This is our first health blog post and today we are looking at achilles problems. Hopefully you find the information useful, if you have any suggestions or requests for topics to discuss please leave a comment.
There are a few types of achilles problems, grades and severity but we are going to look at two to keep things simple, these are tendinitis and tendinopathy.
Tendinitis = short term problem, inflammatory – early stages, acutely painful and swollen
Tendinopathy = long term problem, chronic swelling and physical changes to the achilles tendon.
We are also going to look at some of the causes we see in clinic, the theory behind the injury and the treatment plan to resolve the issue in relation to the different scenarios.
The time of onset is important to know as this starts to give us an impression of the stage of the injury. Severity of pain, location, functional limitation and daily patterns indicate the severity of the problem and the impact on lifestyle. Generally the achilles area will be stiff and potentially painful first thing in the morning but once it “warms up” the pain reduces and function improves.
What causes it?
To know this we need to know the time of onset, was there a specific time of injury? For example, playing a game of tennis or squash and it suddenly became painful? Or has it gradually started and just got worse?
The types of causes we see in clinic include, when runners suddenly start hill training, change running style or speed. The calf muscle and achilles may not be strong enough to cope with the change in activity so the achilles takes the strain and becomes injured (or the calf muscle tears).
We also see patterns where a client may exercise regularly, hasn’t changed anything in the routine but the symptoms gradually come on, this can indicate a lack of stretching or lack of strength for the activity the person is trying to perform.
A more sedentary picture may be someone who works at a desk and gradually over time the calf muscles become shorter. Due to a general lack of activity the calf muscles will become tight and slowly place more strain on the tendon, even during minimal physical activity. Subsequently leading to irritation.
When feeling the calf muscle it will be firm to the touch, tight on movement and painful on palpation. To check for a full rupture, kneel on a chair and squeeze the calf muscle the foot should move, if it doesn’t this would indicate a rupture. Feeling through the calf muscle down to the achilles and squeezing the tendon will help to identify the source of the irritation. This often feels like a little lump on the side or back of the achilles and will often give a sharp type discomfort.
So what do we do about it?
One of the main problems is an urge to get back to exercise. This is critical in the rehabilitation of the achilles tendon and the calf muscle. The tendon does not cope well with high levels of stress if it is already irritated or inflamed, you need to avoid pain. If you are doing something which is causing the achilles pain to start or get worse the inflammation will worsen and it will slow down the healing process.
The required exercise regime is fundamental to the treatment programme and should include stretching the soleus and gastrocnemius muscles (The two calf muscles). In addition and only if the exercise is pain free, we can include a heel raise exercise. This needs to be monitored closely as this exercise is aimed at rehabilitation of the tendon rather than the calf muscle, that comes later. The heel raise exercise can be started by simply standing on the floor and lifting your heels. Progressing to standing on a step, letting your heels drop so you feel a calf stretch then pushing up on to your toes. However this is the important one and the specific exercise needs to be set according to ability and onset of pain and be progressed as the symptoms improve. Technically the exercise is performed eccentrically, meaning the muscle is working but getting longer. Allowing the heels to drop slowly causes the load on the achilles to increase and aids normalisation of the fibres of the tendon.
Manual treatments including calf massage, acupuncture, passive stretching and specific tendon massage will all be beneficial in speeding up the recovery of the tendon. If you relieve the stress on the achilles by stretching and releasing tension in the calf, the achilles can recover and the body will heal.
Once pain and stiffness has resolved it is important to look back at the cause of the injury. This is the bit most people miss out and generally leads to re-injury! If the runner went up the hill too fast and was not used to it, we would need to look into specific strengthening of the calf muscle. For the individual who doesn’t stretch we would recommend a programme of stretching exercises for the whole leg to be done after physical activity. For the person sat at the desk we would recommend gluteal, hamstring and calf stretching as these are all vulnerable for this individual.
Please feel free to comment, question and discuss but remember the information provided is for information only and is not to be substituted for medical advice.