel) is applied to the tendon after the patient has been through a session of tendinopathy treatment.

Unless your condition is caused by tendinitis, you are advised not to take anti inflammatory medication like ibuprofen. Eccentric strengthening and stretching of your calf muscles can help you heal quickly. Calf raises or calf lowering are some of the common physical therapy exercises for tendinopathy. Massage may also be used as part of the treatment plan.

At New York Dynamic Neuromuscular Rehabilitation, we offer Achilles tendinopathy treatment necessary for you to recover. We also provide ESWT; a regenerative treatment where sound waves bearing a high frequency are produced to trigger the body’s healing process. Our centre is one of the few facilities in New York that offers ESWT. We also offer other non-invasive treatments. Many of the patients that we treat respond positively when their condition is diagnosed and treated early.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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