Hi!
I'm Ali. I'm one of the physios from
treatmyachilles.com,
and today I'll be talking about isotonic
exercises
as part of our exercise series. In our
exercise series, we'll be talking about
what types of exercises are there for
Achilles tendinopathy,
how do they work, and when should I use
them?
So, for isotonic exercise: In a nutshell,
if you've ever googled
"exercises for an Achilles tendinopathy",
you've probably come up with a calf
raise.
A calf raise is a perfect example of an
isotonic exercise.
Basically it means a contraction with
movement.
So, with a calf raise, you go up off a
step or off
on the floor up onto your tiptoes, and
then you drop back down again, either to
level
or off the bottom of the step. There are
two different phases to this isotonic
movement, as there are with any isotonic
exercise:
the concentric phase and the eccentric
phase.
The concentric phase means the
shortening phase, so when the muscle
contracts and shortens as you move.
So with the calf raise, that's the way up.
And then the opposite... the opposite phase
be the eccentric phase,
and the eccentric is where the muscle
lengthens as it contracts,
so that's the way back down again.
Now, there's been lots and lots of
research about which is the better
option for Achilles tendinopathy, and
people have looked at just the eccentric
component
or they've looked at both the concentric
and the eccentric component.
And really, the summary is that both are
important,
and both are important to be
strengthened.
If we think about our Achilles and the
anatomy
and why an isotonic exercise might work:
If you think about your calf,
your calf is made up of two different
muscles. Those muscles are called
your gastrocnemius and your soleus. Your
gastrocnemius and your soleus are your
big thick calf muscles at the back
that come down and attach into your
Achilles tendon to your heel.
If we were to take a microscope and look
inside that Achilles tendon,
what you'll see is lots and lots of
fibers of collagen
in big bundles next to each other. So if
you
took a pile of uncooked spaghetti and
held it in your hand with all of the
spaghetti hanging in this direction:
essentially lots and lots of those
bundles of what your
Achilles would look like. When you get an
Achilles tendinopathy,
some of those fibers - and not in every
bundle, so not every bundle, not every
fiber, lots and lots of them stay healthy -
but some of those fibers become affected.
So if you were to look at those fibers,
they look less organized, so they're not
in such
linear lines - they're a bit more
higgledy-piggledy... An example would be
if your spaghetti was a bit saggy.
So what we need to do, is strengthen both
the
calf muscles that create the Achilles
and the Achilles itself by doing some
strength exercises.
One of our body's natural systems is
called...
One of the systems in our body that's
quite natural and is happening right now
is called the collagen cycle. So, as we're
both sitting here
- you're watching this and I'm talking -
this is happening in our bodies.
So our collagen cycle is where our
bodies
take away old cells that we don't need
in our collagen anymore
and replenish them with new cells.
Therefore it promotes a nice
healthy tendon by replacing those
collagen fibers on a regular basis.
We know that exercise promotes this
cycle and therefore we know that this
can make your tendon more robust
and is strong. As to how this works,
there's quite a few theories out there,
and no one particularly knows exactly
why strengthening exercises helps in
Achilles tendinopathy.
One of the theories is that those fibers
that aren't quite in those linear lines
anymore
revert back to being in that position.
The second theory is that, particularly
if you've had your Achilles pain for
quite a number of months or years, it may
be that
instead of those bits reverting back, all
of the collagen fibers in that bundle
around it and all those other bundles
just become more strong and more robust
and so
protect those fibers... and that creates
it
like a brace or a splint, so it makes it
feel a lot stronger.
The important thing to notice when we
start doing these strengthening
exercises, it's all about making your
calf and your Achilles more robust.
So, we're looking at function, and we're
looking at how you're doing for quite a
number of days or
weeks into this program, and that is when
after that number of days or weeks, when
your tendon becomes more robust,
do you then start thinking, "Oh, my
symptoms are settling now and they're
calming down!...
So essentially, "When do I use my
isotonics? How do I know that they're for
me?"
Really get a guide from a professional,
because everybody has a different
starting point. You'll be chatting to
some people that have already had
Achilles problems
and they'll be telling you, "Oh yeah, I can
do these really easily! I'm
lifting weights and doing these isotonic
exercises." And other people saying, "I
can't do them at all because my pain is
too sore!"
Everybody comes from this from a
different starting point, from health and
fitness levels,
from problems with other injuries in
that leg,
and also everybody has a different...
end point.
Some people like to run just around the
block, other people like to do ultra
marathons.
So it's important that you are looked at -
at what your tendon can do now,
and how your symptoms respond to
activity, and how far we need to progress
those exercises up to get you back to
your goal.
So please, do seek a professional or have
a look, a little bit more at our website
for any more information. Thank you very
much, bye!