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#218 - 2475 Bayswater Street, Vancouver, B.C. V6K 4N3 604-732-4665
Achilles TendonitisBy Peter Roach, RMT, CNMT, Laser Therapist
Many of my patients are runners. Some compete at a high level while others are more the fun-run kinda people. With COVID-19 I’m sure all organized runs have been cancelled however that hasn’t stop my patients from getting out there and continuing to train. But some of you are experiencing tightness or pain in the achilles tendon or at it’s attachment on the heel.
So what do we do with this? If you’ve been keeping up
with my newsletters you will find it’s similar to Tennis/Golfer’s elbow, or Groin Pulls. It’s the same type condition only on another part of the body. However it can be somewhat different as well.
There are 3 continuous stages of Achilles tendonitis, reactive tentinopathy, tendon disrepair, and degenerative tendinopathy. And the two main categories depends on the location of the tendonitis, either what is
called insertional, occurring at the heal attachment and noninsertional tendinopathy, meaning feeling pain in the area 2-6 cm above the heal.
Let’s further explore this most common condition.
Peter Roach, RMT, CNMT, Laser Therapist
The Achilles tendon is a tendon that is made up from the Gastrocnemius and the Soleus muscle.
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#218 - 2475 Bayswater Street, Vancouver, B.C. V6K 4N3 604-732-4665
Achilles tendonitis is one of the most common conditions I see in the office. Although most of the patients I see who complain of this are active in running, training, etc. it also occurs in more sedative patients as well.
Studies have shown that achilles tendonitis is more common in older people, with only approximately 25% being young athletes.
There are 2 risk factors in developing tendonitis, either intrinsic or extrinsic or a combination of both.
Intrinsic factors include: -posture -biomechanics abnormalities (such flat feet)-limited mobility of the ankle Extrinsic factors include: -running (especially hill runs) -overload of the tendon (such as weight lifting or too many repetitions) -increase in mileage when running -stop/start sports (such as tennis or squash)-poor footwear.
The achilles tendon is a rounded type structure that is white and somewhat elastic. Think of those chicken wings and thighs and the white part. The cells are predominately tenoblasts and tenocytes, making up more than 90% of the structure. The blood supply is most abundant on either end of the tendon, whereas the area 2-6 cm above the heel is the least vascular area, hence injuries in this area can take longer.
Usually in the acute phase of Achilles tendonitis the area will be inflamed and if we can catch it in it’s early
stages the prognosis is good. As it progresses the tendon will become thicken and uneven. This is the time I usually hear about it. At this point it becomes more difficult.
This is a very complicated condition, and much research has been conducted on the cellular changes that occur. Studies show that there is so much change in the cells, the tenocytes, tenoblasts, collagen, fibronectin, tenascin, aggrecan, biglycan and more, that this becomes a difficult condition to treat. The pain may originate from multiple factors such as increase in prostaglandins, neovascularization in the tendon body, changes in the structure of the tendon, and various chemical irritants that may be the source of pain. I don’t want to get overly technical and what you really want to know is how to get better!
So how do we address this one. Let’s look at this. Read on.
Peter Roach, RMT, CNMT, Laser Therapist
Treatment consists of ...
• Icing - to reduce swelling
• Anti-inflammatories - prescribe by your physician
• Massage therapy - to break adhesions
• Light therapy - to increase healing
• Kinesio tape - to increase blood flow
• Exercises - to stretch & strengthen area
So what is Achilles tendonitis exactly?TA
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Treating Achilles tendonitis in the office.
#218 - 2475 Bayswater Street, Vancouver, B.C. V6K 4N3 604-732-4665
Once I have established the severity and the location of the tendonitis, treatment can begin. Again protocol for any acute tendonitis is as follows,
• rest
• ice
• compression
• elevation
• anti-inflammatory (prescribe by you doctor)
To speed healing additional treatment may include:
Massage - deep friction massage and tendon mobilization has been shown to increase protein output and restore elasticity, restoring reduced strain in the muscle-tendon unit.
Ice application - reducing the metabolic rate of cells and reducing pain, however not clear with studies that this actually is effective.
Stretching - studies have shown the eccentric exercises are beneficial in the early stages. Eccentric (lengthening exercises) help in reducing pain and improving the healing process by strengthening and lengthening of the muscle unit.
• Light therapy - studies show that light therapy could reduce the inflammatory makers, increase collagen production, and stimulate the healing process
• Kinesio Taping - to help support the therapies above. This can help to reduce friction between the tendon and the surrounding sheath.
Unfortunately there is no Gold standard of the treatment of Achilles tendonitis because of the controversial clinical results between various studies. However from almost 40 years as a massage therapist I have found the earlier we can begin treatment on the achilles the better the outcome.
Let your therapist know the moment you start feeling something in this area. It may mean the difference of getting back to the gym or suffering for many months of chronic heel pain.
So what exercises to do? Well read on.
Peter Roach, RMT, CNMT, Laser Therapist
Treatment for Achilles TendonitisTA
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How I use Kinesio Tape to treat Achilles tendonitis.
#218 - 2475 Bayswater Street, Vancouver, B.C. V6K 4N3 604-732-4665
Exercises for Achilles TendonitisTA
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Contact me at [email protected] if you need help with groin pulls
Bayswater Neuromuscular Massage Centre - Peter Roach218-2475 Bayswater Street - Vancouver, BC V6K 4N3 - 604-833-6269 -
AK5103: Soleus Calf Muscle Stretch for Peter Roach Exercise 5 of 8
Category Stretch Rehab Level Beginner Muscle(s) soleus, CalvesPurpose Correct ankle imbalances and restore function.Benefit Increases flexibility, improves joint range of motion, and
improves circulation.
Body Part Ankle Equipment None
START: Begin standing with leg to be stretched extended behind body facingwall. Leg should be straight with heel flat on floor.MOVEMENT: Bend front knee slightly slowly setting hips back allowing rearleg to bend while maintaining heel-floor contact. A gentle stretch should befelt in lower calf muscle. Hold for 20-30 seconds. Repeat for prescribedrepetitions and sets. Alternate sides as directed.
Instructions/Calendar: 04/10/2020 - 04/24/2020 (2 weeks)
Sets 1 Time 30sec Freq Daily CommentsReps 3 Rest 0
Apr 10 Apr 11 Apr 12 Apr 13 Apr 14 Apr 15 Apr 16 Apr 17 Apr 18 Apr 19 Apr 20 Apr 21 Apr 22 Apr 23
AK1118: Single Leg Balance for Peter Roach Exercise 6 of 8
Category Exercise Rehab Level Beginner Muscle(s) gastrocnemius, soleus, peroneus longus/brevis, tibialisanterior, tibialis posterior, Calves
Purpose Increase ankle strength and muscular endurance.Benefit Improved stability, functional strength and injury prevention.
Body Part Ankle Equipment None
START: Begin standing with feet flat on floor. If necessary, grasp stable chairwithout wheels for additional stability.MOVEMENT: Lift one foot off ground, bending at knee. Attempt to balancefor 30 seconds. Return to start position and repeat for prescribed sets.
Instructions/Calendar: 04/10/2020 - 04/24/2020 (2 weeks)
Sets 1 Time 30sec Freq Daily CommentsReps 5 Rest 30
Apr 10 Apr 11 Apr 12 Apr 13 Apr 14 Apr 15 Apr 16 Apr 17 Apr 18 Apr 19 Apr 20 Apr 21 Apr 22 Apr 23
If you experience an exacerbation or have a change in medical condition, you should promptly seek appropriatemedical advice.
© 2020 WebExercises, Inc. All Rights Reserved.
Bayswater Neuromuscular Massage Centre - Peter Roach218-2475 Bayswater Street - Vancouver, BC V6K 4N3 - 604-833-6269 -
AK1116: Single Leg Heel Raise for Peter Roach Exercise 7 of 8
Category Exercise Rehab Level Beginner Muscle(s) gastrocnemius, soleus, CalvesPurpose Increase ankle strength and muscular endurance.Benefit Improved stability, functional strength and injury prevention.
Body Part Ankle Equipment None
START: Begin standing with feet flat on floor. Bend one leg at knee, liftingfoot off ground.MOVEMENT: Lift other heel off ground and pause momentarily. Return tostart position and repeat for prescribed repetitions and sets.
Instructions/Calendar: 04/10/2020 - 04/24/2020 (2 weeks)
Sets 3 Time 0 Freq Daily CommentsReps 10 Rest 30
Apr 10 Apr 11 Apr 12 Apr 13 Apr 14 Apr 15 Apr 16 Apr 17 Apr 18 Apr 19 Apr 20 Apr 21 Apr 22 Apr 23
AK5101: Calf Stretch with Towel for Peter Roach Exercise 8 of 8
Category Stretch Rehab Level Beginner Muscle(s) gastrocnemius, soleus, tibialis posterior, CalvesPurpose Correct ankle imbalances and restore function.Benefit Increases flexibility, improves joint range of motion, and
improves circulation.
Body Part Ankle Equipment None
START: Begin seated in a chair or on a firm surface. Extend one leg and placea towel around ball of foot and grasp with both hands.MOVEMENT: While maintaining good sitting posture, extend leg fully as armspull towel until gentle stretch is felt in calf muscle. Hold for recommendedduration. Repeat for prescribed repetitions and sets.
Instructions/Calendar: 04/10/2020 - 04/24/2020 (2 weeks)
Sets 1 Time 30sec Freq Daily CommentsReps 3 Rest 0
Apr 10 Apr 11 Apr 12 Apr 13 Apr 14 Apr 15 Apr 16 Apr 17 Apr 18 Apr 19 Apr 20 Apr 21 Apr 22 Apr 23
If you experience an exacerbation or have a change in medical condition, you should promptly seek appropriatemedical advice.
© 2020 WebExercises, Inc. All Rights Reserved.
