Believe it or not, the remedy may come from your nervous system!
Achilles tendonitis is the recurring plague of many of our sports-people patients, and particularly the marathon runners who are training hard at this time of year. If it’s not sore enough to prevent them from perusing their sport entirely, the often-chronic nature of this condition slows their progression and blights their performance.
What is Achilles tendinopathy?
This body part got its name from the Greek legend of Achilles, who’s only weakness was to be found at the bottom of his calf. The correct anatomical name for this tendon is the Calcaneal tendon, connecting the calf muscles on the back of the lower leg to heel bone, and then to the plantar fascia at the sole of the foot. Your Achilles tendon is the thickest and strongest tendon in your body. If we think of all these tissues as one continuous sheet, it is much easier to understand the reasons that pain occurs in the first place.
Tendons are thick fibrous tissue with poor circulation, which connect muscle to bone. The term tendinopathy is best used because the old term tendonitis implies an active inflammatory response – but often there is minimal inflammation. Quite frequently we see Achilles tendons which have been chronically aggravated and are visibly thick with scar tissue.
So, tendinopathy then refers to any dysfunction of the tendon that causes pain.
Why does it happen?
Achilles tendinopathy is usually caused by overuse – this means repeated stress on your Achilles tendon over time. This can cause changes to the structure of your tendon and sometimes tiny tears, making it weaker.
Any sports or activities that put stress on your Achilles tendon can lead to Achilles tendinopathy. This includes running and anything that involves jumping – for example, dancing, gymnastics, squash and tennis. You may also be more likely to damage your Achilles tendon if you:
use badly designed equipment including wearing the wrong footwear
have a poor technique or haven’t trained properly for the activity you’re doing
suddenly increase how much exercise you do or the intensity of your exercise
train on hard or sloping surfaces
Any one of the interlinking parts of the anatomy can put stress on to the Achilles tendon. Tight calves can pull on the tendon, poor footwear can stress the plantar fascia and pull on the tendon, and any misuse of the ankle joint can cause undue biomechanical load to be put onto the Achilles tendon.
Thinking as a manual therapist, whether it be osteopath, physio sports therapist etc, the function of the knee, hip, lower back, and indeed the trunk position on the pelvis and the whole of the opposite leg are also very important to assess in patients presenting in clinic with Achilles tendinopathy.
How can it be sorted?
A full assessment of your biomechanics may be able to identify the causative factor in your tendinopathy. Once the root cause has been found, these are some of the common treatment techniques that can be used to help improve the Achilles function.
Eccentric heel-drop calf stretches - Standing with your toes on a small step, lift onto your toes. Squeeze you calves as tight as you can for 10-15 seconds. Lower your heels off the back of the step, lower than your toes, very slowly and carefully. Do not bounce in this stretch, as it is deep, and your tendon is already vulnerable. Hold the stretch for 20-30 seconds. Repeat 3 times.
Taping - I use the tape from the sole of the foot, all the way to the top of the calf, with extra horizontal pieces to reinforce areas of particular stress.
Gluteal strengthening techniques - Sometimes Achilles tendinopathy is the by-product of having weakness in the glutes – BUT NOT ALWAYS
Laser therapy - This can work a treat for those complex tendinopathies, in conjunction with other aspects of rehabilitation. It enhances blood flow and oxygen uptake to the area and therefore improves healing. Improves local nerve function to the area.
Postural assessment - assessing if the foot leg and pelvis carry the load!
This might seem very strange to you – of course you can stand on your leg! But it’s how you stand on your leg. All too often I see patients who have strong glutes, and they are using the correct footwear. However, what I commonly see is that people have postural problems which mean that their body and their nervous system are not working optimally. They may have very strong glutes, but they are not using them when running or jumping etc. They may have poor sensory feedback in their foot which causes havoc with their central nervous system which they are totally unaware of and then that havoc is passed onto their musculoskeletal system. Sounds challenging but all these things can be easily remedied.
If you are experiencing any issues, please don't hesitate to contact us at the Centre. We will work with you to find a solution.