Achilles Tendinopathy

Achilles tendinopathy, like its name suggests, is a condition affecting the achilles tendon of the foot. The achilles tendon attaches the calf muscles (gastrocnemius) to the heel bone. Most often, this condition results from overuse of the tendon while running and walking for athletes. However, it can also be suffered by anyone who remains standing for too long at their job, or those with underlying conditions such as arthritis or structural foot problems.

Common symptoms include soreness and pain along the backside of the calf and heel, stiffness and inability to walk smoothly, and swelling and tenderness of the achilles tendon itself. At times pain and stiffness of the sole of the foot (plantar fasciitis) can occur alongside it as a compilation.

Treatment of achilles tendinopathy by a Traditional Korean Medicine practitioner will depend on first and foremost a precise diagnosis of which anatomical structures have been affected. If different structures of the lower limb are affected, it naturally follows that this will pathologically manifest itself in the particular complaints of the patient. Therefore, the practitioner will seek to first understand the current musculoskeletal state of the patient in a comprehensive manner. Afterward, the treatment will include the following as the chief goals.

• Release tension in the muscles that are connected to the tendon
• Facilitate recovery of the achilles tendon by introducing greater circulation and release of inflammatory chemicals of the body
• Resolve any referred pain or any other structures that are affected in tandem.

Treatment Case: 24 year old male

   The patient is a competitive hockey player, who has been suffering from pain and stiffness in the left Achilles tendon for four months. Symptoms began gradually three months ago. They were initially mild, and he only felt some discomfort and pulsing after practice which subsided after a few days. However, it gradually worsened. Especially after intense practices and traveling far for away games, the pain became unbearable and made it very difficult for him to play to the level he needed to. 

   Now the patient reports pain at 5/10 at rest, escalating to 7-8/10 after intense exercise, localized in the mid-portion of the left Achilles tendon. There was also slight swelling, stiffness, and pain with palpation, as well as pain on resisted plantar flexion and limited tolerance for single-leg heel raises. Furthermore, there was slightly reduced dorsiflexion in the affected ankle, and moderate weakness in calf muscles on the affected side compared to the unaffected leg.

   The principles of treatment in this case were to reduce pain, promote blood circulation to the affected area, and enhance tendon healing. Some local points around the tendon area, as well as points around the gastrocnemius and soleus muscles were chosen and electrically stimulated to relieve tension, enhance circulation, and restore muscle function. The patient was also prescribed daily isometric and eccentric calf exercises, with the addition of light stretching and mobility work.

   After the third treatment, the patient noted a notable reduction in pain at rest (2-3/10) and improved morning stiffness. There was also improved ankle dorsiflexion and less pain during resisted plantar flexion. After the fifth treatment, there was now only minimal pain (1-2/10) during regular daily activities and light practices, with improved tolerance to calf loading. After eight treatments, the patient now reported being able to perform during regular hockey practices and strength training very close to what he was able to do before his injury. He therefore returned to full intensity practice, and at a 3 month follow up call reported no return of symptoms. 
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