What is achilles tendinopathy?
What are the causes of Achilles tendinitis?Achilles tendinitis most commonly occurs due to repetitive or prolonged activities placing strain on the Achilles tendon. This conditions typically occurs due to:
- excessive walking, running or jumping activities,
- from tight calves,
- following a sudden forceful force thru the Achilles tendon beyond its limit,
- a sudden acceleration or forceful jump,
- following a calf or Achilles tear or poorly rehabilitated sprained ankle,
- individuals with poor foot biomechanics or inappropriate footwear,
- with long distance running, biking, walking, sailing or any endurance activity,
- pressure points exerted on the tendon from high tech shoe, rigid reinforcing materials applying a focal pressure point.
What is the prognosis of achilles tendinopathy?
What activities may aggravate Achilles tendonitis?
- Running especially uphill or on uneven surfaces
- Walking, standing and virtually everything in standing
- Heel raises, hopping, jumping
- Basketball, tennis, squash, baseball, badminton, curling and virtually every sport in standing.
How can physiotherapy and massage therapy do for achilles tendinopathy?
Physiotherapy and Massage treatment may comprise of:
- Low Intensity Laser Therapy is also very important to heal the damaged tissues
- devices including crutches, braces, heel lifts, and night splints to rest the affected tissues
- stretches – although stretching is not effective on it own
- joint mobilization
- ice or heat treatment
- exercises to improve strength, flexibility, core stability and balance
- education advice so we can be strategic and design a personal improvement plan
- anti-inflammatory advice
- activity modification advice
- biomechanical correction including teach proper functional movement skills
- footwear, training surface, and equipment advice
- a gradual return to activity program
- shockwave therapy
How can exercise and physical development help after achilles tendinopathy?
The Kinetic ChainOur body functions best and with minimal stress when it is in optimal alignment and posture. Proper structural correction is achieved with proper footwear and support. Proper functional mechanics requires skill development and neuromuscular training and is the science of motor learning. The kinetic chain is a integrated functional unit of systems that work interdependently to allow structural and functional efficiency. It is made of the soft tissue system (muscle, ligament, tendon, and fascia), the Neural system ( peripheral nervous system of nerves and the central nervous system or brain), and the Articular system (joints). If any of these systems do not work efficiently, compensations and adaptations may occur in the other systems. A dysfunction in the kinetic chain leads to decreased performance and predictable patterns of injury. Imbalances may result from postural stress, a pattern of overload, repetitive movement, a lack of core stability, and a lack of neuromuscular efficiency. All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all planes of motion at varying speeds. Optimum posture and alignment provides optimal structural and functional efficiency to the kinetic chain. If one component is out of alignment, it creates predictable patterns of tissue overload and dysfunction, leads to decreased neuromuscular control and initiates the cumulative injury cycle. Muscle imbalance leads to abnormal neuromuscular control leads to overloaded tissue and tissue fatigue which leads to inflammation and eventually leads to tissue trauma or injury. The most common patterns of compensation are the Pronation Pattern of the lower body and the Forward Head Pattern of the upper body and these two patterns are the focus of our screen examination and our subsequent corrective preventative exercise plan. Identification of biomechanical imbalances in a way that is specifically related to the multi planner movements and that involves acceleration, deceleration, stabilization and occurs at multiple speeds in those specific body positions and posture activities of daily living. Assessment of the muscular system (functional anatomy) the articular system (functional biomechanics) and the neural system (motor behavior) becomes important in the prevention and treatment of overuse injuries and repetitive strains. In order to live a healthy and active lifestyle, one has to train their body the way it moves during daily functional movements.
Exercise Training and Physical DevelopmentFoot stability and posturing is the most important physical training that you can do to prevent and maintain good foot mechanics and reduce abnormal stresses on the tendons and muscles of the lower extremity. As for Achilles tendonopathy itself, often strength training will cause more tightness and subsequently overload the tendon and make it worse. This overuse injury often does well with soft tissue techniques and laser techniques. By decreasing inflammation initially, strengthening exercises may be less aggravating and more effective. We must remember that our calves are typically strong and tight and overused simply by virtue of the functional demands placed on these muscles as we ambulate. To prevent this from happening, recovery techniques such as massage should be a part of your regular routine.
How can low intensity laser therapy help achilles tendinopathy?
Physiological effects of Low Intensity Laser TherapyWith LILT there is an increased production and release of:
- Endorphins which - natural analgesics
- Cortisol – a precursor of cortisone
- Growth hormone – instrumental in tissue repair
- ATP – improves and regulates cellular metabolism
- An increase in protein synthesis – collagen, DNA, fibroblasts
- A facilitated venous and lymphatic flow
- Increased angiogenesis – the elevation of oxygen saturation
- Enhanced immune response
What life style and self-care measures can you do for yourself to relieve achilles tendinopathy?
- Rest. Avoid activities that increase the pain or swelling. Don't try to work or play through the pain. Rest is essential to tissue healing. But it doesn't mean complete bed rest. You can do other activities and exercises that do not stress the injured tendon. Ask your physiotherapist which activity is best. Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility.
- Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 15-20 minutes, several times a day. Ice packs, ice massage or slush baths with ice and water all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
- Heat. For more chronic tendon conditions, and if the goal is to release tight soft tissue, heat can be helpful in increasing blood flow to the muscle and tendon. This includes deep heat, moist head, and hydrotherapy
- Over the counter Meds. Ask your doctor about medications. You can also try over-the-counter medications, such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others), in an attempt to reduce the discomfort associated with tendinitis.
- Physiotherapy and Massage Therapy. Book an appointment with your physiotherapist and massage therapist for an assessment and treatment. Soft tissue techniques that release the tension in the muscles and or release the myofascial tensions placed on the extensor tendon will not only rehabilitate the injury but also prevent further injury and reoccurrence.
PreventionTo reduce your chance of developing tendinitis, follow these suggestions:
- Develop Strength and fitness. Often those who develop tendonitis have are not prepared physically to perform either the volume or intensity of the activity which they participate in. If your goal is to be active, talk to your physiotherapist to help you develop the components of fitness that are most important to the activities that you do.
- Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.
- Recover from activity and get ready for the next. Ask your therapist about the strategies that are best for you to recover from your specific activity. Heat, ice, massage, baths, stretching and include.
- Warm up first. Before you exercise, take time to increase your core temperature and break a sweat and then stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember, regular massage by your physiotherapist and or your massage therapist helps too.
- Use appropriate footwear for each activity. If possible, get an foot assessment and recommendations from your physiotherapist about the best footwear for you given your specific assessment findings. For some, cushion is important, for others correction is important, some require a lower heel cup and others a more rigid sole to prevent the great toe from being strained.
- Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
- Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
- Ease up. Know your body. If you are not fit to perform the activity ease up, avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest. If you are unable to progress and develop your sport, seek help from a physiotherapist who understands how to develop athletes.
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