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Running Head: ACHILLES TENDINOPATHY
Achilles tendon is the toughest and a thick muscle in the body that attaches the
triceps surae to the calcareous. This type of tendon is commonly susceptible to acute and
chronic injuries and directly implicates pathogenic conditions on foot and ankle (Nunley,
2009). The tendon is on the latter exterior of the calcareous distal and posterior-superior
calcaneal tuberosity; the paratenon surrounds it with the single cells that are responsible for
According to Ansorge et al. (2012), the leading causes or mechanism of injury is
excessive jumping or landing activities, also occurs as a result of the physical trauma. In most
of the cases, the situation is attributed to the age and gender; it begins at the end of the
training sessions with o diminishing discomfort of pain. Additionally, the injury results from
a single overload that exceeds the maximum tissue tolerance and high application of force
(Whiting & Zernicke, 2008).
The patients of the Achilles tendinopathy injury often complain of the pain and
difficulties in valuation that rise from the general area of the ankle and heel. Moreover, the
tendon may show some signs of swelling, and the leg may look thicker than the other leg
(Anderson, 2006). Additionally, some other common symptoms include morning stiffness
around the tendons and tenderness of the muscles while touching.
Achilles injury can be treated with the application of the ice, changing of the
training activities or excesses to rest and use of the anti-inflammatory drugs. The ices will
help to relieve pain and also reduces excessive pain. Moreover, the injury may be ace wrap to
calm swelling and lifting of the heel to reduce stress on the tendon. Further, rehabilitation can
also be used as a measure to strengthen the muscles while stretching the Achilles tendon
(Ansorge et al., 2012).
According to Heslop, (2014) many athletes have experience Achilles injuries during
the training or practice excesses in the filled, and each gives his or her experiences during the
period and some of the preventive measures to Achilles injury.
Preventive measures of the Achilles Tendon Injuries include stretching before
exercises for professional athletes to avoid musculoskeletal injuries, it helps to prevent
tendon stiffness and increase the length of the muscles, therefore preventing potential
injuries. Since Achilles tendinopathy is a common ailment for the most of the people
stretching is one of the health measures as it reflects and determines Achilles injuries,
therefore, developing passive and active forces and myoelectric motion that establishes the
parameters of neuromuscular performance (Park & Chou, 2006).
Anderson, B. C. (2006). Office Orthopedics for primary care: Diagnosis. Philadelphia:
Ansorge, H. L., Hsu, J. E., Edelstein, L., Adams, S., Birk, D. E., & Soslowsky, L. J. (2012).
Recapitulation of the Achilles tendon mechanical properties during neonatal
development: a study of differential healing during two stages of development in a
mouse model. Journal of Orthopaedic Research, 30(3), 448-456.
Nunley, J. A. (2009). The Achilles Tendon: Treatment and Rehabilitation
Park, D. Y., & Chou, L. (2006). Stretching for prevention of Achilles tendon injuries: a
review of the literature. Foot & ankle international, 27(12), 1086-1095.
Whiting, W. C., & Zernicke, R. F. (2008). Biomechanics of musculoskeletal injury.
Champaign: Human Kinetics Publishers
FOOT & ANKLE INTERNATIONAL
Copyright 2006 by the American Orthopaedic Foot & Ankle Society, Inc.
Stretching for Prevention of Achilles Tendon Injuries: A Review of the Literature
Don Young Park, M.D.; Loretta Chou, M.D.
reducing the force production transmitted through the musculotendinous unit and preventing potential injury.8 However,
little evidence exists that clearly demonstrates a reduction
in the incidence of injury by stretching, and many clinicians recommend the practice based largely on intuition and
Achilles tendon injuries are among the most common
ailments seen by orthopaedic surgeons, affecting millions of
active individuals in the United States today. The Achilles
tendon is prone to injury from the load placed on it
compared to other tendons in the body.19,40 It is one of
the few tendons that cross two joints, which increases stress
experienced by the tendon. The powerful gastrocnemiussoleus muscle unit allows for explosive activities, such
as running and jumping, and the large Achilles tendon
transmits these high forces to the ankle joint. Although the
Achilles tendon experiences such high mechanical loads,
the tendon exhibits biomechanical properties that are similar
to those of other tendons, increasing the risk for failure
and injury.40 Overuse from repetitive loading, overloading,
and natural aging may lead to Achilles tendon injuries,
including tendinitis, tendinosis, and tendon rupture.1 In
addition, vascular studies have shown that an area of
hypovascularity, 2 to 6 cm from the insertion of the tendon,
correlates with the area prone to tendinitis, tendinosis, and
Although many studies have examined the role of
stretching in preventing musculoskeletal injury in general,
little is known about its effect in preventing tendinous injury.
It is not clear if the same observations and conclusions
made in those studies also can be applied to the Achilles
tendon. The aim of this paper was to review the current
literature on the utility of stretching in injury prevention,
provide an overview of the biomechanical properties and
injuries to the Achilles tendon, and review the existing literature on the potential effects of stretching the Achilles tendon
for preventing injury. It poses the question: does stretching
prevent Achilles tendon injuries?
Professional and recreational athletes commonly perform preexercise stretching to prevent musculoskeletal injuries. Little
definitive evidence exists that clearly demonstrates the efficacy of stretching in reducing injury. Achilles tendon injuries
are among the most common injuries affecting active individuals in the United States today. Clinicians commonly recommend stretching the Achilles tendon without concrete scientific
evidence to support such a claim. Few studies have addressed
the effect of stretching in Achilles tendon injuries, and it is
unclear if the conclusions made for musculoskeletal injuries
can be applied to the Achilles tendon. Biomechanical studies
of the Achilles tendon and measurements of the tendon’s
reflex activity have demonstrated possible mechanisms for the
potential benefit of stretching, including load-induced hypertrophy and increased tendon tensile strength. Recent prospective studies have contended that reductions in plantarflexor
strength and increases in ankle dorsiflexion range of motion
from stretching the Achilles tendon may increase the risk of
injury. Studies examining stretching in injury prevention, the
biomechanical properties of injuries to the Achilles tendon were
compiled and reviewed. Although many theories have been
published regarding the potential benefits and limitations of
stretching, few studies have been able to definitively demonstrate its utility in injury prevention.
Key Words: Achilles Tendon Injury; Injury Prevention;
Stretching before exercise is a commonly practiced routine
used by both professional and recreational athletes to prevent
musculoskeletal injuries. Stretching is believed to reduce
muscle and tendon stiffness and increase muscle length,
Loretta Chou, M.D.
Department of Orthopaedic Surgery
Sanford University School of Medicine
300 Pasteur Drive R144
Stanford, CA 94305-5341
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Foot & Ankle International/Vol. 27, No. 12/December 2006
STRETCHING AND INJURY PREVENTION (TABLE 1)
Many studies have attempted to shed light on the efficacy
of stretching in injury prevention, and a general consensus
cannot be reached among orthopaedists regarding this controversial topic. The President’s Council for Physical Fitness
and Sports concluded in 2000 that stretching may not protect
against injury and may actually reduce performance in certain
activities.18 Decreases in joint stability, increased soft-tissue
compliance reducing the body’s ability to absorb energy,
creation of body positions that could overstretch ligaments,
decreased strength before the recovery phase of training,
and increased pain tolerance are possible theories to explain
how stretching may not prevent injury and may reduce
The Centers for Disease Control and Prevention reviewed
the existing literature on the impact of stretching on sports