Achilles tendinitis/tendinosis/tendinopathy?

[Coxy]

I must seriously be the most chronically injured freak on this forum.

Last week or so a pain has developed in my achilles tendon, predominantly the left but also a bit in the right. It's not right down at the heel, more so about half way up between the heel and bottom of my calf.

It flared up quite a bit last night after refereeing oztag, despite having taped it up beforehand. Quite tender to touch but little more than an occasional throb in general. No obvious swelling and I can walk reasonably well today after an initially tight first couple of steps.

First things first - I know I need to rest it.

I've just read about tendinitis, tendinosis and tendinopathy (I gather the last two are pretty similar?)

What does it sound more like? And is the treatment much the same? ie, RICE, then light, passive stretching, then eccentric strengthening of the calves.

That was the routine I did last time and it came good in a few weeks. Just want to know I'm not doing something wrong.

I think it flared up this time because I've had a couple of twinges in my calves recently and so they're a bit tighter than normal, thus more strain on the tendons.

[jamesbarker]

Some general info that may help with your achilles stuff. If this does not work..............see the guru Dr John Orchard!

Tendinosis describes the pathology of tendinopathy in that it is a non inflammatory chronic breakdown of the tendon.

If you have inflammation it sounds more like an 'itis', though if you have been rebounding between pain free and inflammation states and this is a trend in your life, then you may have some 'itis' and some chronic underlying weakness (and breakdown) of the tendon.

With tendon pathology once it becomes chronic it becomes a longer process to treat. This is largelly due to the fact that tendons have a very slow metabolism, hence breakdown slowly, but also build up tensile strength qualities slowly too!!

You need to get any inflammation down, modify the aggravating activity and start some graduated and progressive eccentric training (bent and straight leg). This needs to be done daily and once pain has dimished carry on a 3 x weekly maintenance regime. Star with 3 x 15 daily and see how it goes.theyt will initially cause some soreness for the 1st 1-2 weeks. do not go over about a 5/10 pain/discomfort

Soft tissue therapy may help to address any pelvic imbalances and take any 'tone' out of the overloaded tissues. If you are tight in the talocrural joint (ankle) then this can be treated aswell. If you are tight in ankle dorsiflexion (less than 10cm approx) then they may benefit from stretching - compare both sides.

It is not uncommom however to have the symptomatic side more flexible than the asymptomatic side. If this is the case don't go overboard with the stretching here.

Try some taping down the back of the soleus/achilles and under the foot to de-load the achilles when doing any running activity.

James Barker

There are heaps of options available to us.............these are just some hope they help

[Coxy]

Cool! Thanks for all this info, really helpful!

On the weekend I had Oztag training - and I really wanted to be part of it since we were working with another team. So Saturday I did some eccentric strengthening - very carefully. The process itself caused no pain that I could detect, though it was a little stiff and sore afterwards, so I iced and rested it.

Got a bit sore while walking around a shopping centre Saturday arvo so bought a couple of heel pads which immediately helped.

Sunday morning it was feeling much better and so I taped both of them up good and proper (anchor around foot and half way up calf, with tape down the soleus and over the heel which limited dorsiflexion). After a good warm up before training that afternoon I found I was able to run without discomfort, albeit slightly slower.

Iced them up 20 minutes every hour afterwards.

Following morning there's a little bit of tenderness, but i've kept them taped up and I can walk unimpeded today, no discomfort. Still wearing the heel pads in my shoes to keep the pressure off them.

I'll be giving them a good rest from any strenuous walking/running over the Christmas/New Year period so I think I should be ok.

Also seeing my podiatrist for some proper orthoses - I have out of the packet ones which have been good for over a year, but they're starting to wear and my podiatrist said 6 months ago I'd be better off with custom fitted ones.

I still think the calf strain I suffered a few weeks ago contributed - I felt obvious tightness in the muscles and I'm sure that put more pressure on my tendons when I foolishly kept playing/refereeing ;-)