Pickleball continues its meteoric rise in popularity across the nation due to accessibility to the game, ability to be enjoyed by all ages, and - quite frankly - its addictiveness.
One of these key drivers in the rise of Pickleball's popularity - the ability to be enjoyed by all ages and athletic abilities - is a large factor in the sudden influx of an assortment of injuries, but notably, Achilles Tendon and Calf Injuries.
Achilles tendon injuries are complex and the injury most likely involves more than just the calf muscle. In order to understand how to avoid these potentially serious injuries, it is important to first understand both what the Achilles Tendon is and its function.
Anatomy of the Achilles Tendon (aka Calcaneal Tendon - I agree, Achilles Tendon sounds better)
Let's start here, what even is a tendon? A tendon is the structure that connects the muscle to the bone. It has different properties and serves different functions than its attached muscle. And, in this case, the Achilles tendon is generally accepted as the largest and strongest tendon in the body, and the tendon that attaches the calf muscle to the heel bone (calcaneus).
The calf muscle is commonly thought of as simply one muscle, the “calf.” But in all actuality, the Achilles tendon is made up of THREE different muscles (depending on the source) that make up the triceps surae complex of the calf. The three muscles that make up the Achilles tendon are the Plantaris muscle (which can actually be absent in many people - and not be a big factor in these injuries), Soleus muscle, and the Gastrocnemius (Gastroc) muscle. For all extensive purposes, the muscle that you see when you flex your foot forward/stand on your tippy toes is the gastroc muscle and its two large muscle bellies.
These three muscles have overlapping muscle actions, including pointing the toes forward/down and/or bending the knee. Each muscle is important in its own regard and is more prominent based on knee joint position in space; however, the take home message in this case is that the Achilles tendon is actually made up of three separate muscles that all have to act together as a unit to function properly.
Fun Fact: The name "Achilles" is derived from Greek Mythology when the hero, Achilles, was dipped into the River Styx by his mother to make him invulnerable. His heels remained exposed when he was dipped, thus leaving a weak spot was the base of his heel for enemies to exploit.
Why is an Achilles Tendon injury common in Pickleball?
One of the largest draws to Pickleball is that it is fun for people of all ages, activity levels, and athleticism. This does, however, mean that many weekend warriors and inexperienced athletes who do not routinely exercise or are unfamiliar with the proper precautions to avoid an injury are suddenly exposed to repetitive stresses to the body.
I would say the following reasons, in no particular order, are a few of the reasons that Calf Strains/Achilles Injuries are so common:
Improper warm up - It is paramount to dedicate the appropriate time both before and after a Pickleball match to prepare your body for exercise to prevent injury
Poor footwear - Footwear plays a key role in ankle stability and traction while playing Pickleball. Poor shoe choice can predispose a Pickleballer to slipping or improper ground reaction forces through the Achilles Tendon.
Slippery/Uneven playing surfaces - The rise in popularity of Pickleball has grown faster than some local communities' ability to provide dedicated courts. This means that many Pickleball courts are haphazardly created, and the playing surface may have cracks and various imperfections leading to injury.
Explosive and Dynamic Movements - Despite the idea that Pickleball is a relaxing and “easy” game, it requires explosive and reactionary movements throughout matches. These dynamic movements can cause injury to the Achilles Tendon or, more commonly, a Calf Strain.
Sudden Overuse and Overload to the ankle - The fact that Pickleball is so darn fun makes it overwhelmingly addictive. While this is a great thing that countless people are spending many hours exercising and having fun, this does predispose the Achilles Tendon to sudden overuse and inflammation. This overuse injury is commonly referred to as Achilles Tendonitis and progresses to Achilles Tendinosis.
How to Avoid and Injury to the Achilles Tendon
The easiest way to avoid the injury is to prepare your body to stay healthy for your active lifestyle.
This includes wearing proper footwear and performing a dynamic warm up for all associated structures.
Additionally, on days that you are not actively playing Pickleball, it is important to stretch the Achilles Tendon to maintain healthy flexibility of the calf musculature. Including general lower extremity strengthening exercises on your off days are also important to avoid injury.
Another key component is staying hydrated and to consume proper nutrition to keep your body performing in top shape.
OK, but what do you do if you’ve already injured your Achilles Tendon or strained your calf?
Common consensus can appear that you should just rest and ice for a few days. But is that really the best option? Or what about possibly succumbing to the intrusive thoughts that you aren’t cut out for Pickleball and quitting altogether?
Let me help with both of the above ideas - No, you should not just rest and ice or even quit playing Pickleball with your friends.
The longstanding idea of RICE (rest, ice, compression, and elevation) is an outdated approach and leads to chronic issue and subsequently more time away from the Pickleball court.
The first thing you can do if you’ve sustained a Pickleball Achilles injury is call the expert in orthopedic injury treatment and prevention, an Osteopractic Physical Therapist.
At Flow Physical Therapy and Wellness in The Woodlands, TX we will take a deep dive into your suspected Achilles, calf, and heel pain. We will rule in and out a variety of conditions such as fracture, tendon rupture, tarsal tunnel syndrome, plantar fasciitis, or even referred pain from your lower back. This attention to detail in uncovering the exact structures allows us to create a patient specific treatment plan, which may include dry needling among many other techniques.
So if you’ve been sidelined by sudden calf or Achilles tendon pain and you're ready to get back on the Pickleball court, click the button below to experience the cutting edge treatments provided by an Osteopractic Physical Therapist and get back on the court!
Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic
Owner of Flow Physical Therapy and Wellness
832.299.5447
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