Ah the achilles tendon. That big rope-like structure connected to your calf muscle and heel. So useful when things are going well… and oh so crippling when you did just that little bit too much hill running or those 1000 box jumps you did last week.  If you have ever felt this pain before and it stopped you from your usual exercise – chances are you had some form of Achilles Tendinopathy.

Achilles Tendinopathy is a common overuse injury of the Achilles tendon and a condition we treat ALOT in the clinic.

What is Tendinopathy?

The widely accepted Cook and Purdum model explains Tendinopathy in 3 stages:

1. Reactive tendinopathy: When compressive or tensile overloading takes place, the tendon thickens and stiffens in attempt to reduce the stress on the tendon.

2. Tendon disrepair: If the tendon is not offloaded and allowed to repair back to stage 1, the tendon cell matrix will start to separate and breakdown physiologically.

3. Degenerative tendinopathy: If the tendon is further overloaded, permanent damage of the cellular makeup will occur.

Tendon change occurs along this continuum and may go back and forth between these 3 stages.

How does overloading occur?

Overloading commonly occurs in the form of:

· Excessive loading through high impact activity such as running or jumping. The Achilles tendon may take loads of up to 2x your body weight when running.

· An increase in training load of high-impact activity or resistance training.

· A return to training after weight gain.

How can improve you improve your Achilles pain?

The key to moving back through the stages of tendon damage needs to follow 2 simple yet crucial steps.

1. UNLOAD – Give the tendon the rest it requires to move back down the stages of damage. This may not be complete rest, but instead a “relative” reduction in your activity e.g. reduce kilometres running by 20%

2. LOAD the tendon to prevent further disrepair. This step requires a careful gradual and progressive loading program which is tailored to the individual’s needs. Rehabilitation with a safe loading can begin straight away and reduces recovery time versus complete rest.

Check out the video below I posted on Facebook for some examples of exercises we use in the clinic to gradually load the achilles tendon during a tailored rehabilitation program.

If you need help managing your Achilles pain pop in to see Sam Mullany at the practice. You can make a booking with him online or by calling 4721 5567

Overuse injuries are by far the most common type of presentation I encounter in runners presenting for physiotherapy.

When you run (or do any form of physical activity) you create micro-trauma to your tissue (bone, muscle and tendon) which is then replaced, regenerated and strengthened by the laying down of new cells such as collagen. Each individual has a certain rate at which they can lay down this new tissue. This process actually strengthens your tissue and improves its ability to withstand more load

Overuse occurs when the amount of loading has exceeded your ability to lay down this new tissue.

Here is a great picture expanding on this principle from Tom Goom’s Running Repairs course I attended 2 years ago now

This picture on the left shows the different components that can make up your training load. It is important to note that these aren’t JUST running! They can also include other activities like work or going to the gym.

On the right side we have a list of ways we can increase your tissue load capacity. Plenty of options to explore there and a lot of stuff you can start looking at right now!

So looking at both sides of the see-saw – the main things I see increasing people’s risk of overuse injury are generally pretty simple errors:

1. Increasing training load by too much too quickly e.g. increasing kilometres by more than 30% compared to the previous week or that moment of brilliance when you decide to start running up a whole heap of stairs this week.
2. Non optimal structuring of your total exercise program (doing a massive run after training legs hard at the gym)
3. Rapid change in running technique e.g. change to forefoot strike done in one fell swoop and getting a calf blowout
4. Changing external factors too quickly e.g. significant change in footwear type without a transition period
5. Not doing enough strength conditioning to increase tissue capacity

These are errors we can all make and they are understandable. All part of just being excited about running!

So if you are a runner here are a couple of things for you to consider right now:

1. Make sure you are doing adequate strength conditioning particularly for calf, glute, hamstring and hip flexors. Can you do 30 single leg calf raises? Can you do 30 single leg bridges? If not put in some work!
2. Keep an eye on your kilometres and incline – try not to increase your km’s more than 10% per week
3. Check how stable you are – can you balance easily on single leg? Can you hop side to side/forward and back with ease? Can you stand on a Dura disk for 30 seconds? If not, you may need to work on some balance and core stability
4. If you’re trying to change your running style or footwear – don’t do it all at once! Do small doses of the new change and ramp it up gradually 10-20% more each week

Jared Reyes is a physiotherapist who has extra training in running gait analysis and management of runners. He enjoys running on the Blue Mountains trails each and every week.

If you would like his assistance managing your running injury or would like to have a running assessment Book Now or call us on (02) 4721 5567

COMING SOON | LYMPHOEDEMA & VESTIBULAR MANAGEMENT

We are excited to announce and proud to offer two new services in 2018.

Adding to our already vast offering, both Lymphoedema & Vestibular Management will officially be available upon our return from 8th January 2018.

Our last trading day will be Friday 22nd December and we will return on Tuesday 2nd January 2018.  If you need to make a booking during this time, you can do so by visiting our book now page.

What a year 2017 has been. We thank you all for your support and look forward to supporting you in 2018.

Merry Christmas & Happy 2018. Be safe!