Achilles Tendinopathy

Accurate Diagnosis

Achilles Tendonitis is a term that is very rarely used these days. A more accurate diagnosis would be Achilles Tendinopathy. Although this may just sound like semantics, it is actually very important when it comes to treatment approaches. 

-itis means inflammation. Research has shown that the majority of Achilles Pain doesn't have a classic inflammatory response. It is actually a far more complex process. 

Jill Cook is a key researcher in Tendinopathy. She has identified a tendon can go through 3 different phases. 

reactive phase          into             dysrepair phase        into            degeneration  phase      

An accurate diagnosis will also identify what phase of Tendinopathy you are in, which is crucial when it comes to an appropiate rehabilitation programme. 

Why the different phases matter

Reactive Phase- This is the acute response to tendon overload. Without going too scientific, a reaction to this overloading occurs, and causes a number of chemicals to go the the area.  This is a protective response to help handle the extra load on the tendon. This is a short lived response that has no long term damage. This reaction can also be a painful response.

If this caries on, or is intense enough, then there may be some disorganisation of the collagen in the Achilles. This will affect the ability of the Achilles Tendon to handle load.

This is moving into the Dysrepair Phase. And then when this develops even further, it will move into the Degeneration Phase.

The Reactive Phase however can happen at any stage. So it is possible to have a Reactive Phase ontop of a Degeneration Phase. This is usually seen when an individual has been struggling with Achilles pain for a while, then tries to do to much on it, and experiences a 'flair up' of symptoms.

When should you seek help?

If you are experiencing Achilles Tendon Pain, then you should seek some specialist advice as soon as possible, rather than ignore it for weeks or even months. 

This is because we want to see your Achilles when the least disruption to the tendon has actually occurred. The goal of rehabilitation is to remodel the tendon so it can absorb load again. If the tendon has been ignored for months= more remodelling needed= longer recovery. 

Our team at Resilience will help establish what phase the tendon is in, help settle the reactive response (pain) and then start an appropriate loading programme that will help teach the tendon to absorb load efficiently again. 

Previously failed treatment?

3 sets of 15 heel drops right? This advice came from a study done in 1998! Yes, it can certainly work. However, that completely depends on the phase the Tendinopathy is in, your age and fitness levels and more. 

If you do not match the loading with the appropriate phase, then what may be a perfectly good rehabilitation programme on paper, could actually make the tendon worse.  

We also think it is vital that we identify the causes of the overloaded tendon in the first place. Training load error? Underlying movement imbalances causing too much ankle and Achilles Work? Gait? Strength? Jump-Landing Mechanics? etc.. 

We will assess all of these potential causes in the Initial Consultation and build the corrections needed into your programme. 

Avoidance

There are many areas that need to be addressed when trying to prevent Tendon Injuries. However an easy drill that can be added is skipping ( https://rphysio.com/blog/2018/4/3/running-tip-1-skipping)

Tendons just used to be thought of as connectors of muscles to bone. But they actually have elastic properties in them that help us with force absorption and force transmission. Skipping is a great way of training this mechanism and help keep the Achilles Tendons healthy. 

If you are struggling with Achilles Tendon Pain, or have in the past and would like to discuss how we could help you, feel free to contract us on 07842911104 or email on Clinic@rphysio.com

Running Tip #3- Breathing Techniques to help Recovery

This article follows on from our article about why Recovery is important (rphysio.com/blog/2018/4/5/running-tip-2-recovery). We will give you 2 simple breathing drills that directly affect your system and gets you into Rest and Digest mode. 

Breathing is underrated!

We all know that breathing is pretty important! However, how we breathe directly affects our Fight or Flight/Rest and Digest response. 

Breathing in the Fight or Flight state- (a few key points)

  • Breathing rate increases
  • You exhale too much CO2. 
  • You actually need to retain some CO2, when you don't your nervous system excites (Fight or Flight)
  • Breathing becomes shallow and you over use the neck muscles to pull air up into upper chest
  • Exhalation becomes passive and the rate of inhalation increases
  • This results in you being hyperinflated
  • Long term hyperinflation causes muscle tension, anxiety, fatigue, burnout, pain and more
  Ever noticed the bottom of your ribs sticking when lying down? This picture shows hyperinflation. Hyperinflation results in air getting trapped in the body. This is like having a balloon inside you. This can limit our ability to efficiently bend, reach, twist and run. It increases rigidity. 

Ever noticed the bottom of your ribs sticking when lying down? This picture shows hyperinflation. Hyperinflation results in air getting trapped in the body. This is like having a balloon inside you. This can limit our ability to efficiently bend, reach, twist and run. It increases rigidity. 

The Switch and the Exhale

Effective breathing triggers your off switch (read the Recovery article to learn about the switch). More specifically, effective exhalation triggers your off switch. When you get out of a hyperinflated state, you also allow the body to get out of a Fight or Flight state. 

Techniques

The Exhale is very important. It drives the bottom of the ribs down. This allows the inhale to start in the correct position. Think of the exhale as the start of the breath cycle.

  1. Exhalation
  • Lie on your back with your knees bent
  • Place your hands on the bottom of your ribs and breathe out of your mouth
  • Try and make your exhalation last for 8 seconds, and focus on the bottom of your ribs dropping down/descending
  • On inhalation, breathe through your nose filling up your belly and then the chest wall. Make sure you do not use your neck to pull air up. Make the inhalation last for 4 seconds
  • After the next exhalation (8 seconds), Pause at the end for 4 seconds before the next inhale. 
  • Repeat. 

2) The principles of the above exercise can be applied to any position. Here is a simple exercise you can do when sitting during the day.

  • Place the tongue behind your upper teeth.
  • Focus on the exhalation of your breathe cycle. Work on the ability to make this longer. 
  • Focus on your ability to hold the pause after the exhalation. (like the above exercise)
  • The better you get at the exhale and pause, the easier you will find getting out of hyperinflation and therefore get into Rest and Digest. 

There are many other more advanced breathing exercises. We will include some in our Exercise of the Week Tips in the coming months.

Long standing pain or tightness? Sometimes recurrent injuries or long standing pain can be caused by us being stuck in a hyperinflated state. Hyperinflation causes back tightness, neck tightness and restricts our ability to move. 

If you or someone you know is struggling with any pain or injury, take advantage of our free, no obligation 15 minute Physio or Sports Injury consultations.

Call us on 07842911104

Running Tip #2- Recovery

Why you may be getting Injured, feeling Tight or your Sporting Performance is Plateauing

Even though we are writing this article during the Running Series we are doing. It is very applicable to not only runners, but anyone wanting to live a healthy and active life without pain and injury. 

Why the need for Recovery…… I feel fine!

Your body is like a credit card. You can keep on with the spending and throwing the unopened statements in the bin, but eventually this spending will catch up with you. The same with training, if we keep the intensities high, and training/playing sport regularly without good recovery, eventually you will tighten up, get injured or your performances will plateau or even reduce.

When you start to feel that you are in need of a break, this is usually too late. This is why it is important to put regular Recovery Strategies into your routine. 

Does Recovery mean just stop training?

Recovery doesn't just mean stop playing/training. Yes de load weeks and periodisation of your training are important, however there are other easy strategies that can be added alongside your programme to keep you performing, training and being well. 

Rest and Digest and Fight or Flight

Without getting too scientific….. You have a system called the autonomic nervous system. This is working all the time without us knowing. There are two sides of this system, Fight or Flight and Rest and Digest. You should be able to switch into either side of this system when needed, and both are very important for optimal pain free health. 

Rest and Digest- This should be your default state. Here, your body can repair, recover, digest etc.. This side pays the credit card bills. 

Fight or Flight- This side was developed through evolution to protect you from danger. It is also the side you want to be in when training and playing sport. It provides speed, energy, alertness and fuel to thwart danger or perform at your maximum. 

This side does all the credit card spending. We can't live in this state all the time, something will burnout. 

The Switch

After a hard training session/game, you should switch back from a desired Fight or Flight state back into a Rest and Digest state. This will give you proper recovery, digestion, rest and repair ready for your next training session. 

However, it is very common for individuals to lose the ability to switch back to Rest and Digest. Long term low level stress (work stress, training stress, kids stress, bills stress and importantly body rigidity/tightness stress) can contribute to this. 

A good switch is linked to a high level of health and fitness,

whereas a poorly functioning switch is linked to stress, fatigue, injury and burnout

 

Techniques to help you switch into Rest and Digest

Here are a few techniques that are great at making sure you do switch into rest and digest mode, so you can maximise your Recovery when you are not training/playing sport. Not only will it help you reduce pain, recover from injuries and maximise performance. But it will also help with fatigue and anxiety if you are struggling with those. 

We will expand on these in our follow up article next week.  

  1. Proper Breathing Exercises
  2. Sleep
  3. Massage

 

For the whole of April we are offering 50% off our Sports Massages and also offering free 15 minute Physiotherapy or Sports Injury Consultations. Call or Text us on 07842911104 if you would like a session. 

Edit: Here is a link to our follow up article

https://rphysio.com/blog/2018/4/6/running-tip-3-breathing-techniques-to-help-recovery

Running Tip #1- Skipping

Skipping for Runners. 

Training the reflexive properties of the Calf and Achilles unit is very important for runners of all ages and abilities. Loading this area in a transferable way (think sport specific) helps overcome niggles, prevent injury and improve running performance. 

Our runners have had great success with these techniques rather than traditional slow calf loading exercises on the edge of a step, so give it a go.

To begin with, skip for 20 seconds, and then rest for 20 seconds and repeat 5 times. Build from there.

The focus should be on spending the least amount of time on the floor (quick feet) and getting some height, rather than using it as a cardio workout. This will help train the ability to absorb and create load/force efficiently.

Skipping can be then progressed into hopping, bounding and running drills that focus on both prevention and performance, which we use with our Performance Therapy Clients. 

If you are struggling with a running injury, take advantage of our free 15 minute injury consultations that we are offering for the whole of April 2018.