Monday, April 3, 2017
Achilles Tendon Pain: Where Do I Start?
Achilles Tendon Palpation
So, you begin to hurt in the achilles tendon. A Golden Rule of Foot: If you look at the achilles tendon the wrong way, it will hurt for 9 months. Is it all gloom and doom? Only a few unlucky ones. Are you about to tear it? Usually not, in fact most of my patients that tore their achilles did not have any symptoms beforehand. They are unlucky, probably a small defect in the tendon. Only rarely on both sides. But, this fear we have around the health of our achilles, typically when it begins to get sore, is not justified. However, we do not know if we are beginning to feel just the tip of the iceberg (with a bigger problem brewing).
When you first feel your achilles aching, try to play Sherlock Holmes and discover why. I like to always use a rule of three. Therefore, there is probably 3 causes of this injury, and each may have played a big or some role in the injury. Treatment of the possible causes can help in the prevention of its returning. The most common causes of achilles tendon pain are tightness, combined with some common overuse pattern (too much, too fast, too different), combined with some technical issue (switching from normal heeled shoes to zero drop, experimenting with lower heel drops in exercises, going to a shoe far too unstable). I have seen hundreds of combinations.
The athlete needs to immediately cut their distance in half, as long as they have caught the problem early. If not, and they limp from normal activity, they may need a 2 week or more period in a removable boot. After finding the amount of exercise they can do without flaring up the pain, they need to stretch the achilles (even the plantar fascia), 3-5 times a day. I have included my video on achilles stretches and link for the general principles of stretching. Occasionally, I will find the patient on the opposite end of the spectrum that is overly loose, and stretching is a bad thing. Sorry if that is you. Start thinking about what either over-stretches the tendon, or torques the tendon with pronation or supination (rolling out) forces. Immediately try to remedy that aspect. Could be that you were doing too many negative heel stretches where your heel fell off the edge of a stair? Could be you changed into some lighter, perhaps less stable shoes?
So, you have created a pain free environment for healing by controlling the activity, begun to stretch 3-5 times a day, adjusted other possible causes (switched back to more normal shoes), and now you must ice. The achilles is the most powerful tendon in the body. It can lift 8-10 times your body weight under distress. But, it has relatively poor blood supply, and that is a bell shaped curve. The curve means you could be one of the lucky ones to get a lot of blood supply or not. There are so many beliefs in how to get blood supply that it is not the place for that discussion, but it is the place to tell you to control that initial soft tissue swelling from day one or day five, but quickly. Ice pack over the tendon is relatively easy and 10 minutes you are done. But do it 3 times a day.
So, smartly use activity modification, stretching, biomechanical awareness, and icing to help change that aching achilles into an achilles you want to bring home to mother.