[Music]
Hi guys!
In this video I'm going to discuss why
you should not
confuse heel drop exercises that you do
for Achilles tendinopathy
with stretching, because it's two very
different things, and the one is helpful,
the other one not.
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 your injuries.
Have a look at the description
of this video if you want a link to our
website.
Okay, so heel drop exercises: what do I
mean with that?
I think it's easiest if I just
demonstrate.
So you'll notice my step today is just a
thick book.
Anything will work for them really, as
long as it allows you to drop down the
level...
below the level of the floor. So with the
heel
drops you can get many forms. Some people...
some people have to do them double leg
at the start.
You get single leg going up and down where
you drop below the level of the step.
But then you also get the classic
eccentric ones where you go up on two
legs:
Lift one up, slowly down,
to be repeated. Now,
because of the stretch effect you get
down there,
people see these exercises and then they
think it's all about the stretch,
and they end up spending loads of time
in that position,
and guess what? Then quite often they end
up
really making their tendon worse. Now the
reason for that
is twofold. Oh well, there's plenty of
reasons for that. Let me explain
some of them. So you know how your
tendon feels quite stiff, especially
first thing in the morning, and tight
when you wake up, and it just feels as if
you really want to be stretching it?
Now that stiffness that you feel is a
sensation. It's not true stiffness, it's
because of the...
the extra fluid and things that
accumulate in that tendon and the
injured tissue in there.
You can stretch until the cows come home,
that... that stiffness will remain.
Yes, it will go off for a little bit, but
it'll come back and tomorrow morning
it'll be stiff again. And that will stay
until that injury is healed. So it's the
injury that makes it feel stiff, it's not
that the tendon is stiff and needs
stretching.
And I know this because there's actually
research on this.
The very expensive ultrasound machines
these days that you get
can also give us an indication of how
stiff tissue is. So it's called shear
wave...
"something" that I can't remember the
third term now... that third...
word from. But with shear waves you send
a signal through the tissue and how
quickly
it moves through that tells you about
the stiffness of the tissue.
And what they've done is, they've looked
at people with stiff tend...
ah, with injured tendons versus
uninjured tendons and they found that
people with Achilles tendinopathy
actually have a softer tendon than people
with healthy tendons.
And that makes sense, because a healthy
tendon needs to be stiff because
remember, they act like springs,
so they've got to return energy for you.
So as soon as it's injured, it's a bit
softer, so now it can't return that
energy so well.
So although it feels tight and stiff,
it's not actually stiff
in the tissue itself; it's the injury
that makes it...
makes you perceive it as being stiff.
Okay, so
it's an important thing that, because
tendons that's injured
do not actually like being stretched, and
stretching, especially if you're going to
do strong stretching,
can often make your pain worse. Now it
doesn't have to be at the moment that
you're doing it;
it's often a delayed response but
it can actually keep that pain cycle
going, and I've had patients where
they've misinterpreted... or to be honest
most of the time it's actually a
therapist who's told them to really
stretch,
and stretch at the bottom there, and then
they're hobbling around.
And just by getting them to come off
that
and stop doing it over the side of a
step for a while and just strengthen up
to floor level, that we take
all the stretch off that Achilles for a
few weeks, really settles down and they
can get on with their rehab.
Now, besides the fact that it really
flares the tendon up
and doesn't work for the stiffness,
strength training takes the stiffness
away in the long run.
Also if you're gonna force your...
So what I often see is people try to go
as low as they possibly can because they
think the lower they go the better.
But then to get that low, they often
compensate by turning their foot in or
out,
and then they end up straining the
tendons that either run on the inside of
the foot or the outside, so the tib-posts
and the
peroneal tendons. And I've had people
actually aggravate those to the point
where they had tendinopathies in those
ones because they were doing their heel
raises, trying to force that movement. So
let me demonstrate that;
what that would look like if I show you
from behind.
Let me see, that is
if I just went to where my natural stop
is, that's my natural stop. If I wanted to
go further than that,
I would have to drop my ankle and roll
it in, but to be honest, luckily my foot
hurts too much when I do that now.
But at that point I'm going to start
straining this bit.
So honestly, it's
not about how far you go. Because also, if
you
naturally have a stiff ankle
or less range of motion in your ankle,
you won't be able to drop very far down
below that level of the step. So if we
think of people with high arches for
instance:
The shape of the bones in the arch stops
their movements so that they're blocked
from going
far into dorsiflexion. And it's not that
they've got a defect that they've got to
stretch out of it;
they can stretch as much as they like.
It's a bony
block that they have so it's not going
to improve, and they don't need it to
improve because that's their natural
form. So for the heel raises off the side
of the step,
what are you meant to be doing? The
reason we do them is because it gives us
that little bit of
extra range of motion when you drop
below the step that we can't get when
you just do it to floor level.
And especially mid-portion Achilles
tendinopathies really like that and they
do well with that if you can get the
exercises done over the side of a step.
But you should only drop as far as you
feel your natural block is.
And if you've got really flexible ankles,
and you can't get to the end of it,
don't even go that far, you only need
about that far below the level of the
step if you've got that flexible ankles.
So my advice to you is: do not think of
it as a stretch.
It's not meant to be a stretch and if
you're going to do severe stretches for
your Achilles tendon that may be the reason
why it's still sore.
Second, if you do it just feel where your
natural movement is and if you've got to
start turning your foot in or out,
no, don't do that. Come back up because
that's your normal stop that you've got
there.
Also, remember do not do heel raise over
the side of a step if you've got an
insertion Achilles tendinopathy. I'll put
a link here to that
because there's a different way to treat
that. So have a look at the information
thingy; there'll be stuff about that...
insertional tendinopathies in there
as well.
Good! I think that's it. Let me know if
you've got any questions, specifically
about this as well,
and if you want to know how you can get
treatment for your Achilles tendon,
we do video call assessments as well as
treatment plans and follow you up over
several months to get you through your
whole rehab.
You're welcome to take a look at the
description of this video, there's a link
to our website there.
Have a good day!