[Music]
Hi,
I'm Ali, one of the physios from
treatmyachilles.com,
and today we're going to be talking
about flare-ups and why flare-ups may
not necessarily be a bad thing.
Flare-ups are so common when people have
an Achilles tendinopathy.
They are a change in the symptoms that
we are perceiving.
So those symptoms can be pain, they can
be stiffness, particularly
first thing in the morning when you put
your feet to the ground, or after you've
had a rest from doing activity and then
get back up again,
or general soreness, especially if you
were to prod around the Achilles
tendon.
Now, a flare-up is a change in those
symptoms for the worse,
but that is it; there is no other
correlation to
a change in the pathology, i.e. what is
going on inside your tendon.
A flare-up and change of symptoms
doesn't relate to harm, so it doesn't
relate to deterioration
or that problem getting worse, and most
of the time,
unless there is an obvious reason behind
it, there isn't a need to change the
diagnosis.
Nothing else has happened within that
tendon. So we know that a flare-up is a
change in
symptoms; it is not necessarily a change
in what is going on.
And a flare-up in symptoms can be really
demotivating,
particularly if it's stopping you from
doing the rehab exercises to get better,
but more importantly things that you
like to do in your
day-to-day life or your sports,
particularly
if you can't then go out and do the
things that you love and enjoy.
So what we want to do is examine what
are the main causes for
flare-ups within this discussion and
then we'll have a look at some ideas
about how
that might give us some information for
the future, so
we can then learn from this flare-up and
therefore stop this from reoccurring
or manage them better if they were ever
to happen again.
So, some of the common reasons why
flare-ups might occur:
One of them can be that there has been a
change in our load
or change in our activity. This is the
most common,
and it's something that if you were to
start experiencing increase in symptoms,
it might be worth sitting down and
looking back over the last few weeks
or months to find out whether there's
been a change in your activity
or load. Some of this may have been in
your control,
and some of it may not be. So examples
could be
going on holiday or visiting people
where your lifestyle is changed and
you're not doing your normal day-to-day
things,
and then coming back and going back to
your normal lifestyle. So that could have
been doing less
and coming back and doing more, or doing
more while you're away
and then coming back and having to deal
with having done more activity than you
would normally do.
It also could be something to do with
illnesses or time where you've had
to have a layoff from doing your
activity and you start back
where you were prior to that illness, so
you've had not
something where you've been working
quite hard, not very much,
and then working quite hard again. Or you
may have changed your training program.
Your training program might mean that
you've changed the intensity and how
you're working,
change the terrain that you're working
on, and you might have increased the
frequency, so how often that you're doing
sports.
You might have thrown in a totally new
different activity that you thought you
might like to try.
Another example, and speaking from
personal examples here:
I went camping and wore a pair of
flip-flops for three days solid, I think
maybe four days solid, where I did 18 000
steps each time
and then wondered why I felt different
in my calf and my Achilles at the end of
that
than I did before. So it's something to
have a look at;
it's something to consider: what you've
been doing and is there something
different or odd that has meant that
there is a change in your load or your
activity.
This then gives us some ideas about what
we might be able to do in the future.
So if there has been changes in your
intensity or your frequency
or how much recovery you've been having,
they are things that we can then plan
for when we look at your training regime,
or if you've got a particular event to
work towards,
or a holiday coming up. The second
reason might be that you've just stopped
your rehab exercises. Your Achilles was
feeling a lot better,
you've got back into doing the things
you want to do and you've gone off the
boil with a bit of the exercises.
Totally normal, and totally normal human
behavior.
Things feel better, we don't necessarily
remember to do the exercises anymore or
we get out of the habit of doing them.
But also you might be feeling like "Well
gosh, these exercises again.
Oh I do these every day and I'm looking
into the future and I'm seeing myself
doing them every day still."
It's not the most motivating thing. So
trying to find a way where these
exercises become part of your daily
routine, so you've done them without
really thinking about them,
or your weekly routine, depending on how
often you're doing them,
so they become just as ingrained into
your lifestyle as cleaning your teeth
is. So, a good way of trying to get around
this
"Oh gosh, I've got to do these exercises
again!" feeling
is trying to attach them onto a habit
that you already have.
So could you do them for example while
the kettle's boiling
and you're making a cup of tea,
especially if you're from England.
Or if you are from somewhere else or
you don't like tea and you do something
different,
can you attach it onto when you are
standing by the sink and brushing your
teeth and cleaning
and getting your hair sorted? Is there
times where you go to the gym
anyway and it will only be five minutes
to add your exercises
in the gym at the end of your program? So
one way is attaching it to a habit that
you already do,
and if you attach it to that habit
you're more likely to remember to do it,
and it's more likely to be habit forming
for you to do them in the days to come.
Another reason why a flare-up might have
happened is that the exercises haven't
been progressed.
So if you're sitting with the same level
of exercises and strength, which are one
of the most fundamental important things
in the treatment of an Achilles tendon,
and these exercises have just bumbled
along, are at the same sort of level,
they've not been made more difficult
when you've been able to do them,
and then you're still trying to do your
sporting activity on the top
or increase your walking activity. What
you then might find
is that you need to consider building up
those exercises to go alongside the
activity that you're doing.
If we went to the gym and started
lifting two kilo
bicep weights, we're trying to get big
biceps, we're not gonna get that with two
kilos.
And if I tried in a year's time to
suddenly start lifting five
kilos, I'm still not going to be able to
do it: I've trained at two kilos and no
heavier.
So it's about progressively loading
and making the exercise more difficult
and knowing when to do that. And
discussing that with a
professional is a good idea. So things to
take away from this:
Don't despair if you're in a flare-up.
Flare-ups happen
and flare-ups settle. They settle by
reducing
some of the more aggravating factors
that you're doing in your exercise
routine.
And to have a look at one of our other
videos about how
pain can give us clues about how to
structure our rehab
would be a good starting point. It also
means that we
can dial down the exercise program that
you may have been prescribed.
And there are different levels; Like we
need to progress, there are also levels
below,
and we can start at a different level
that can help calm this pain down
and build up the robustness of your
tendons so you're able to go back and do
activity again.
Then we need to look at the training and
was there a pattern
in the last few weeks to months? And if
there was a pattern, can we change that?
Can we look at your rest and recovery?
Can we look at how frequently you're
doing your exercises?
Can we have a look at what type of
exercise you're doing and how intense
you're working
and come up with a plan? So please do not
despair.
And if you need any more questions,
please always feel free to book a quick
call with us or email.
And you're very welcome to also book an
appointment. Take care! Goodbye!