Sunday, June 14, 2015

Achilles Tendonitis or is it Tendinosis?

The slight ache at your heel starts to haunt your every run. First you notice the pain after your run, then during the run. You hope it goes away. You stretch. You take ibuprofen. You massage. BUT nothing helps. Months later, what began as Achilles tendonitis has turned into a case of Achilles tendinosis. The ending -itis denotes inflammation while -osis means abnormal. The difference between tendonitis and tendonosis is the presence of inflammation. Prolong inflammation causes the tissue to change it's composition into an abnormal arrangement making it tenodinosis. There is decreased ability to absorb shock and generate power. This change in composition makes the tendon thicker but contains more water and mis-aligned tendon fibers. Since there is no active inflammation, ice and anti-inflammatories can't come to the rescue. Another term that medical professions are using is Achilles tendonopathy. 


Providing compression to the Achilles tendon will help improve fluid dynamics. Compression will push stagnant fluid out and allow nutrient-rich fluid into the tissue.  Proper hydration of the connective tissue restoring the mobility of the connective tissue. Start at the base of the ankle and heel. Cover half of the band as you wrap the band up to the calf muscle. Move the ankle in all planes of motion to maximize compression of connective tissue in with the sitting or standing position.
*** Compress for no more then 2 minutes. If the skin turns white, take the band off.


Eccentric Exercises

Eccentric strength exercises have been shown to be the most effective in re-aligning the connective tissue. During eccentric exercises, muscles elongate while it's working.  In concentric exercises which muscles shorten to generate force. Eccentric exercises force remodeling of the tissue which has been shown to restore strength.

Glute Strengthening/ Hip Flexor Tightness

Another factor contributing to Achilles tendonopathy is weakness of the gluteals.  The gluteals and the calf muscles (which becomes the Achilles) both help to extend our legs backwards. Our body will compensate for weakness in the gluteals by making the calf muscles work harder. This increases stress to the Achilles tendon.
If the hip flexors are tight (typically from prolong sitting) gluteal recruitment is hindered. Please refer to my post on hip flexor mobility for more information.

Tri-Planar Loading

And of course, all our muscles and tendons are 3 dimensional, it's vital to exercise in all available motions. Combining the concept of eccentric strengthening and tri-planar will maximize results.

Lunge with Achilles Focus

Below is a video on how to use lunges to load the calf muscles. Reaching the hands forward will increase the load of the calf and Achilles of the back leg. The direction of the lunges isolates the action of the Achilles while running.

Tri- plane Heel Raises

To better isolate the calves we can perform heel raises. Changing foot position can vary work of muscle fibers. Changing the speed of the exercises will activate different sensors in the muscles and tendons. Two ways our body can work eccentrically is to go slower then gravity or faster then gravity. Performing both exercises help to improve the strength of the muscle tendinous group. Here are examples of changing foot position to isolate different muscle fibers.

I recommend performing 10 repetitions at various angles. Performing these exercises as part of a strength routine will help with recovery of Achilles tendinosis.  

Jumping Exercises

Adding jumping exercises will help retrain the muscle and tendon to absorb the impact of running. Jumping in different directions will activate more muscle and tendon fibers. Perform 5 in each direction.

Arya , S.Kulig, K., Tendinopathy alters mechanical and material properties of the Achilles tendon.