Modern & measurable results

Physical therapy for an Achilles tendon injury.

The fast facts:
  • The average age of an Achilles injury is often over 30 years old
  • Men suffer from Achilles injury more often than women

The calf muscles consist of the gastrocnemius muscle and soleus muscle. These muscles of the calf are located at the back of the lower leg. This muscle group runs from the heel bone to the inside and outside of the knee and the head of the calf bone. The gastrocnemius muscle is bi-articular. This means that the muscle runs across multiple joints, namely the ankle(upper ankle joint) and the knee.

Trochantor major syndrome
The different types of Achilles tendon injuries

We distinguish two types of Achilles tendon injuries. One type in which damage to the tissue occurs as in a (partial) rupture and the other in which there is more of an overuse injury. A rupture generally occurs after an explosive movement with a lot of force. That is, a moment in which at least a lot is asked of the tendon while it is being extended. This does not always have to happen during an accident with, for example, a sports game. You can also be unlucky and suffer this injury during, for example, the push-off in running. Typical is the inability to walk together with the inability to stand on your toes. The tendon with the area around it is painful. Often a distinct snap can be heard at the time of onset or the feeling of being tapped from behind. 

Overuse (tendinopathy = disorder of the tendon) occurs gradually. The reason is that you ask too much of the tendon too often without allowing it to recover properly. When this happens over a long period of time, the structure in the tendon changes. Thus, vascularization is seen to occur and the structure of the tissue changes somewhat, In particular, the ingrowth of free nerve endings causes an increase in pain. We also see more of a certain type of connective tissue in the tendon. This is collagen type 3. This type of connective tissue is less strong and for that reason somewhat more vulnerable. So with prolonged overuse, the quality of the tendon actually decreases.

Cruciate ligament injury
Diagnosis of an Achilles tendon injury

Often, at first glance, there is not much to see about the Achilles tendon. After further examination and palpation, in the case of a rupture, a distinct break in the tendon may be seen or felt. In the case of a tendinopathy, a thickening and some redness of the tendon is sometimes observed. In addition, the picture is confirmed by pain with tightening and stretching of the Achilles tendon. Additional examination is often not helpful in an Achilles tendon injury. The chosen treatment will not change much, if at all. Unless there is a complete tear of the Achilles tendon then a choice to operate or not must be made in consultation with the specialist.

Physical testing of the Achilles tendon

Often the diagnosis is already fairly clear based on the intake interview. To confirm this suspicion, several physical tests are performed where the recognizable symptoms are provoked. 

Tightening of the Achilles tendon
The Achilles tendon is especially tightened when we come to stand on our toes. We call this movement plantarflexion. Depending on the type of complaint, there may be recognizable pain or inability to stand on the toes. 

Stretch and specific testing of the Achilles tendon
With the knee in an extended position, the ankle is flexed. When there is recognizable pain, the test is positive. Specifics include the Thompson test. In this, the patient lies flat on the stomach with the feet free. The therapist gently squeezes the calf muscles where, if the Achilles tendon is intact, the foot should move. If this does not happen it is clear that there is a rupture

Risk factors for acquiring an Achilles tendon injury

There are several known risk factors for developing Achilles tendon injuries:

  • A previous injury to the Achilles tendon
  • Presence of a rheumatic disease
  • Untrained
  • Fatigue during sports
  • Reduced neuromuscular control 
  • Men between the ages of 30-40


Knee osteoarthritis
Kevin van Geel
The different stages in the treatment of an Achilles tendon injury

Successful rehabilitation consists of several stages and steps. Good strength, stability and control is necessary to safely return to your sport. Both after a surgical procedure and with conservative management.

In a (partial) rupture of the Achilles tendon, several phases of tissue repair take place. Immediately after it occurs, the inflammatory phase begins. Here, the body sets to work clearing damaged tissue in the affected area and making room for new tissue. This phase is characterized by pain, swelling, blue discoloration, warmth and an inability to bear weight. During this phase, it is important to rest especially. The physical therapist mainly advises on the policy and expectations of recovery. In addition, some exercises can be given to restore the mobility of the ankle joint.

The inflammation phase takes about 7-9 days on average and progresses into the proliferation phase. In this phase, new connective tissue is produced. This tissue is not yet strong enough and should therefore not be subjected to heavy loads. During the transition from the inflammation phase to the proliferation phase you will notice that complaints such as blue discoloration, pain, etc. will decrease. The ability to exercise more also increases. 

In the remodeling phase, the newly created connective tissue is remodeled as the name implies. Thus, collagen tissue (laid out in proliferation as type 3) is transformed to type 1. The difference is that type 1 collagen tissue is much stronger than type 3 tissue. Under pressure and tensile forces demanded in the remodeling of the tendon, the body causes tensile strength of the fibers to become stronger to accommodate as many forces as possible. This makes that in this phase of recovery the load capacity increases but also actually built up must become. We do this in several stages from basic strength to sport-specific training. 

Rehabilitation at Physio Fitaal

An Achilles tendon injury can be unpleasant. Our specialists will guide and motivate you as much as possible during this process. Fysio Fitaal works with specialists in the field of sports rehabilitation. Through the combination of expertise, extensive facilities and passion for sports you have come to the right place.

Team Physio Vital

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