The manner you walk or run can be one of the contributing factors to the development of Achilles tendon problems.
If you are experiencing pain in the Achilles when walking or running working with your Physical Therapists and using slow motion video analysis the following model can provide a beginning point to solve the problem.
Some of the movement faults during walking or running associated with Achilles pain can be self-observed; some require visualization from behind or from the side. Some of the movement faults require slow motion video to identify. Sometimes the movement faults only manifest when walking or running faster and/or when fatigued. The gait analysis process requires that the pain occurs when walking or running.
Thorough analysis and treatment of Achilles pain requires gait analysis and gait training. Research suggests that strengthening exercise alone without gait retraining will not result in a meaningful improvement in walking/running form.
Meaningful gait analysis should include secondary analysis using conscious modification of observed movements and observing the effects on pain. Modifying movement has potential to decrease, alleviate, or increase pain. If pain can be decreased or alleviated by conscious modification of walking/running form it can be a powerful suggestion regarding the most appropriate intervention. If conscious modification of walking/running movement increases pain, that is also valuable, suggesting the observed movement fault may be a subconscious positive compensatory modification.
The evidence used in model below is based previous clinical experience and peer reviewed published research. The published research is generally low quality, case study and anecdotal. The model presented below is a starting point for additional research.
The description and definition of the movement faults and when the frequency of the movement fault reaches a harmful threshold requires more discussion and investigation.
If you have Achilles pain when walking or running, and if you show or see this (these) movement fault(s) when walking or running, try to consciously modify the observed movement fault(s) when walking or running using the following verbal cues and observe whether the conscious modification of gait decreases or alleviates the pain when walking or running. Watch or monitor for the following adverse effects or over correction
- Strike ground with a forefoot strike when running:
- Consciously alter foot strike, increase foot/ground angle, run foot flat strike,
- Monitor for an avoid loud foot strike
- See excessive pronation of the heel at foot strike:
- Consciously engage the intrinsic foot muscles (short foot exercise or dooming exercise) during mid-stance while walking or running.
- See the foot crossing the mid-line of body:
- Consciously walk/run with slightly wider foot placement – keep daylight between knees
- Monitor and avoid overcorrection or waddling gait with too much side to side motion.
- See there is no knee window – no daylight between knees viewed from behind:
- Consciously keep daylight between knees
- Monitor for overcorrection of waddling gait with too much side to side motion.
- See the knee skin crease viewed from behind (popliteal skin crease) is oblique instead of horizontal – excessive inward rotation of thigh:
- Consciously engage gluteal muscles at foot strike and/or when foot is coming off ground, keep knee cap point straight ahead
- Do not increase amount of out toeing (angle of foot progression).
- See there is an accentuated heel strike:
- Consciously alter foot strike from heel strike to mid-foot strike, walk/run quiet, minimize avoid heel strike
- Monitor for increased strain on calf/Achilles, and avoid excessive up and down motion bounding gait
- See there is early heel off the ground during terminal stance – diminished dorsiflexion:
- Consciously strive to keep heel on ground longer, consciously engage gluteal muscles to increase amount of hip extension.
- Monitor for compensatory hyper-extension of knee, and monitor for development of Achilles pain or over compensation and possible prolonged heel contact.
- See there is prolonged heel contact on the ground at terminal stance – excessive dorsiflexion:
- Consciously engage push with big toe late in stance phase conscious effort to plantar flex ankle, shorten steps take more steps/minute – increase cadence to decrease amount of ankle dorsiflexion
- Monitor for calf muscle strain or Achilles pain.
- See there is excessive out toeing -Lateral Toe sign:
- Consciously push the heel outward – decrease out toeing when walking/running
- Look to see if static lower extremity exam suggests pelvic anti-version, femoral torsion, tibia/fibula torsion, or excessive mid-tarsal pronation. Monitor for knee symptoms. Assess habitual sitting postures and avoid sitting with habitual external tibia torsion
- See or feel there is excessive up and down motion of center of mass, bounding gait;
- Consciously dampen/minimize the amount of up and down motion – do not bound; Walk/run quiet; Walk/run up incline on treadmill
- Monitor for Decrease in economy or increase in sense of fatigue.
- Take too long a step/stride too slow a cadence:
- Consciously shorten step/stride take more steps/minute – increase cadence, Seek to have foot strike beneath the hips
- Monitor for Increase fatigue poor economy initially.
- See the foot strike is anterior to knee axis – Foot strike to far forward of center of mass:
- Consciously shorten step/stride take more steps/minute – increase cadence
- Monitor for decrease in economy or increased sense of fatigue
- Hear a loud foot strike:
- Consciously walk/run quiet
- Monitor for a decrease in economy or increased sense of fatigue.
Notice the 13 identified movement faults associated with Achilles tendon problems are not mutually exclusive. With additional research the prevalence and importance of the various movement faults can identified. Similarly the some of the cues to consciously modify movement faults are the same for different movement faults.
If you have opinions or questions regarding the descriptions of the movement faults, I am eager to hear from you.
Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591
At-Home, At Office, At Fitness Facility I come to you, I do home visits