Massage techniques
As with traditional forms of treatment, activity modification is required to get the chronic tensile forces off the affected tendon. Healing is enhanced with a variety of soft-tissue treatment approaches. Massage techniques applied to the triceps surae group, including compression-broadening techniques (see Figure 1) and deep longitudinal-stripping methods (see Figure 2), help reduce tension and decrease the tensile load on the Achilles tendon. The compression-broadening techniques are designed to enhance the muscle’s ability to broaden during its concentric actions. Stripping techniques are helpful to encourage elongation potential. Both these techniques are helpful in reducing tension in the affected muscle.

In addition to the broadening-and-lengthening techniques mentioned, static compression is helpful to address myofascial trigger points that may be in the gastrocnemius or soleus muscles. These trigger points not only perpetuate the hypertonicity in the muscles, but also may refer pain distally into the tendon, thereby mimicking tendon pathology when it is really referred trigger-point pain.

In addition to the techniques applied to the triceps surae, deep friction massage is applied directly to the affected tendon (see Figure 3) to stimulate collagen production in the damaged tendon fibers. It appears that pressure and movement are the most important factors in the application of deep friction massage. Pressure can be applied either transversely or longitudinally. Deep transverse friction may be more effective in helping break down fibrous adhesions between the tendon and the surrounding paratenon, although this has never been verified.

Since the collagen degeneration of tendinosis may be present before there are other symptoms, massage can also be used as a preventive measure. Reducing tightness in the triceps-surae group can reduce the chronic tensile loads on the tendon. Friction massage to the tendon can stimulate collagen reproduction if there is an early degree of degeneration even prior to the onset of symptoms. Keep in mind that tendon-thickening resulting from overuse is probably fibrosis in the paratenon and not acute inflammation. Therefore, massage is still beneficial.

The Achilles tendon is frequently subjected to chronic overuse. Due to the increasing popularity of massage as a means of addressing overuse injuries, it is likely that massage practitioners will have clients seeking help with this problem. While there are other beneficial options, such as shoe inserts and stretching, these may not fully address the present tissue dysfunction. As a result, a multi-disciplinary approach will achieve the best therapeutic result. Massage is a highly effective complementary method for addressing Achilles tendinosis and peritenonitis, and the better we understand this problem, the more effective our therapeutic work can be.

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