by Eric Winder, DC   

Limping due to a painful, inflamed Achilles tendon can cramp your lifestyle. A form of tendonitis, this problem affects the large tendon that connects your calf muscles to the back of your heel. For many, this pain becomes persistent, making it difficult to treat. Frustration builds when treatment brings the sufferer initial relief, only to flare up again later.  

Fortunately, problems with this tendon can often be greatly relieved by looking at underlying causes in the connective tissue called fascia. Many cases of Achilles tendonitis are caused by repetitive stress in activities like running or jumping. However, most cases are not caused by a specific injury and seem to develop for no obvious reason. In my practice, I find that inflammation and pain in the tendon can be traced to problems in the fascia, which is a fabric-like fibrous tissue found throughout the body.   

Structural Fabric 

Fascia covers the muscles and bones, connecting them to other tissues. This structural fabric, which is found everywhere in the body, holds special nerve endings that sense pressure and tension. When you move, these nerve endings send signals that tell your brain where the body parts are located in space.  

The medical term for this is proprioception, which means “position sense.” This information allows you to maintain coordination, balance, joint alignment and muscular stability. A restriction or distortion in the fascia in one area of the body can confuse those signals and affect another area, resulting in subtle weakness and instability of muscles or joints. As a result, this can cause pain and injury, including problems like Achilles tendonitis.  

No Beach Walks 

A patient, whom I will refer to as Stan, came into my office looking for help with tendonitis that had caused heel pain for years. While he could walk normally for short distances, he would start to limp after more than 10 minutes of walking. The extra muscle resistance of walking on sand made beach walks with his wife out of the question.   

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

            Stan’s initial examination at the office showed restriction of the fascia near his Achilles tendon and in the muscle just above. More importantly, there were tight restrictions in the fascia of certain hip and low back muscles that triggered uneven muscle tension in both the hip and thigh on his painful side.  

That instability caused a deep tension in his calf muscle, resulting in excess strain on the Achilles tendon. In this situation, Stan could stretch the calf for temporary relief, but the calf tension would never fully alleviate since it was triggered from another part of the body.    

Getting Relief 

Treatment for Stan focused on hands-on therapy to release fascia restrictions in the low back and hip area, then eventually in the calf muscle as well. Low-level laser therapy was 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 again and enjoy strolling 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 muscular imbalance or pain throughout 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 tendonitis are exactly the same. However, I find that using the principles above 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 provide remarkable results when treating Achilles tendonitis. I recommend that anyone who is suffering from this type of pain consider seeking out a practitioner who can evaluate potential problems in the fascia, using a whole-body approach.             

Dr. Eric Winder uses gentle manual therapy and rehabilitation techniques to help patients with a wide range of pain and injury problems. For more information, call 941-957-8390 or visit https://gentlebay.com/ Dr. Winder’s offices are located in Sarasota and Osprey.