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Sunday, August 3, 2014
Top 10 Treatments for Achilles Tendinitis: A Starting Point
Golden Rule of Foot: Look at the Achilles Tendon Wrong and it will be sore for 9 months.
Introduction to Achilles Pain
Treating achilles tendon problems can be very challenging and frustrating. So, it is so important to understand the basic rules of rehabilitation so you can get ahead of the problem as soon as possible. If I was to tell you two things to take to heart regarding achilles injuries, they would be “do not ignore achilles pain for it is not like other injuries, and begin working on controlling the swelling the day before it hurts”. Swelling is the deal breaker with achilles since it cuts off the normal circulation to the tendon and stops any chance of healing in it’s tracks.
It is so important to know how to stretch the achilles tendon safely. I love the 3 positional achilles stretches I also teach for plantar fasciitis to be done 5 times daily, as long as there is no pain. Stretching the achilles tendon should give you instant and temporary help where you feel better. If this is not the case, you may have an over stretched tendon, a nerve problem, or a partial tear of the tendon (plus a few other things).
The top 10 treatments for achilles tendinitis are:
1. Stretching 3-4 times per day (see chapter 3)
2. Icing 2-3 times per day (see chapter 3)
3. Heel lifts in all flat shoes, or an elevated shoe like Dansko clog or heels/cowboy boots
4. Orthotic devices if over pronating or over supinating
5. Use activity modification to avoid “bad pain” (see post on Good Pain vs Bad Pain)
6. Begin calf strengthening as soon as pain free
7. If cannot walk, you need a removable boot with EvenUp on the other side and probably MRI
8. If symptoms are significant or persist, use PT or acupuncture, but consider an MRI to really see the 3D images.
9. Calf massage with massage sticks (always emphasized if you go to PT)
10. Avoid activities that are too explosive or over stretch the tendon, or modify activities like
staying on the seat of the bike in spin class, or not lifting your heel on the elliptical
Below is a few further thoughts on achilles stretching. These are all enclosed in the posts on stretching principles and achilles stretching.
Proper Stretches for the Achilles Tendon are a vital part of every pre and post activity, and especially with injuries to the achilles, calf, plantar fascia, and hamstrings. There are two muscles, gastrocnemius and soleus, that make up the achilles tendon. These two muscles can be stretched separately by first having the knee straight (gastroc stretch on the left photo above), and then having the knee bent (soleus stretch on the right photo above). It is the back leg that is being stretched. The soleus stretch is being done incorrectly (on purpose) to demonstrate that the heel should be on the ground the whole time. With both stretches, it is important to keep the heel on the ground. Hold each stretch for 30 to 60 seconds, or 8 deep breathes. Deep breathing gets oxygen into the stretch, a good yoga principle. Do not bounce, called ballistic stretching. It is never good to jerk the muscle or stretch through pain. You want that good ache feeling. Try to stretch several times a day to actually gain in flexibility, even on days you do not do your normal activities. When non-athletes complain of cramping in their calves, often low potassium or dehydration is blamed. Have them try stretching 2 or 3 times a day and many will experience complete elimination of the cramps.
A vital part of the treatment of achilles tendinitis and plantar fasciitis is stretching these structures. The photo above shows a very powerful achilles and plantar fascial stretch. It normally feels great as you lower one or both heels off the edge of a stair or curb. But this stretch, called Negative Heel Stretching, can be damaging to your tendon and/or plantar fascia. I do not recommend it at all, but I emphasize it with my achilles and plantar fasciitis patients to avoid with a passion. With the heel in a vulnerable, non-protected, position, the heel is lowered into a position it is just not used to being. If you think about heel position in life activities (functional activities), our heels are either at the same height as the front of the foot, or elevated above the front of the foot as in a normal heeled shoe. Negative Heel Stretching places our heels in a position that life has not accustomed them to being. Almost our full body weight goes into the achilles attachment in the back of the heel and into the attachment of the plantar fascia into the bottom of the heel. Golden Rule of Foot: Avoid Negative Heel Stretching. Do not take a chance that this stretch is overloading the weakened areas leading to greater damage of the tissues. There are too many other ways to stretch these areas which will be handled in other posts.