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Tender tendons

This article is supplied by Shannon Chown, senior physiotherapist at Livewell Pain Management Centre Townsville.

I had a client in the clinic recently with an all-too-familiar pain picture: a three-month history of gradual onset Achilles pain located just above his heel with mild swelling and localised heat. Sounding uncomfortably recognisable?

Despite resting the injury by doing two weeks of office work, he returns to active duties and exercise and the pain returns. Within 1km he is limping heavily.

The problem

What we have here is an Achilles tendinosis – an overuse injury of the Achilles tendon. This common condition sits somewhere along a continuum of damage.

Tendons are designed to withstand high tensile forces, but repeated bouts of overloading without adequate time to resolve will eventually lead to degeneration and failure of the tendon tissue.

The cause

Many researchers have attempted to pinpoint a specific cause, but it seems the smoking gun is illusive. Fingers point to a combination of factors common to tendons being overused.

These include excessive foot pronation (rolling in) which is thought to add greater load through the middle part of the tendon; a more lateral heel strike which loads the outside portion of the tendon; a combination of muscle group weakness (hip muscles in particular leading to knee rotation and increased foot roll) and decreased joint motion at the ankle.

The plan of attack

Identifying where you have gone wrong may be easy, for example, an impromptu 5km run or an extra 100km on the bike would certainly do it. But often it is less obvious and the pain could occur after a period of relative rest when you return to a usual routine, for example, going on holiday or a change in roles at work.

A small heel wedge can unload the Achilles a little, ladies can try a low heel, the regular RICE method (Rest, Ice, Compression, Elevation) doesn’t go astray, and taping can help. Watch the video below for the taping technique.

It’s important to return to the aggravating activity gradually and slowly wean yourself off the tape and heel raise. If the condition is old and nags away every so often unloading may be counter-productive and your Achilles will likely need a specific loading regime.

I would strongly recommend seeing a physiotherapist for accurate assessment to identify what stage your condition is at, and they can try some manual therapy, stretches, dry needling and an eccentric loading program (similar to this video below) to get you back on track a little quicker.

Please note: The information provided is general in nature and should not substitute any health or medical advice. Please consult a qualified professional to assist with any specific conditions or queries. You know the drill ;)

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Shannon Chown

Shannon Chown

Shannon is the senior physiotherapist at Livewell Pain Management Centre Townsville. He graduated with a bachelor degree in physiotherapy from James Cook University and has a diverse background in sports, musculoskeletal, aged care, hospital inpatients and persistent pain conditions. He is currently completing his masters of manual therapy through the University of Western Australia and enjoys keeping fit with his family in the wonderful surrounds of Townsville.

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