Achilles tendon injury

Training with knee pain

The fast facts:

  • The average age of an Achilles injury is often over 30 years old
  • Men are more likely to suffer from an Achilles injury 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.

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 one 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 lengthened. This does not always have to happen during an accident with, for example, a sports match. You can also be unlucky and incur this injury during, for example, the push-off in running. The inability to walk together with the inability to stand on the toes is characteristic. The tendon and the surrounding area are painful. Often a clear snap can be heard at the moment of occurrence or the feeling that you are being tapped from behind. 

An overload (tendinopathy = disorder of the tendon) occurs gradually. The reason for this is that you ask too often and too much of the tendon without allowing it to recover properly. When this happens over a long period of time, the structure in the tendon changes. Thus, it is seen that vascularization takes place 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 clear break in the tendon can be seen or felt. In the case of a tendinopathy, sometimes a thickening and some redness of the tendon is observed. In addition, the image is confirmed by pain during 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 in consultation with the specialist a choice must be made to operate or not.

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 stand on our toes. This movement is called plantarflexion. Depending on the type of complaint, recognizable pain may occur or inability to stand on toes. 

Stretch and specific testing of the Achilles tendon

With the knee in a stretched position, the ankle is flexed. When there is recognizable pain the test is positive. Specifically, for example, is the Thompson test. The patient lies flat on the stomach with the feet free. The therapist gently squeezes the calf muscles. 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 on Achilles tendon injuries:

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


Knee Osteoarthritis
Kevin van Geel

Rehabilitation specialist Casper Bolkenbaas

The different phases in the treatment of an archilles tendon injury

Successful rehabilitation consists of several phases and steps. Good strength, stability and control are necessary to safely return to your sport. Both after an operative procedure and with a conservative policy.

With a (partial) rupture of the Achilles tendon, several phases of tissue repair take place. Immediately after the occurrence, the inflammatory phase starts. In this phase, the body sets to work to clear away damaged tissue in the affected area and make room for new tissue. This phase is characterized by pain, swelling, blue discoloration, warmth and the inability to bear weight. In this phase, it is important to rest. The physiotherapist mainly advises on the policy and expectations of the recovery. In addition, some exercises can be given to restore the mobility of the ankle joint.

The inflammatory phase takes about 7-9 days on average and runs into the proliferative phase. In this phase, new connective tissue is created. This tissue is not yet strong enough and may therefore not be heavily loaded. During the transition from the inflammation phase to the proliferation phase you will notice that symptoms such as bluish discoloration, pain, etc. will decrease. Also, the possibility to move more increases. 

In the remodeling phase, as the name implies, the newly created connective tissue is modeled. Thus, the collagen tissue (laid down in the 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 ensures that tensile fibers become stronger to accommodate as many forces as possible. This makes that in this phase of recovery, the load capacity increases but also really builds up must become. We do this in different phases from basic strength to sport specific training. 

Rehabilitation at Fysio Fitaal

An Achilles tendon injury can be annoying. Our specialists will guide you in this process as best as possible and motivate you where necessary. Fysio Fitaal works with specialists in the field of sports rehabilitation. The combination of expertise, extensive facilities and passion for sports makes us the right place for you.

Team Physio Vital

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