With marathon and triathlon season fast approaching we often see an increase in injuries around the foot and ankle, in particular Achilles tendon pain. Last weekend Physiosports hosted a weekend conference for physios and sports doctors run by the world’s best tendon experts. Here are their 5 super important tips for anyone who thinks they have Achilles Tendinitis (although we call it Tendinopathy).
1. Ensure a correct diagnosis.
There are lots of tendons and other structures around the back of the ankle that can get sore with running. Given that management of tendon injuries is very different from injuries to joints and other structures, being sure it is your tendon that is the problem is vital before undertaking any treatment plan.
2. The findings of your scans are inconsequential to your recovery.
Often those with tendon complaints will have an MRI or ultrasound reporting partial tears or degeneration. The latest evidence suggests that these same findings often exist in pain-free tendons and is an expected tissue response. Furthermore, it has been found that these altered tissues can be rehabilitated back to normal function through exercise.
3. A specific loading program is vital.
Your Achilles tendon acts like a giant spring; this is why only performing calf raises for your exercise will not be enough to get you back to running and jumping sports. A carefully graduated exercise program, starting with low load activities (calf raises) and eventually progressing to dynamic jumping/hopping exercises are needed to prepare the tissue for the demands of your sport.
4. Complete rest and passive treatments (injections, needling etc) will not fix the issue.
As for point 3, tendons act like springs. Any treatment that stops you loading the tendon is ultimately making the tendon less capable of being a spring and this, in turn, makes it harder to rehabilitate the tendon back to normal strength. While sometimes injections and medications can reduce the pain, they do not ever help to restore the tendon’s strength or function and should be used very carefully.
5. Do not stretch the tendon.
Achilles tendon problems exist where the tendon wraps around the heel bone. The injury is a result of a combination of tensile (stretching) and compressive forces on the tendon that are too large for it to cope with; as a result the tendon makes itself stiffer through changing its cellular structure. Even though the tendon feels tight walking around (especially in the morning or when you start running) – remember this is a response in the tissue to protect itself. When you try and stretch the tendon to loosen it up you are actually placing a compressive and stretching force on the tendon and actually making it worse.