Tuesday, June 3, 2014

Tendinosis of the Achilles rehab.

Have you ever had tendinosis of the Achilles? It is definitely not a lot of fun. The difference between tendinosis and tendinitis is that tendinitis is an inflammation of the tendon and stems from micro-tears. It typically comes from a sudden, acute injury like overloading. Tendinosis is a chronic condition that comes from overuse with characterised by changes in the form of the tendon and loss of strength (lumps and weakness). There seems to be a lot of confusion in the diagnosis of these two problems. A typical cause of tendinosis of the Achilles is, for example, a runner ramping up their kilometres too quickly in preparation for a race or body builder stepping up their leg training too quickly or without adequate rest. In my case, it was a combination of trying to make up for lost time and increasing my running volume too quickly whilst simultaneously experimenting with endurance barefoot running.
Under the microscope, tendinosis shows an increase in "young" type III collagen fibres instead of the “good” type I fibres. The problem with type III fibres are that they often do not link together to help load-balance, are significantly weaker and are often misaligned (source 1.0). My problem first revealed itself as a lump on the medial side of the Achilles. The result was stiffness and the inability to run more than 7 KM without pain. However, things seem to be getting better now with a combination of rehabilitation and staying at a lower running volume.

I am sure that you are probably most interested in the rehabilitation of a similar injury if you landed here.
Most research of late has shown that there is one, relatively simple, treatment for this problem (source 2). The exercise involves extension exercises targeting the lower leg muscles also known as triceps surae, but particularly the gastrocnemius.
This is quite a simple exercise. I do it in a Smith machine but if your gym has a calf press then you can also perform it there with another variation being dumbbell work (pictured). The trick is to perform the exercise on the lower leg suffering from the Achilles problem, fully extending, but to use your good leg to push you back up. Use as heavy a-weight as is comfortable. It will burn. This is normal. Take the exercise slowly with at least three seconds, preferably five, on the extension. Allow your heal to drop fully creating a good stretch in the extension and then use the good leg to remove the weight, allowing you to return to the starting position.
I already notice that the lump is shrinking and I have begun to notice less pain as I approach my 7 KM threshold. I have also started to use some self-administered trigger point massage to loosen the stiffness in the gastrocnemius (calf) and am considering finding a professional to continue with it. I will write some more about this if relevant.

As usual, feel free to comment or get in touch by e-mail with any questions.
Source 1: Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/ Evelyn Bass March 31st 2012.

Source 2: Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. http://www.ncbi.nlm.nih.gov/pubmed/9617396 (abstract) Department of Orthopaedic Surgery, University Hospital of Northern Sweden, UmeƄ, Sweden.

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