Elvis Dumervil and his Achilles Heel: An Injury Overview

Elvis Dumervil has been held out of practice the past few days due to what is being reported as Achilles tendonitis (we'll address this terminology later on). With the regular season opener just six weeks away, many Ravens fans are wondering whether this could be a lingering issue moving forward.

WHAT IS THE ACHILLES TENDON?

Tendons are tough bands of fibrous tissue that help connect muscles to bone. The Achilles tendon happens to be the strongest and largest tendon in the human body. It is crucial to athletic performance and has been shown to support loads up to ten times one's body weight during running, jumping, and other athletic activity.

It is formed through the conjoined tendons of the gastrocnemius and soleus muscles of the calf, and extends down and inserts onto the calcaneus (heel bone). Its main purpose is to allow for the transfer of power from the calf muscles to the foot. When the calf muscles contract they create plantar flexion at the ankle (the act of pointing the toes downward and elevating the heels); a movement that is essential for someone to be able to "push-off" and perform actions such as sprinting or cutting. Thus, without a functioning Achilles, these movements become impossible to execute.

TENDONITIS? TENDINOSIS? TENDINOPATHY?

Many clinicians apply the term "tendonitis" to any tendon pain, but this is not entirely accurate. Tendinopathy is a more generic and accepted descriptor while tendonitis and tendinosis are specific conditions. The only way to correctly distinguish between the two is with histopathological examination (biopsy).

Tendonitis is defined as inflammation of a tendon. However, researchers have found that the vast majority of people with Achilles tendon pain actually have Achilles tendinosis, not tendonitis. Tendinosis involves micro-tearing and degeneration of the tendon due to overuse and repetitive stresses. It becomes important to differentiate between tendinitis and tendinosis because they each have different treatment goals and healing timeframes.

WHAT CAUSES ACHILLES TENDINOPATHY AND WHAT IS THE EXPECTED RECOVERY TIME?

Despite being thoroughly researched, the actual cause of Achilles tendinopathy is somewhat unclear. Tendinopathies can occur in anyone, but those who make repetitive movements appear to be much more susceptible. In addition to overuse and repetitive stress being factors, other theories include muscle imbalances, flexibility deficits, abnormal foot mechanics, and several others.

Studies suggest that Achilles tendonitis can take anywhere from several days to 6 weeks to heal. On the other hand, Achilles tendinosis can take a bit longer to recover from. If caught early, healing can take as little as 6 weeks. However, if it reaches chronic stages, recovery can take as much as 6 months. If healing has not taken place by 6 months with conservative measures, surgical intervention may be required.

Nevertheless, it appears that the Ravens have caught Dumervil's symptoms early and those who start treatment early for Achilles tendinopathy tend to have the best outcomes. The majority of patients respond well to conservative treatment and there's no reason at this point to believe that Dumervil won't either.

- Bobby Esbrandt, PT, DPT, PES