The Achilles tendon connects the calf muscles to the heel bone. Overuse can lead to Achilles tendonitis, characterized by pain and stiffness resulting from degeneration and microtears within the tendon tissue. This injury is common among runners and individuals involved in activities with repetitive lower leg stress. Doctors of Chiropractic (DCs) are trained to manage musculoskeletal conditions and frequently treat Achilles tendon issues. They use a comprehensive, non-pharmacological approach focused on restoring biomechanics and promoting tissue repair.
Chiropractic Assessment and Differential Diagnosis
A thorough assessment is the first step a chiropractor takes to manage Achilles tendon pain. The DC begins with a detailed patient history, noting factors like activity level, footwear, and recent changes in exercise intensity. This history helps distinguish between non-insertional tendinopathy (middle portion) and insertional tendinopathy (attachment to the heel bone).
The physical examination includes orthopedic tests and functional assessments of the entire lower kinetic chain. The chiropractor performs a gait analysis to observe walking or running, looking for abnormal foot mechanics like excessive pronation or limited ankle range of motion. Palpation locates the precise area of tenderness and checks for tendon thickening.
Crucial functional tests include the single-leg heel raise, which often reproduces the patient’s pain. The Thompson test is also used to rule out the possibility of a more serious, acute Achilles tendon rupture.
Manual and Modality Therapies for Tendon Repair
Chiropractors employ various hands-on treatments aimed at stimulating tissue healing and improving the tendon’s capacity to handle load. Soft tissue mobilization techniques address adhesions and scar tissue within the tendon and surrounding calf muscles. Manual therapies, such as Instrument-Assisted Soft Tissue Mobilization (IASTM) or Active Release Techniques (ART), apply targeted pressure to release tightness and promote blood flow.
To correct underlying biomechanical issues, the chiropractor may utilize joint manipulation. Adjustments often target the foot, ankle, and lower leg joints to restore proper alignment and reduce abnormal stresses contributing to tendon overload.
Therapeutic modalities may also be incorporated, such as dry needling to address myofascial trigger points or cupping therapy to improve circulation. The goal of these in-office treatments is to prepare the tendon and surrounding musculature for the next phase of recovery.
Chiropractic Role in Rehabilitation and Coordinated Care
The cornerstone of long-term recovery for Achilles tendinopathy is prescriptive exercise, particularly an eccentric loading protocol. Eccentric exercises involve strengthening the calf muscles while they are lengthening, such as slowly lowering the heel from a step (the Alfredson protocol). These controlled movements strengthen the tendon structure, reduce pain, and improve the tendon’s tolerance to stress. The chiropractor prescribes variations of these heel drops, performed with both a straight and bent knee, to target the gastrocnemius and soleus muscles.
Rehabilitation also involves addressing intrinsic risk factors, including recommending supportive footwear, orthotics to correct excessive foot pronation, or modifying activity levels. Recovery can be slow, sometimes requiring several months of consistent adherence to the exercise program. A chiropractor recognizes when a patient’s condition is not improving and necessitates a referral to another healthcare provider, such as a medical doctor or orthopedist, especially if imaging studies are required.