Neal Reynolds has worked as physiotherapist to Premiership and England International teams. Here he discusses how a full time professional team might approach the treatment of Achilles tendon injuries.
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Susan Findlay teaches sports massage at the North London School of Sports Massage. She explains how massage can aid in the recovery of Achilles tendonitis.
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Ian Sadler is a Sports podiatrist who has worked extensively with athletes and the British Military. He talks about the biomechanics of Achilles tendon pain.
Early stage treatment
Achilles tendonitis must be treated early and you must listen to your Achilles when you start to feel any kind of problem. If the injury becomes chronic where the injury is long standing it is really hard to get rid off. Whereas if you catch it early it is more often easily treated.
As soon as you feel any inflammation on the Achilles then rest. The first sign well be pain. Then later the tendon may appear thickening. If someone stands behind you and compared both Achilles tendons the injured one will most likely be thicker. Then it is important to begin to apply the PRICE principles; protect the Achilles, resting it is very important. Ice or cold therapy applied to the tendon to start to get rid of the inflammation. Compression is more difficult for the Achilles and elevation is not so relevant either but ice is important.
Monitoring activity levels is important as complete rest may not be possible due to daily walking around. Just listen to your body. If it still swells up then you're doing too much.
Other treatments might include ultrasound or laser. Friction massage can be helpful to break down adhesion's. This can be started quite early, depending on pain levels.
Achilles tendonitis exercises
Very similar to a calf strain you are loading the Achilles tendon every time you walk. So I wouldn't look at doing any kind of strengthening exercises other than eccentric exercises. This is where you do a normal calf raise but it is the lowering down on a single leg that is the important part of the exercise. That gets some tensile strength into the Achilles so it can withstand load.
When you walk there are large forces going through the tendon and when you run it is even worse so you must be able to withstand those loads. It is important you start to do the eccentrics once the acute stage has settled down. Keep looking at the swelling, keep looking at the pain. If both of those are ok then just keep doing more and more eccentric calf raises.
Eventually you need to be doing 180 exercises a day which sounds a lot but you need that strength in the tendon and it needs to be done in that controlled manner as an exercise. Over a period of time you will slowly notice the pain and swelling decrease then you just carry on those exercises throughout.
Late stage rehabilitation
Transcript: With outside rehabilitation for an Achilles you are really looking for how it is going to react. There is nothing specific for example jumping is going to make it worse specifically or any other activity. It is going to be the total amount of work and can the sports person withstand that amount of training.
With Achilles tendonitis I would not do a specific rehab session. I would just do a normal training session then at the end assess if the athlete has any pain either during, straight after or the next day. That is when I would look at it and think it is not quite ready as opposed to thinking I need to do this particular activity or that particular activity. Often walking and jogging are one of the hardest things to do with an Achilles so pain when training will be the biggest guide.
Achilles tendonitis can be prevented by understanding the possible causes of the injury and following these guidelines.
- Gradually increase the duration and intensity of training.
- Avoid training on soft surfaces such as grass or sand for long periods of time. The soft surface allows the heel to drop more, so placing more strain on the tendon.
- Avoid wearing shoes that are too old.
- If you overpronate, the Achilles is twisted putting more strain on it so ensure you wear the right training shoes or insoles.
- Make sure you warm-up sufficiently before training.
- Ensure that you stretch on rest days, as well as before and after training.
If you feel you have done just about everything right and still have ongoing problems you may need to see a Podiatrist and get a full biomechanical analysis to identify the cause.