At Mac Physio & Pilates we get a lot of enquiries from clients about tendon problems – ranging from achilles tendon (heel pain), patellar tendon (knee pain) or tennis elbow (elbow pain).
There have been big advances in the research on tendon problems over recent years and how best to manage them. Subsequently there are a lot of mixed messages and incorrect beliefs out there, so we thought we would give a brief overview of the myths and truths out there!
For this blog we are going to focus on Achilles tendinopathy as this has been a common complaint that has presented to us over the new year period mainly due to an increase in people taking up running or runners increasing mileage in build up for marathon season. However, quite a lot of the information can be transferred over to tendon problems in other areas of body.
Main causes of tendon problems:
- Training error – both sudden increase or sudden decreases. E.g. mileage / volume – if you previously ran approx. 12 miles per week, 3 times per week (e.g. 3, 3, 6 miles) and then in one week you increase your total mileage to 18 miles (e.g. 4/4/10 miles) this would result in a 50% increase in load. Ideally you need to follow the 10% week increase rule.
- Lack of strength / endurance in local areas such as calf or glute – resulting in increasing load through calf & Achilles tendon complex.
- Mobility – lack of joint / tissue mobility at ankle or hips, which again will influence Achilles function.
What NOT to do:
- Rest completely for long periods. Resting simply decreases the ability of the tendon to take load.
- Static Stretches- this will irritate it more and make it angry.
- Ice / massage locally to the tendon thinking ice or massage will get it better. Ice only helps pain short term & massage to the local area can aggravate symptoms.
- Continue to ignore and only treat symptoms by using pain relief, it is harder to address the issue as it progresses.
What can you do to help?
- Address the reasons that are overloading tendon. Is it a training error or an underlying weakness?
- See a health professional. Your physio should rarely tell you to completely rest or that you that need to ice lots or use electrotherapy. These methods will not help to improve your symptoms. See somebody who is up to date with research, so you are not wasting time and money on sham treatments.
There are several stages of the condition, reactive, disrepair & degenerative. An example of some early stage exercises during that painful / reactive phase include, double or single heel raise static holds – aim to stay up on your toes for 20-30 seconds as long as it is pain free, building to 40 – 60 seconds as pain allows 3-4 reps alternate days – the main focus for this exercise is to help get acute pain under control.