By Eric Winder, D.C.  

 
A painful Achilles tendon can cramp your lifestyle. Achilles tendinitis leads to pain and inflammation in the large tendon that connects your calf muscles to the back of your heel.  While traditional treatments of rest, physical therapy and anti-inflammatory medications can provide relief, for many, the issue still persists, or the relief does not last once you return to a regular lifestyle. Fortunately, problems with this tendon can often be relieved when underlying causes are addressed in the connective tissue called fascia. 

Most cases of Achilles tendinitis are not caused by a specific injury. The traditional view is the cause is most often unknown, but there are also many cases attributed to repetitive stress by activities such as running or jumping.  In my practice, I find these cases—whether in casual walkers or running athletes—can usually be traced to problems in fascia which is a fabric-like fibrous tissue found throughout the body.  

 
Structural Fabric 

Fascia covers other tissues, like muscle and bone, and connects them to other tissues. This “structural fabric” is found everywhere in the body and holds special nerve endings that sense pressure and tension. When we move, these nerve endings send signals that tell our brains where our body parts are in space.   

This information gives us the ability to have coordination, balance, joint alignment and muscular stability. A restriction or distortion in the fascia in one area of the body can confuse those signals with another area, resulting in subtle postural weakness and muscular instability.  In turn, this can cause pain and injury including problems like Achilles tendinitis. 

 
No Beach Walks 

Recently, a patient I will refer to as Stan came to our office, looking for help with tendinitis that had caused him heel pain for years. While he could walk normally for short distances, he would start to limp after more than ten minutes of walking. The extra muscle challenge of walking on sand made beach walks with his wife out of the question.   

Physical therapy with ultrasound, stretching and strengthening would help to relieve acute pain flares, but no treatment had resolved the problem. He heard that we took a whole-body approach to find the underlying causes and, therefore, wondered if we could find an explanation for his problem. 

Stan’s initial examination at our office showed restriction of the fascia near the Achilles tendon and in the muscle just above it. More importantly, there were tight restrictions in the fascia of certain hip and lower back muscles that triggered uneven muscle tension in the hip and thigh on his painful side. This instability caused a deep tension in his calf muscle that resulted in excess stress on the Achilles tendon. Stan could stretch the calf for temporary relief, but the calf tension would not leave entirely since it was triggered from another part of the body.  

Finding Relief 

Treatment for Stan focused on hands-on therapy to release restrictions in the lower back and hip area, then eventually in the calf muscle also. Low level laser therapy was also applied to the Achilles tendon itself to improve tissue health and decrease pain and inflammation. After several weeks of treatment, he was able to resume two-mile walks for exercise around his neighborhood with only mild discomfort. By the time his treatment was finished, Stan could walk in the sand and enjoy the beach with his wife.  

            There were two keys to successfully relieving Stan’s pain. The first was realizing the importance of fascia restrictions in creating muscular imbalance and pain in the body. The second was looking beyond the area of pain and assessing his entire body framework to locate the true underlying sources of the problem.  

No two cases of Achilles tendinitis are exactly the same. However, I find that using the above principles leads to successful treatment almost every time.  This is true even when there is a bone spur, bony enlargement of the tendon attachment (Haglund’s deformity) or even scar tissue from surgical repair of the tendon. Therapies that treat and release restriction from fascia can offer remarkable results when treating Achilles tendinitis. I recommend that anyone suffering from this type of pain consider seeking out a practitioner who can evaluate for potential problems in the fascia, using a whole-body approach. 

Eric Winder, D.C., uses gentle manual therapy and rehab techniques, without forceful manipulation, to help patients with a wide range of pain and injury problems. For more information, call 941-957-8390 or visit Gentlebay.com. Dr. Winder’s offices are located in Sarasota and Osprey.