Achilles tendonitis actually is not a tendonitis at all. The tendon is an inert bunch of collagen fibres that lie together to make a rope like structure that attaches muscles to bones. They do not contain very many blood vessels so do not get inflamed in the classic sense.
Inflammation in the classic sense is a tear, this causes a bleed, this causes cells to gather from the blood stream and release chemicals that cause new blood vessel formation and healing. This process will cause redness and swelling and pain. This is an “itis”
In tendons, as there are no blood vessels, this chemical reaction does not happen. With repeated activity in an unconditioned tendon you get a disruption of the rope fibres, i.e. it frays. This causes new nerve growth to the area which are pain fibres. This is not an “itis” but an “osis”.
Achilles tendonosis typically occurs in an unconditioned foot when mileage is increased too quickly. This can be equally likely if you go from 1 mile to 2 or 30 miles to 50 a week. It is much more likely in a foot that either pronates or supinates with each step. This is because uncorrected gait abnormality also gives a side to side whip to the tendon as it tenses and relaxes with each step.
So what do we do about it. For many years people advised sufferers to rest , Ice and stretch them and I know runners who have had to have 18 months off and still have a problem. This clearly is not satisfactory. Recently in Scandinavia a sports Physio decided that the best way to get his tendonosis resolved was to push it and rupture the tendon so it could be surgically repaired. He tried to do this but standing on a step and dropping his heels low suddenly. This did not work so he took to wearing a rucksack with weights in it. After 6 weeks of doing 20-30 reps twice a day the pain got worse. Encouraged he increased the weight. Then after 7 weeks the pain subsided, and after 8 weeks it disappeared forever.
What had happened was that he had inadvertently realigned his frayed tendon fibres and destroyed the new pain carrying nerve fibres. The swelling disappeared and he was cured.
There has now been a large study completed that has shown:-
Do these eccentric exercises, reduce the pace but continue your mileage (reduce pace by 2 min per mile from your marathon pace, do this by shortening your stride) Support your gait properly with new footwear or orthotics . Expect an increase in pain at 6-7 weeks then it should subside. To date there has been no case of rupture and the success rate is over 80%.
This has to be better than doing nothing for 18 months. The healing rate can be improved by doing proprioreceptive rehabilitation on the ankle too. The simplest way is to stand on one foot when brushing your teeth twice a day. When you get good at that close your eyes and do it. When you have done that move your lifted foot from side to side as you do it.
Sports Physicians and physios in this country have been slow to take up this advice but it seems to be working well through America.
If ti works it is a great help at worse it will do nothing and you have nothing to lose. The principal can be applied to other tendonoses such as Tennis elbow, Patellar tendonosis, and posterior tibial tendonosis
Just thought I would share my latest update course as I know many of you will be interested
Further reading
Link (roll over me to see where I go)
Acupuncture as a possible cure
I have had Achilles problems on and off, usually caused by wearing th wrong shoes (unfortunately this often does not reveal itself until the damage is done, especially if I change shoe model, which, alas, most of us are forced to do now and then). The day after Abingdon I had it bad; acute pain (the kind that feels like a knife jabbing the tendon) and the familiar dull ache. I was quite worried. That night I was at my brother's (he has a clinic in Brighton) ad after a few beers I mentioned the pain. He got out his needles and proded about as acupuncturists do.
The next day the pain had vanished. Not only that: the large lump of scar tissue that had developed over the years had shrunk to less than a third of its former self.
The pain has not returned. The scar tissue has not grown back.
The point about shortening your stride is to reduce the pressure on your tendon. I mean by this to ensure you land under your COG with a relaxed foot, and you do not push off behind you but lift the akle off before the knee straightens - to reduce landing tension on the AT as well as pushing off tension. You will need to lean forward and engage the core to do this. If you do this you will find your pain levels decrease rapidly and you can continue to run. But you must correct landing in front of your COG and the big push at the end. You will notice your cadence goes up to maintain the new, slower, pace.
Achilles tendonitis
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SummaryHow to rehabillitate that tendon in 12 weeks and keep runningThis article is owned by cabletow |