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Hi guys!
In this video I'm going to talk about
the myth that seems to be doing the
rounds that
the pain that you feel in your Achilles
tendon when you have a tendinopathy
is due to micro-tears in that tendon,
because it's just not true.
So, 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
Achilles tendons,
all via video call. Have a look at the
description of this video if you want to
link to our website.
Okay, so why is it important to
understand
that it's not actually micro-tears in the
Achilles tendon causing your pain?
Well, it's because it's freaking scary to
think that you're walking around with
loads of micro-tears,
and I've had quite a few patients being
really frightened of tearing their
Achilles tendons
where they didn't really have to be. So,
I couldn't quite understand why people
would think
there are micro-tears in it, and then I
realized this is because actually
they think it's the same as when you do
exercise and strengthen your muscles.
And you know how people, especially the
guys who
do a lot of weight training, talk about
tearing the muscle and
getting it to grow bigger? So they... they
assume that it's the same thing that
happens in the tendon.
Now yes, Achilles tendinopathy is caused
when you overload the tendon,
and it's quite often when you don't
allow enough recovery time. So when we
exercise,
you do get micro damage - not micro-tears -
micro damage which doesn't have to be
tears. It's single cells that are...
that sustain damage and it doesn't have
to be that they torn...
after exercising, and that repairs and you
grow stronger.
And it's when you don't allow that
repair cycle to fully happen and you
keep on training
before the repairs happen that you
then accumulate micro damage
and then you get Achilles tendinopathy.
Now also it doesn't mean that you
accumulate micro-tears;
it's different. Let me show you what it
looks like under a microscope.
So the first slide is of a healthy
tendon.
So if you look at a healthy tendon under
a microscope, you have loads of
collagen fibers that's aligned parallel
with each other,
and that's what makes it so strong.
Because if you think of... if you take
one piece of string you can easily snap
it, but you
have a lot of strings next to each other
in parallel
and you try to snap it: not gonna happen,
really strong structure.
You'll also notice there's a few cells
in there, the little round things,
and there's a little bit of white stuff
in between
that's kind of like a gooey stuff in
between there: that's a healthy tendon.
Now, if you start to develop a
tendinopathy,
what you see on a microscope is this
slide:
So you're seeing that these fibers are
now moving a little bit further away
from each other.
Those aren't tears, it's just the fibers
that's not that closely packed anymore
because you've got more of the fluid
stuff in between.
You're also getting a different type of
cell in between them,
and then, if it progresses even further,
that's how it looks: So in this slide
you'll see it...
it looks like a bit of a mishmash and
it's because the collagen fibers are now
no longer parallel with each other,
they're kind of disorganized and
that's what it looks like when you have
a tendinopathy.
So it's not a tear, it's not scar tissue,
it's mal-aligned
fibers and cells and things. So the
structure has changed in there,
and you can turn that around. So a
carefully graded strength training
program
can realign those cell, those fibers, also
helps you to produce
stronger collagen fibers and things
again. So,
getting through a really proper
structured rehab program
is a very important thing when you have
this. So the main message here
is: don't be worried if you've been
thinking that you've got micro-tears in
your tendon,
you don't. Yes, you can get tears in the
Achilles tendon,
but with tendinopathies most of the time
it's just that the structure has changed
a little bit in there because you've
overworked it, it's not tears.
Now, if you need more help with your
injury, you're welcome to consult us via
video call.
Link to our website is in the
description of this video.
But yeah, let me know if you've got any
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questions!