Hi, guys!
In this video I'm gonna address a
question
that's asked quite commonly to me and
that is "What
exercises should I be starting with?" So
I'm... I'm often emailed or messaged by
people saying...
They give me the whole history written
down of "My Achilles hurts there, this is what
I've done,
blah blah blah, what exercise should I
start with?"
And to be honest, I don't know. It depends
on quite a few things. So let me explain
to you how I decide what exercises you
should start with.
For those of you who don't know me, my
name is Maryke. I'm one of the
physiotherapists from treatmyachilles.com,
where you can get online physiotherapy
assessment as well as treatment for your
injuries.
So have a look at the description of
this video if you want a link to our
website.
Yeah, and it's quite funny to think of
that question as well. People get quite
angry as well with me in the comments of
the videos sometimes about
"You've got to demonstrate the exercises!"
But honestly, I don't demonstrate the
exercises because it's a waste of my
time and it's a waste of your time and
puts you at risk of doing exercise
that's not right for you.
The reason I don't know what exercise
you should be doing, even though
you send me two pages full of your
history, is because
it depends on more than just your
history. Plus you often don't even answer
the questions that I need to know...
to know how reactive your tendon is. So
the first thing that decides
what exercises you do is how reactive
your tendon is - so how
easy is it to flare it up - and I get that
information from
the detailed conversation we have before
we start testing you. So
things like the activities you can do at
the moment,
how it feels first thing in the morning,
how does it feel if you do little bits
of extra activities.
Then also when we test you I get to see
how
the pain reaction is after I make you do
certain things.
Then the second step is this testing
procedure.
So I will make you do physical movements
and tests in front of the video
so that I can see your quality of
movement... can see how easily you get to a
number of repetitions,
how many repetitions of the different
exercises - heel raises and things - you can
actually do,
because that tells me about the capacity
of that tendon and
of the calf muscle complex. And then,
depending on your history, I may even
make you do high impact stuff like
hopping or jumping,
but I won't do that for every patient. It
will depend on your history that you've
just told me.
Because for instance, I had a patient the
other day who...
her tendinopathy started because she was
taking fluoroquinolone antibiotics,
and they are known to weaken tendons. So
she had no pain
and she probably could have hopped for
me if I asked her to, but it would
likely have caused quite detrimental
effects, because
I had no idea of knowing how strong that
tendon is,
because those tablets have a way of
really weakening it.
So it would have been dangerous for me
to make her hop, so I didn't make her hop.
I rather waited until we strengthened it
up before I made her hop.
So that's the second way how we then
decide what your tendon can cope with.
And then we also want to look at the
total load in your week and in your day,
because it's not just about those
specific exercises you do,
it's also about your other activities.
Are you able to cope with any running?
Are you able to cope with any walking,
or not at all? Because that will depend
what exercise I get you to do,
the frequency of those exercises I make
you do, as well as what other activities
we put in there.
So I know it feels like quite a simple
question to be posing, but actually
there's a lot of
ifs and buts that go into it to figure
out the right program for it.
So
ah, I nearly forget... forgot that: You've
got to remember that's
all about the Achilles tendon, but then
also
there are other exercises that may be
useful as part of your treatment,
because we've got to look at the cause
of this. So most of the time it's just
a plain old overload that training or
something caused you to have a spike in
your...
in your load and that caused it to flare
up, but sometimes there's a lack of
muscle strength and key muscle groups,
like your glutes or your hamstrings,
so that you're not actually getting the
support from those muscles,
and it causes the Achilles to overload,
so we've got a test for that as well.
And then there's always the lovely old
sciatic nerve, where
low-grade neural tension... I've made a
video about that if you want to know
what
it is... can actually cause or
contribute
to tendon injuries, and we've got to test
for that as well, whether you've got any
elements of that.
And, then also how sensitive it is
depends...
will determine... how sensitive your
sciatic nerve is will determine what
exercises
I prescribe for that. So yeah,
that's a very long way of saying "Don't
get angry with me when I don't
demonstrate exercises."
It's just not possible. There's so many
different varieties
that I can't demonstrate all of them and
tell you which person has to do what.
So let me know if you've got any
questions, and if you need more help with
your injury,
you're welcome to check out the link to
the website is in the description of
this video.
Yeah, take care!