Achilles Muscle Strain

Everyone’s talking about Kevin Durant’s devastating Achilles tendon Injury. But what is the Achilles tendon? Was this preventable? How long will it take to recover?

What is the Achilles: The Achilles tendon is a band of connective tissue that connects the calf muscles (Gastrocnemius and Soleus) to the heel bone (Calcaneus). Its primary function is force transmission between the muscle and bone to perform plantar flexion of the foot, or pointing of the foot towards the floor.

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Mechanism of Injury: The force of quickly pushing off of the foot requires the calf and Achilles to transmit force from the muscles to the heel, allowing propulsion. With Kevin’s prior calf strain having had 32 days to heal, is it likely that the calf muscle was no longer the weakest point in the kinetic chain. With immobility or disuse over even short periods of time, the Achilles tendon can remodel and become weaker relative to the strength it had before resting. His return to sport was likely too quick to allow the Achilles to return to its prior pre-injury strength, leading to overloading and subsequent rupture.

Clinically, most overuse tendon injuries are due to repetitive motion, which creates ‘‘microtrauma’’ that accumulates over time.1 Additional factors include muscular imbalance, muscular weakness, anatomical factors (leg length discrepancy etc.) and training errors.

Muscle strain injury/healing and how Physical Therapy can optimize healing:

By placing the injured muscle at rest for the first 4–6 days after the injury, the excessive scar formation and re-ruptures at the injury site can be best prevented.

At this point it is recommended that gradual mobilization, both active and passive, be started followed by a progressively intensified exercise program to optimize the healing. Healing is optimized by restoring strength of the injured muscle, preventing muscle atrophy, and loss of flexibility, all of which can follow prolonged immobilization. The rehabilitation program should consist of progressive agility and trunk stabilization exercises as well as exercise to lengthen (eccentric exercises) the injured skeletal muscle.

Proper progression of exercises, active and passive range of motion, Kinesiotaping, Active Release Technique, movement retraining, agility, plyometric training in addition to modalities such as ice, heat, ultrasound and electrical stimulation are all supported by the literature to optimize recovery after an Achilles tendon rupture.

What this means moving forward:

“…healed tendon has been shown in many studies to take upwards of a year to more closely approach the functional strength of uninjured tissue.” (T.W. Lin et al. / Journal of Biomechanics 37 (2004) 865–877

According to a 2011 study, “When players were compared with matched controls, an Achilles tendon rupture resulted in fewer games played ( P < .001), decreased play time ( P = .025), and worse performance statistics ( P < .001) at 1 year but not 2 years postoperatively ( P > .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance.3

Unfortunately for Kevin Durant, he will likely experience significant reductions in his performance next year. According to the literature he will likely require 2 years before his player efficiency returns to his preinjury levels. Hopefully this article brings to light the importance of a rehab in the world of sports medicine and the information can be useful for anyone suffering from musculoskeletal injuries.


  1. Hess, et al. Prevention and Treatment of Overuse Tendon Injuries. Sports Medicine. 1989;8(6): 371-384.
    2. T.W. Lin et al. Biomechanics of tendon injury and repair. Journal of Biomechanics. 2004;37(6): 865–877
  2. Trofa, DP. Professional athletes’ return to play and performance after operative repair of an Achilles tendon rupture. Am J Sports Med. 2017;45(12): 2864-2871

Sport Imagery: A Powerful Tool for Olympians

olympic skiierOlympic athletes have trained their bodies to near perfection by the time they arrive in PyeongChang for the 2018 Olympics.  However it is the mental preparation for the pressure that comes with competing at the 2018 Olympics that is critical, and may ultimately determine a gold versus silver medal.  Visual imagery has long been a part of the training regimen of elite athletes and has become increasingly more utilized across the world.

The US Olympic team traveled with nine sports psychologists this year to help athletes with overcoming fears and visualizing success.  Being able to envision success is critical to achieving such goals for athletes.  US team sports psychologist and professor at Univeristy of Utal, Dr. Detling states, “You are training those muscles, and if you are training those muscles to fail, that is not really where you want to be. So one of the things I’ll do is if they fail in an image, we stop, rewind and we replay again and again and again.”†

Visual imagery is a mental training technique which involves the athlete creating a picture of their sporting event in their minds.  Visual imagery can be used for the following:

-Increase confidence before competition
-Help with healing and recovery
-Improve relaxation between events
-Reduce discomfort and muscle inhibition that comes from intense physical demands
-Overcome prior mistakes and fears of failure associated with past errors

Here is a highly effective visualization exercise to help mentally gear up for the performance of a lifetime—whether you’re a dancer, high school baseball player, swimmer, avid runner, or recreational tennis player.  Spending just a few minutes before any big event just may give you that extra winning edge!

  1. Find a quiet place and sit comfortably with your eyes closed.  Start by imagining yourself just before your event.  Picture yourself approaching the starting line, climbing up onto the diving block, getting into position, lining up with your teammates, etc.
  2. Take a deep breath and begin to notice the sounds you hear around you
  3. What do you see?  What’s happening around you?
  4.  What do you smell?
  5. Notice the sensations inside your body and on your skin.
  6. Take another deep breath and let the event begin!  Picture yourself as if watching a movie.  Watch yourself spring into action—it’s your best performance ever!  Pay attention to the sensation of your flexing muscles and the movement of your body.  Note all of the sensations, sights, sounds, and smells as you push your body to its limit.
  7. Take another deep breath as you gear up for that final push.  You may even feel your heart rate and breathing speed up a bit as you imagine the exhilaration of this moment.
  8. Finally, imagine your big win.  Listen to the crowd cheer and feel the congratulatory pats on your back.  Allow the emotions to bring a smile to your face and congratulate yourself on your best performance ever!
  9. Take one last deep breath and open your eyes.

This exercise is really easy and well-worth the few minutes it takes to do.  Creating successful mental imagery requires practice and patience.  To learn more about how to practice this technique and the power of mental preparation before an athletic event, here are a few links to articles we think you might enjoy:

Huffington Post Article on 5 “Mind-Hacks” for Performance

Psychology Today article about Sport Imagery

A Peer-Reviewed Article from the Sport Journal on Performance Strategies

New York Times Article on Sports Imagery


†Source: Clarey, Christopher. “Olympians Use Imagery as Mental Training”  New York Times. Feb 2014. Link to Article.

How to Manage Hip Arthritis


Osteoarthritis (OA) is the most common cause of hip pain in adults over 50. Simply put, OA is a degeneration of the hip joint. The cartilage that lines the joint degenerates over time until the femur (ball) and the acetabulum (socket) no longer have the lubrication and protection required for normal, smooth joint motion.  This can become quite painful and ultimately lead to decreased activity levels and increased difficulty with daily tasks such as walking and standing up, especially first thing in the morning.

Treatment for hip OA can include stretching and strengthening of the muscles surrounding the hip. Ultrasound and hot packs can be used in the short-term management of pain and activity limitations in order to return to exercise and begin therapy quicker. Manual therapy including joint mobilization, soft tissue release and massage all have significant evidence supporting their use to improve function and reduce activity limitations in people with OA.

2017 updated risk factors for osteoarthritis of the hip include, but are not limited to:

  • Decreased hip internal rotation and flexion range of motion
  • Morning stiffness
  • Male sex
  • Higher BMI
  • Hip pain
  • Age over 50

Hip Internal Rotation : range of motion becomes limited


Hip Flexion also becomes restricted and painful


We’re here to help. In many cases, a prescription of manual therapy to improve hip range of motion, as well as an individualized exercise program can help to prolong or prevent joint replacement surgery.

Treatment recommendations include:

  • Ultrasound for short-term pain reduction
  • Flexibility, strengthening and endurance exercises
  • Manual therapy for joint mobility, flexibility and pain
  • Education on activity modification, exercise, supporting weight reduction when overweight, and methods of unloading arthritic joints.

Recent evidence suggests that NSAIDs (such as Aspirin and ibuprofen), COX-2 inhibitors, and steroid injections are effective at relieving pain and symptoms in hip OA. However, there is some evidence that suggests NSAIDs may increase the progression of hip OA my decreasing glycosaminoglycan synthesis. In addition, there can be serious gastrointestinal side effects associated with NSAID use. Consult your physician before use.

What can you do at home?

Below is a video with a few stretches recommended to improve hip mobility. This is not an exhaustive list but rather a starting point and something to try. It is always recommended that you see a physical therapist to individualize your treatment approach.

The information provided is not medical advice. If you would like more information please visit us at or call to schedule an appointment. 

Achilles Tendon Tears: Are you at Risk?

The Achilles tendon is the largest and strongest tendon in the body, but unfortunately the aging tendon undergoes various changes that put it at risk for injury. Some changes that increase with age include decreased collagen density, decreased glycosaminoglycans and water content, decreased tensil strength and increased stiffness.

A study of 891 ruptured tendons in humans revealed 97% of the changes were degenerative in nature and about 50% of them were Achilles tendons.

How can you keep your Achilles tendons healthy?

Know your risk factors associated with Achilles tendon disorders and schedule an appointment for a physical therapy evaluation to determine the likelihood of your developing an Achilles tendon disorder and to learn research proven treatment strategies to help strengthen and avoid surgical repair.

Risk factors include:
-abnormal dorsiflexion (increased or decreased ability to flex foot)
-abnormal subtalar range of motion (increased or decrease foot joint mobility- pronation or supination)
-decreased plantar flexion strength
-abnormal tendon structure
-medical conditions associated with Achilles tendon disorders: diabetes, obesity, high blood pressure, high cholesterol

Studies have shown and proven that eccentric exercises with a focus on slow and controlled movement is an extremely effective nonsurgical method to treating Achilles tendonitis/tendonosis. Below are some helpful exercises for anyone dealing with symptoms or has been diagnosed with this very common injury.

Eccentric Heel Drop on Step: (Achilles Tendon Strengthening)
Begin this exercise with both feet in a neutral position with only the forefoot on the step
Perform a toe raise with both feet
Remove the unaffected leg from the step and slowly lower the affected back to neutral, keeping knee straight
Perform 3 x 15 repetitions twice a day. This is maintained every day for 12 weeks.
As soon as 2 x 15 repetitions twice a day can be done pain free, the load should be increased.
Progression:  Loaded Eccentric Heel Drop on Step–now add weighted dumbells to increase difficulty and to build strength

Coaches Injury Prevention Workshop

Join Megan Morgan, DPT, orthopedic and pediatric specialist, for a complementary workshop and learn the following:

• How to train proper biomechanics of the lower extremity to reduce ligament injuries
• How to incorporate a sport specific dynamic warm-up
• How to add a simple strengthening and plyometric exercises into each practice to help build strength, flexibility and proprioception
• When is it time to refer your player to seek further intervention for their injury?
This complementary workshop is designed for athletics coaches and trainers working with adolescents in sports such as volleyball, soccer, lacrosse, tennis and basketball.

Wednesday August 30th (7:00-7:45pm)

Active Marin Physical Therapy
421 Miller Avenue, Mill Valley

Call 415-388-8166 or email to reserve your spot.
Ask us about private group lessons for your organization!

Travel Guidelines for a Healthy Back


Summer is a time where many people seek relaxation from life’s daily stresses through vacation.  Unfortunately, the journey to a relaxing getaway can be a lot of work, both physically and mentally.  Don’t let your travels cause you pain by following these simple  travel guidelines….


Tips for plane travel:

– Sit with your back against the seat, both feet flat on the floor
– If planning to sleep on the plane; have a good supportive neck pillow.
– When lifting luggage into the overhead, brace your abdiominal mucles and keep your chin tucked inwards to avoid hyper-extension of the neck and back;
-Ask for help if your bag is too heavy (or better yet, think ahead and check it at the gate….)
– When waiting at the airport;  stand up and walk around to get some movement.
– To reduce potential blood clots and joint stiffness, perform leg circulation exercises throughout the flight (i.e, Pump ankles by pointing/flexing foot, heel raises seated or standing, calf stretches, bend and straighten knees)
– Choose the aisle seat if possible and get up and walk when allowed

Tips for Traveling by Car:
– Sit with your back against the seat, both feet flat on the floor and your head against the head rest.
– Use a lumbar support pillow (as seen in picture) if your car seat does not feel supportive enough.
– Have your seat tilted slightly downward towards your feet to encourage more of a neutral spine alignment.
– Stop for breaks frequently every 1-2 hours if possible.
– On breaks; walk around for a couple mins, and stretch legs (calf stretch, quad stretch).

Myofascial Decompression

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Active Marin Physical Therapy is excited to offer Myofascial Decompression to help patients dramatically improve mobility and reduce muscle tissue tension.  This technique, rooted in Eastern Medicine, uses negative pressure cups coupled with functional movement patterns and Neuromuscular Reeducation.  Myofascial decompression is currently being used by Olympic athletes such as gold medalist Michael Phelps and US men’s gymnast Alex Naddour  for pre and post-workout recovery and detoxification.

What Is Myofascial Decompression?
It is used to decompress adhesions and scar tissue, relax muscles in spasm, decrease trigger point pain, and to reduce inflammation following trauma.  Over time, the treatment can be used to increase muscle endurance, circulation, and lymphatic drainage and to enhance the overall ability to recover from strenuous activity.
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What are the benefits?
1. Decompresses adhesions and scar tissue
2. Helps relax muscles in spasm
3. Stimulates oxygenation and detoxification of blood while promoting a feeling of lightness and relief of pressure
4. Helps separate the various layers of fascia and muscle under skin
5. Increases range of motion and promotes healing in scar tissue and chronic injury sites
6. Increases lymphatic drainage & promotes circulation
7. Enhances the overall ability to recover from strenous activity

What can it treat?
Myofascial Decompression has been shown to be effective for tight and stiff muscles as well as those suffering from back pain, sciatica, piriformis syndrome, IT band pain, rotator cuff injuries, and plantar fascitis.



Sleep and Its Importance For Healing Injuries

Sometimes when we are injured we forget to remember that the simple act of getting adequate sleep can be a huge contributor in helping us heal. The National Sleep Foundation’s sleep guidelines recommend 7-9 hours for the average adult with additional sleep and recovery time needed after injury and surgery.

Sleep is an active physiological process, one in which your body is busy carrying out vital activities while you are unconscious.  While asleep your body alternates between 2 forms of sleep, REM (rapid eye movement) and non-REM.  While REM sleep provides the energy needed to restore the mind, non-REM sleep is essential for restoring the body.

During the restorative phase of non-REM deep sleep, the blood supply available to your muscles increases, delivering extra amounts of oxygen and nutrients to facilitate healing and growth.  Additionally, deep sleep allows for scar tissue to form which the body needs to create and repair injuries and allows our pituitary gland to release growth hormone that is essential for increased muscle mass, bone strength and energy.Physical Therapists can teach you how to position your body in the most effective way while sleeping to promote productive healing.  For instance, if you have a low back injury it is helpful to keep your spine in a neutral position by putting a pillow under your knees while you sleep on your back or between your knees if you sleep on your side. Proper positioning techniques for shoulder or neck pain can also be instrumental in sleep comfort.

How Can Physical Therapists Help With Sleep?

Physical Therapists provide education about the importance of aerobic exercise to aide with sleep as well as teach relaxation techniques.  Diaphragmatic breathing is one such technique which helps relieve physical muscle tension, allows the mental function to slow and relax, improves blood flow to muscle tissues and activates parasympathetic nervous system.

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Sleep Hygiene Tips:

    1. Go to bed and get up at more or less the same time every day
    2. Sleep when sleepy
    3. If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again
    4. Avoid caffeine, alcohol and nicotine for at least 4-6 hours before going to bed
    5. Develop a sleep ritual 15 minutes before bed each night to remind your body that it is time for sleep
    6. Eat a healthy, balanced diet
    7. Having a hot bath 1-2 hours before bedtime can be useful to , as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again
    8. Avoid taking naps
    9. Regular exercise is a good idea to help with good sleep, but try not to do strenuous exercise in the 4 hours before bedtime
    10.  Avoid clock-watching which can reinforce negative thoughts such as “Oh no, look how late it is”

Recommended Sleep Positioning
It is recommended that you either sleep on your back with a pillow under your knees to protect your back or on your sides with a pillow between your legs and arms.  A body pillow can be a very nice purchase for proper alignment.  Sleeping on your stomach can be very aggravating for your low back and neck as the extreme rotation and hyperextension can cause tissue imbalances.
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Dynamic vs Static Stretching: Which Is Best?

This month I would like to discuss the benefits of dynamic over more traditional, static stretching when it comes to warming up before training or competition.

Most of us are familiar with “static stretching” which consists of various techniques to gradually lengthen a muscle for up to 2 minutes while the body is at rest.  Although this type of stretching has been routinely used as a way to loosen up muscles before exercise, research is now showing that static stretching can actually hinder one’s power output, joint stability, reaction time and coordination.  When you think about it, why would one stretch while the body is “at rest” when within minutes you might need to explode from a starting block or hustle up and down a basketball court?  Current research suggests that static stretching should be reserved for after work outs or sporting events and may have little benefit before your activity.

The use of “dynamic stretching” which involves stretching specific muscle groups while continually moving throughout a warm up is now considered to be a much more effective, efficient and fun way to warm up before intense exercise.

Benefits of Dynamic Stretching

1. Prepares your body for exercise by actually activating sport-specific muscles and joints you will be using during your workout.

2. Increases your muscles’ core temperature for improved power output

3: Helps you mentally transition from rest to competition by challenging your body awareness, balance and coordination.

4: Improves range of motion and flexibility around your joints which helps reduce chance of injury and improve performance