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Achilles tendinitis

**Patient Education

(Information use only Back in the Game see references section )

Like ligament, tendons are strong but not particularly elastic. They will stretch only so far then someting has to give. So the weak link is not the bone or muscle its the the tendon. Ankle sprains usually have a dramatic event but tendinitis usually develops over time. For example, your tendon hurt the day after a long run then goes away. Then at the end of the week it hurts more just after the run. A weeks later the tendon hurts while run, which usually a person starts to pay attention. Most patients ignore it until it starts compromising your activity you can't ignore it anymore. Since, the tendon is connect to muscle most people think it is caused by overstretching and tear,. Burt most of achilles tendinitis is the the result of weak calf muscles.

Muscles don't have many ways to tell you something is wrong beside pain. So when muscles are damaged even from fatigue they tighten up; and if they tighten up , they hurt more. That is why it is a good idea to stretch after doing an activity. Muscles taht are fatigued tight up and stay that way all night, and the next day they hurt. Stretching mujscles out at the end of your activity will prevent spasm. So achilees tendinitis is normal stretching that the tendon is unable to bear becaus ethe calf muscles are shorter and tight then usual. Vicious cycle!!!

Swelling is the body's way of healing but it also causes microscropic tears. There simply isn't room for the tendon to slide in the sheath. As the tendon squeaks in the sheaths

ACHILLES TENDINITIS
ICD 9 – 726.71

DEFINITION & DISCUSSION

• “-OSIS” rather than itis

• CHRONIC INFLAMMATION & DEGENERATION OF PERITENON & TENDON

• COMMON TO RUNNING & JUMPING more in older athletes

• EXCELLENT ARTICLE – Paavola, etal., J. Bone Jnt Surg. (Amer.), 84: 2062-2076, 2002.

ETIOLOGY- MANY CAUSES

• REPETITIVE STRETCH

• REPETITIVE CONTRACTION

• OVERUSE / TRAINING ERRORS (10% rule do not increase training by more than 10% per week) beyond that ­ the risk of injury

• INADEQUATE CONDITIONING

• OVERWEIGHT

• INFLEXIBILITY / IN- ADEQUATE WARMUP

• HARD OR UNEVEN TERRAIN

• SHOE DESIGN

• MUSCLE IMBALANCE

• AGING

• BLOOD SUPPLY

• COLLAGEN CHANGE

• FATPAD THINNING

• OVER PRONATION.

• UNDER PRONATION

• HIP & PELVIC ALIGNMENT

• SYSTEMIC DISEASE (RARE)

• ACUTE TRAUMA (RARE)

• RUNNING STYLE (ie. TOE RUNNING, habitiual or tight gs m.)

ETIOLOGY
PRONATION

• PRONATION ­ ¨WHIPPING ACTION ON ACHILLES TENDON

ETIOLOGY
TRAINING ERRORS

• SUDDEN INCREASE IN MILEAGE (10 % RULE)

• SINGLE SEVERE SESSION

• INCREASE IN INTENSITY long distance to speed work, SW needs to have rest day inbetween

• RETURN FROM LAYOFF OR INJURY

• HILL OR STAIR TRAINING (esp. down, lot of pounding and pronation)

• CHANGE OR INAPPROPRIATE SHOES

• COMBINING TWO INTENSE RUNNING OR JUMPING SPORTS

• TRAINING ON HARD SURFACES

HISTORY

• DISTAL POSTERIOR CALF & ANKLE PAIN very specific

• OFTEN A RECURRING HX

Slender tendon is risk factor

• USUALLY ASSOC. W/ RUNNING OR JUMPING (SOMETIMES WALKING IN ELDERLY)

• WHEN ARE THE MOST LIKELY TO HAVE STIFFNESS & SORENESS? AM

• VISIBLE SWELLING? Rarely if there is might be a tear

• NO BRUISING OR DEFORMITY buldge in tendon

• OTHER COMMON COMPLAINTS Planter fascitis, calf pain,

SIGNS & SYMPTOMS

• TENDER 1-2” ABOVE THE CALC. TUBEROSITY

• POSITIVE ACHILLES PINCH TEST

• RARELY VISIBLE SWELLING

• NO BRUISING OR DEFORMITY

• OCCASIONAL PAIN W/ CALF STRETCH OR WITH ACTIVE TOE RAISE

TREATMENT
ACUTE

PRICE

• ICE & REST

• US PULSED/INDIRECT

• BROMALAIN* good anti-inflammatory, not analgesic

• VITAMIN C, CAL., & MAG.

• TAPE FOOT & CALF

• H2O RUNNING* deep water with floatation device

• CYCLING / SWIM (CROSS TRAINING)

• CHANGE SHOES? If needed

• HEEL LIFT? In training shoe ¯ stress on tendon

• DECREASE HEEL HEIGHT in non-training shoes

• MANIPULATE BACK & EXTREMITY

• MODIFIED TRAINING

• DECREASE HILLS

• STOP JUMPING

• STOP SPEEDWORK

• AVOID CONCRETE

BROMALAIN

• PROTEOLYTIC ENZYME

• EXTRACT OF? Skin of pineapple

• ANTI-INFLAMMATORY

• 1800+ M.C.U

• 800-1200 mg / DAY; DIVIDED INTO 3-4 DOSES

• EMPTY STOMACH will bind to food and not absorb

• CONTRAINDICATIONS?

Prior to surgery; bleeding disorder

Allergy to pineapple

Active ulcer

TREATMENT
TAPING

• TAPE ARCHES

• Simple arch

• Lodye

• TAPE CALF/TENDON

• Why not athletic tape? Need to tape foot in plantar flexed position. It needs to be elastic tape or walking on foot will break tape.

TREATMENT
AquaJogger

• DEEP WATER EXERCISE BELT

TREATMENT
SUBACUTE / Post acute

48 –72 hours up to 5 days, swelling needs to be gone

• ALT. HOT & COLD

Cold laser ® deep heat

• CONTINUOUS US

• HEAT BEFORE (exercise in hot tub) & COLD AFTER EXERCISE (ice massage)

• X-FIBER FRICTIONS

• STRETCH CALF & HAMSTRINGS

• TOE RAISES (heel raise ® start on flat surface, then on stair). Tell (have it in writing) them to have something to hold on to for balance.

• MANIPULATE SPINE & LOWER LIMB

• ORTHOTICS?*

• CONTINUE HEEL LIFT, shoe with taller heel

• RUNNING PROG.*

• GRADUAL/SLOW

• AS TOLERATED

• INCR. DISTANCE

Jumping would be last

• CYCLING / X TRAINING

TREATMENT
ORTHOSES

• TULI OR OTHER CUP – LEG LENGTH? Don't create an LLI, increase shoe size by .5

• HEEL LIFT IN RUNNING SHOE ( LOWER HEEL IN CASUAL SHOES)

• ORTHOTIC neutral position cast

• PODIATRY ARTS LAB (PAL) 800-671-2957* will rework if does not work out

• LANGER ORTHOTIC LABS 800-645-5520

TREATMENT
RESOLVING

• SAME USE OF THERMOTX AS SUBACUTE

• X-FRICTION MASSAGE 3-5 (6 max) need a day of rest inbetween TX TOTAL / 2X/WK

• ICE MASSAGE @ HOME

• ECCENTRIC EXERCISE

• STAIR TOE RAISES

• RETRORUNNING? Running backwards (can cause Achilles tendonitis)

• LONG WARM-UP more stretching

• RUNNING PROG. *

• 1 st INCR. DISTANCE

• THEN INCREASE SPEED

• THEN ADD EASY HILLS

• THEN RETURN TO FULL

• BACK OFF IF? Any worsning

• CONSIDER X-TRAINING ¯ high impact, ­ low impact

• ICE AFTER (ice massage) Dixie cup

• CONTINUE HEEL LIFT?

• CONTINUE NUTRITION

CHRONIC & FAILED TREATMENT

• SHOULD RESPOND TO CONSERVATIVE TX W/IN 6 WEEKS

• POSTERIOR NIGHT SPLINT

• CAST? Not a good idea WALKING BOOT? better

• STEROID INJECTIONS? Very risky last resort

• SURGERY? Remove spurs, necrotic tissue, scars,

Tip of the day:

If you want to strengthen your ankle while skating don't use your laces as a crutch. First week start with the first loop undone. Continue on this progression until your laces are completely out. Of course, don't perform jumps just regular skating to improve your ankle muscles.

 

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West Linn Chiropractor Dr. Bellacov, D.C. Chiropractic & Physical therapy to the Portland metro area: West Linn, Oregon City, Lake Oswego, and Tualatin. Owner & Chiropractor. Ryan Lambert Bellacov will give professional service to bring you pain relief. www.bigsportsmed.com; Dr. Ryan Lambert with years of experience helping people with pain. Copyright © 2012-