Heather: Ever had pain at the back of your leg where your calf meets your heel? If so,
it could be caused by your Achilles tendon. This is a really common injury amongst runners
and one that actually needs a unique treatment style. Today, I'll be addressing the warning
signs of Achilles tendinopathy, how to prevent it, and if we are a little bit too late, also
how to treat it. [music]
Heather: As the name alludes, Achilles tendonitis or tendinopathy is a problem with your Achilles
tendon, but maybe that's not made it any clearer what is the tendon and what is your Achilles?
A tendon is actually a thick, fibrous band of connective tissue that connects your calf
muscles into your heel. To be more precise, it's actually your soleus and your gastrocnemius
muscle and attaches them into your calcaneus which is the bone at the back of your ankle
or the back of your heel. You can actually palpate yours pretty easily.
If you sit with your foot at a 90-degree angle, so maybe your foot's on the floor, you run
your hand down the back of your calf, you'll get to the stage where you feel that thick,
fibrous band at the back of your leg and that is your Achilles tendon.
It plays a rather crucial role in running, walking, jumping, anything that involves you
pushing off from your foot, and as a result, it needs to be able to withstand huge amounts
of force repetitively. You might have heard of some people snapping their Achilles tendon.
This is rare, but apparently it sounds like a gunshot going off, as there's so much force
going through that area and your calf muscle then will, as a result, shoot up your leg.
That sounds pretty gross, I don't mean to scare you. It's very rare, but today we're
focusing more on the chronic injury of the Achilles tendon.
[music] Heather: We've identified the affected area,
so let's take a closer look at tendinopathy. You might well have heard of terms such as
tendinosis, tendinitis, and tendinopathy. It can get a little bit confusing, but basically,
tendinopathy covers all of the aforementioned, so we don't get any more bogged down with
that. It's now time to address what's actually going on with a troubled Achilles, and what
the signs are for Achilles tendinopathy. It usually first presents itself as pain in
the actual area during running and after running, and if very acute or severe you might find
that it's aggravated by walking either during and after. Sometimes it can be sore to touch
in the area, as well, and you'll usually find that it's quite stiff. If you try to stretch
your Achilles tendon out, so basically bringing your toes up towards your shin bones, then
that can feel uncomfortable. You might see some swelling around the area, and a crepitus-type
noise if you try and move your ankle, so basically that crunchy sort of feel.
Due to where your Achilles tendon lies on your body, you'll find that when you're asleep
at night it tends to be under less tension, because you naturally sleep with your toes
more pointed. As a result of that, when you go to take your first few steps in the morning
you're putting your ankle through that full range of movement, and that can be really
uncomfortable until it starts to ease off and warm up a little bit.
The same goes for if you're sitting for prolonged periods of time, those first few steps afterwards
really need to be easing gradually because it will be very stiff, but on the opposite
end of the spectrum if you do any exercise that's too vigorous then that can obviously
make it worse. Achilles tendinopathy tends to be common in
runners who increase their mileage too quickly. There's also a rise in cases of those in their
40s, and this could be due to the fact that it's common for this age group to do a lot
of exercise on the weekends, but not having much time to do so much during the week, so
their bodies aren't conditioned for that sudden increase in load.
Guys, I hate to break it to you, but the stats actually say that men are more susceptible
to Achilles tendinopathy than women, but also it does increase with age due to the fact
that the connective tissue is naturally getting a little bit more brittle and weaker.
After all of that bad news, you will be pleased to hear that there are several factors you
can control such as calf tightness and obesity, for example. Also when it comes to your training,
you need to make sure you've got a nice supportive trainer that isn't worn out. You also want
to keep that area warm and covered especially when you're training in winter, and make sure
you don't allow your calves to get too tight. Yes, you can control the controllables. That
said though, Achilles tendinopathy can still occur and that's where we need an expert because
the treatment for Achilles tendinopathy is a little unusual, so I'm heading out to pick
the brains of physiotherapist, Claire Wheller. [background noise]
Heather: The Achilles, I know is very unusual in the way it needs to be treated. What is
so different about the treatment for an Achilles tendinopathy?
Claire: It's looking at the actual tissue of the tendon, because it's the muscle attaches
then into the tendon, and then into the bone. It's that bridging factor. The tendon tissue
is like a spring, so it needs to be stretched, but not overstretched and then recoil, like
what's happening with when you're walking or when you're propelling yourself in running.
The other factor that we have to take into consideration with the Achilles is its poor
circulation, so the healing takes that much longer. The problem is bad loading like running
and jumping too soon is detrimental to the tendon, because it can cause damage, so you
need to decrease the loading and you need to, therefore, decrease the pain. It's the
body's way of making the tendon have the ability to take load.
The best research that has been shown for tendons initially is to get that loading and
that tensile strength back in the tendon, is to do very slow heavy loading of the calf,
so that you're strengthening both aspects of the calf muscle, your gastrocnemius and
soleus to regain the tensile strength back in the tendon. What people tend to do is do
things too quickly because it hasn't got enough tensile strength, which is different to the
muscle. Heather: How do you know when it's ready to
start loading? Claire: That's why it's good to be doing it
alongside with a physiotherapist so that they're slowly bringing in the eccentric loading to
then gradually get the tensile strength back in that, then bringing into a contraction,
and then slowly working into the plyometric training before you go on to doing your running
and walking. Well, obviously, you can do your walking but the running part.
Heather: What is the exercise or exercises would you prescribe?
Claire: The sort of exercises you want to prescribe for it is putting a pillow across
here, a dumbbell, taking your toes right up and then slowly, slowly lowering yourself
down, and doing it with a heavy weight, and doing 10 to 12 reps of that three times and
doing that regularly. That's one of the first exercises you want to do.
Heather: A weight on your lap, so to speak? You're sat at what? Knees at 90 degrees and
ankles at 90 degrees? Claire: Yes, that's right.
Heather: Are you bringing your toes up or are you trying to drop your heels off a platform?
Claire: You're bringing your heels off the platform, so your toes starts at the top and
then you come off a platform to slowly get that tensile strength back into the tendon.
Once you've got the tendon strength again then you can start rebuilding it, but people
try to do things too soon and it ends up, because it's tendon tissue, it's connective
fibrous tissue, which is different to the muscle as well.
Heather: Just remind us. How many we do, and what speed?
Claire: We do it very slowly and that's what they've shown with the research. You do 10
to 12, roughly reps. You do that three times, and you would do that two to three times during
the day. Heather: How heavy a load?
Claire: Quite heavy actually. They've shown that you want a real sandbag or something
really quite heavy on you, a little child or something like that on you to just end
up just getting that [00:07:38] load. It's not too light, because the research, they
need to get the tensile strength in that before you start trying to do the plyometric work,
which people then start doing the running too quickly, and that's why they then go around
in that vicious cycle. Heather: I know it's your individual, but
can you give a rough idea of how we would progress from that and how many weeks you'd
have to be doing? How often before you could start?
Claire: You would probably do that for a good week to 10 days of doing that one, plus a
standing one where you're bringing in your gastrocnemius and soleus, loading it with
your body weight. Heather: That's just down to 90 degrees?
Claire: Yes. Because if you've got an Achilles problems, you don't really want to overstretch
it at that time, because you need the tensile strength to get that elasticity back in the
area through. Then you come back to your physio and then they progress it on depending on
whether you're getting any symptoms. They'd bring in some centric exercises once they
know that the tendon is nicely healed, and you're not getting any symptoms. Then you
bring in your plyometric hopping through, because you do need that elasticity again
to get that sprinting movement through with your running.
The other of the factor always with training, when you're doing running it's making sure
that you've got your strengthening program and your loading program in there at least
twice a week to make sure you're getting the tensile strength and the loading. Going to
the gym and doing the strengthening program has been shown to be doing that twice will
make a difference to you. Heather: Final question, I think is, what's
are the warning signs if you've got some niggle or something? When do you know that this could
be an Achilles tendinopathy and it needs to get treated?
Claire: You've got to be really careful if you're seeing any increase in swelling around
the paratendon as the tendon comes in. If any hotness, warmth around the area, redness,
difficulty when you're trying to go up onto your toes and it really hurts, with tendons,
you don't want to try and run through that area, because you do need to get the loading
back in that tendon. The other thing is if it is really burning
and you're getting a lot of cramping, you do need to be careful, because you can have
that bit where you don't push off, and you suddenly get that pick kick in the back of
the calf which could be a partial rupture or a full rupture. You definitely do need
to go and see a sports physiotherapist or the doctors, because there's a couple of tests
that they can test to see if it's-- [crosstalk] Heather: Is there any way that's really obvious
to tell whether it might be a calf problem or an Achilles problem? Because obviously
there's such different treatments, but without going to see a professional.
Claire: The thing is, the problem with tendons is it can be something you've done a couple
of months ago, so you don't pick up on it, and then it slowly, slowly builds. With the
calf muscle, you tend to feel that you've pulled it straight away and you get the bruising.
You actually just get weakness in that muscle straight away. That's why when people are
up in their mileage with marathons and everything, they don't realize they're getting a slight
tendinopathy. You've also got to also, like you've said,
be careful with the trainers, that the tab is not going into the back or any compression
on the tendon because it can build over a period of time. Whereas, muscular injuries
are much easier to pick up because they happen instantaneously. You might have done something
two, three months ago, and thought nothing of that, and then, suddenly, you're getting
this pain. Heather: That's good to know. Cool. Thank
you so much, Claire. A big thank you to Claire for her expert advice there. As you can probably
tell, Achilles tendinopathy is a slow recovery process. I would seriously recommend doing
all you can to prevent it in the first place. If you do have any early warning signs, then
listen to them and do what you can about it now to avoid too much frustration in the long
run. If you have been unfortunate enough to have
an Achilles problem and you've come out the other side and you've recovered from that
injury, then let us know how you got on, what worked for you. You can share those in the
comment section below. Whilst you're there, give us a like and a follow.
[00:11:20] [END OF AUDIO]