|This article was kindly written for ARC by Ashbourne Physio Gillian Campbell Ashbourne Physiotherapy Centre|
race of the season approaching, all training gone to plan,…..well
almost, you just need that little bit of extra speed so someone suggests;
For many years clinicians and athletes alike have learned to dread the diagnosis ‘tendinitis’. This painful injury, common amongst runners and triathletes can mean frustrating lay-offs of many months or even years from racing and training. Over recent years it has become more widely accepted that, in the majority of cases of tendon injury where symptoms have lasted for over 3 – 4 weeks, there is little, if any evidence of inflammation. The accepted terminology now in medical circles is tendinopathy and where further investigations have been performed the predominant problem is one of tendon degeneration or tendinosis[2-5]. This has led to a marked change in attitudes regarding the management of tendinopathy and has caused clinicians to question the previously accepted regimes involving non-steroidal anti-inflammatory drugs (Ibuprofen etc.), steroid injections and electrotherapy such as ultrasound, shortwave and interferential.
Tendons known to be degenerate are more likely to rupture and 97% of ruptured tendons show signs of pre-existing degeneration. In many cases although there may be degenerative change present within the tendon the subject may be unaware of any signs or symptoms of the problem prior to rupture.
now we still understand very little about the reasons why some individuals
develop tendon injuries and their training partners apparently doing the
same training remain unhurt. Suggested causes have been given as:
what should you do if this strikes you 4 months before ‘the big
one’, be it a 10km road race or Ironman Lanzarote?
Sometimes it will be suggested that you have a Doppler Scan this is similar to an ultrasound scan but enables the radiologist to visualise any vessels that may have developed in the tissue. Tendon normally appears to have a relatively poorly blood supply but in some cases of tendinosis there may be new blood vessels at the site of the injury. It has been suggested that these may be linked with some of the pain experienced by sufferers[8, 9]
Recent rehabilitation regimes involving eccentric exercises have shown encouraging results for return to sport[10-14].
may be worked in 3 different ways:
In order to perform eccentric exercises for the treatment of Achilles tendinopathy, the action would be to lower the heel over the edge of a step. It is important to note at this point, as described above, that tendons with degenerative change are more prone to risk of rupture but there is, as yet no reported ruptures associated with the eccentric exercise programme described.
It is also important to remember that there are two different muscles that both join into the achilles tendon, gastrocnemius and soleus. In order to work them both the exercises should be done first with the knee bent and then with it straight. Generally the exercises are to be performed 15 repetitions for each muscle, three times a day.
is common to experience some discomfort while performing the exercises
and this is not a contraindication to continuing the regime. If in doubt
discuss any worries with your therapist or doctor. It does, in fact, seem
to be a useful part of the recovery to experience some level of pain and
some have suggested that this contributes to the rehabilitative process?
In most cases recovery will take 12 weeks for full rehabilitation and return to sport. In practice there is often some variation in this time scale dependant on the original injury, the level of training the individual pursues and many other possible influential factors.
Throughout the recovery period cardiovascular fitness may be maintained by cycling and swimming. If either prove too painful they may be modified by using light gears and spinning on the flat on the bike and using a pull buoy (leg float). In many cases as the rehab progresses you should be able to return to jogging and light running this should obviously be guided by your own therapist.
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2. Jozsa, L. and P. Kannus, Histopathological findings in spontaneous tendon ruptures. Scand J Med Sci Sports, 1997. 7(2): p. 113-8.
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12. Nieson-Vertommen, S.L., et al., The effect of eccentric versus concentric exercise in the management of Achilles tendonitis. Clinical Journal of Sport Medicine, 1992. 2: p. 109-113.
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