Achilles Tendon strengthening techniques. I would like to address another common presentation amongst our running clientele/patients - an Achilles Tendinopathy. The term tendinopathy basically refers to degeneration of a tendon, and is usually precipitated by tendon overload/overuse. (NOTE: Tendinopathy can be interchanged with the term Tendinosis) Some of you may recall this condition was previously referred to as ‘tendinitis’, this is not the case as inflammatory cells are absent within the tendon itself. There are two types of Achilles Tendinopathy: a mid-portion Achilles Tendinopathy (more common) versus an insertional Achilles Tendinopathy. It is important to distinguish between the two as they differ in the prognosis and response to treatment. Some common predisposing factors to a tendinopathy include: 1. years of running, 2. a recent increase in activity (distance, speed, hills), 3. decreased recovery times between training sessions, 4. a change in training surface or footwear, 5. biomechanical abnormalities (eg excessive pronation of the foot), 6. calf weakness/tightness, and 7. restricted ankle ROM. Clinically athletes will describe a gradual development of symptoms (as opposed to a partial tear or rupture, which is more of a sudden/acute pain at the time of activity). Athletes will often describe they can ‘run through’ the pain, or will report the pain disappears when they warm up, only to return post-run once cooled down. More frequently clients will report pain and stiffness upon rising out of bed the following morning. Treatment for an Achilles Tendinopathy will differ depending on whether the client presents with a mid-portion versus an insertional Tendinopathy. The clinician may also need to order imaging to determine the stage of the Tendinopathy, as this will also affect where we head with rehabilitation. The client’s training schedule and load, as well as any biomechanical errors also need to be taken into account. In terms of exercises, a 12-week eccentric strengthening programme was developed by Alfredson and has been shown to have good results for patients presenting with mid-portion Achilles Tendinopathy. Here is how you perform the Alfredson protocol: 1. Stand on a step with the balls of your feet on the edge. Your heels should be hanging over the edge of the step. 2. Hold onto something stable for balance. 3. Keep both knees straight. 4. Using both feet, lift your heels and rise up onto the balls of your feet. 5. Keep your foot with the painful Achilles tendon on the step, and lift your non-injured foot off the step. 6. Slowly lower yourself down using your injured ankle. Your heel should move towards the floor, and the ball of your foot should remain in contact with the edge of the step. 7. Return your non-injured foot to the step and repeat the exercise. The Alfredson protocol calls for performing this exercise for 3 sets of 15 repetitions. When performing the exercise with your knees straight, a specific muscle that makes up the Achilles tendon called the gastrocnemius is loaded and challenged. Once you perform 3 sets of 15 repetitions with your knees straight on the step, repeat the Alfredson protocol with your knees slightly bent. This places stress upon a specific muscle called the soleus that joins the gastrocnemius to form your Achilles tendon. Again, perform 3 sets of 15 repetitions. The two exercises of the Alfredson protocol should be performed twice daily. That means that you should do 3 sets of 15 repetitions of the straight knee and bent knee heel lowering exercises in the morning and in the evening. In total, you should be performing 180 repetitions of the exercise daily. Finally, it is important to determine the type of Tendinopathy before commencing this programme because doing it over the side of a step for an insertional tendinopathy could potentially make your symptoms worse.
Posted on: Sun, 02 Nov 2014 20:55:23 +0000