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ankle Achilles problem (Read 552 times)

rich d

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ankle Achilles problem
January 10, 2019, 02:26:35 pm
Hi guys wonder if anyone else has had this and has any advice.
On the back of my ankle a few inches above my heel I've got a swollen and painful area around the tendon. I've booked to see the gp to get it checked and a referral for physio, but no appointments for a couple of weeks.
Think it might be achilles tendinitis after doing a bit of google fu, there's been nothing specific to set it off, but has been slowly getting worse over some time.  I've managed elbow tendinitis successfully before (well it's ongoing) with massage, strengthening and stretching as well as stopping pull ups on the beast maker - but can't seem to find any specific exercises etc for the achilles. (PS nowadays for me it's much more likely to have been set off by karate rather than my occasional bimbly climbing)
Cheers Rich

Dan Cheetham

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#1 Re: ankle Achilles problem
January 10, 2019, 06:26:09 pm
Depending on how acute it is Rich, eccentrics and stretches are usually the exercises of choice for Achilles tendonopathy

rich d

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#2 Re: ankle Achilles problem
January 11, 2019, 09:46:12 am
Thanks Dan, been doing the stretches and it seems to help a little, not found any eccentrics yet, any recommendations?
Cheers Rich

T_B

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#3 Re: ankle Achilles problem
January 11, 2019, 10:53:44 am
I thought the standard exercise for achilles tendonopathy was heel raises? E.g. on the lowest step of the stairs. Though I tried them last year when I had achilles problems and they seemed to make it worse!

sheavi

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#4 Re: ankle Achilles problem
January 11, 2019, 12:58:58 pm
TA tendinopathy. Best evidence is eccentric loading off a step/stair.  No stretches as it is generally believed that this causes compression of the tendon against the bone worsening the issue.  Exceptions exist.  Just google achilles tendinopathy eccentric loading exercises.

Dan Cheetham

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#5 Re: ankle Achilles problem
January 11, 2019, 01:07:59 pm
[quote author=sheavi link=topic=29814.msg576782#msg576782 date No stretches as it is generally believed that this causes compression of the tendon against the bone worsening the issue.  Exceptions exist.  Just google achilles tendinopathy eccentric loading exercises.
[/quote]

How do they know? Itís 90% made up anyway

sheavi

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#6 Re: ankle Achilles problem
January 11, 2019, 04:29:12 pm
How do they know what? Are you talking about stretching or eccentric loading?  In answer to your questions the best available evidence says so. Why would you want to 'stretch' an injured achilles? 




« Last Edit: January 11, 2019, 04:37:10 pm by sheavi »

Dan Cheetham

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#7 Re: ankle Achilles problem
January 11, 2019, 05:09:15 pm
Know anything, Physiotherapy is 90% conjecture. If I was to make something up to it might sound like having tight calves may increase the strain on your Achilles so stretching the muscle will help, if itís tight of course

sheavi

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#8 Re: ankle Achilles problem
January 11, 2019, 05:34:54 pm
Yes the muscles may be tight and that may cause an issue with the achilles but then applying a static or ballistic stretch to the muscle and tendon will likely worsen a TA issue.  Much of physio isn't supported by scientific studies but by clinical experience.  It takes time to build up an evidence base and of course not every physio by any means uses evidence based treatments or often the contrary.  The fact remains that if the OP has an injured achilles the evidence does not support placing an increased static load or stretch to it.

sheavi

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#9 Re: ankle Achilles problem
January 11, 2019, 05:42:39 pm
Placing an increased tension load on a tendon that has got 'injured' that way is illogical especially in the early stages of recovery.


sheavi

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#11 Re: ankle Achilles problem
January 11, 2019, 05:49:27 pm
Thanks for the links - as stated in the article avoiding stretching the tendon.

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#12 Re: ankle Achilles problem
January 11, 2019, 06:53:44 pm
Anecdotal n=2...

My wife and I both had recurring achilles issues from new shoes at different points.  Both specific running/hiking shoes, but the issues was really hard to directly relate to the shoes as it would occur a bit randomly and there was no issue while wearing the shoes.  I noticed mine because I left my shoes on a trip to visit family and didn't get them back for 6 weeks.  my achilles finally got better and then once I got the shoes back it came back.  FWIW - they were solomon trail running shoes. 

sheavi

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#13 Re: ankle Achilles problem
January 11, 2019, 07:14:44 pm
Anecdotal n=2...

My wife and I both had recurring achilles issues from new shoes at different points.  Both specific running/hiking shoes, but the issues was really hard to directly relate to the shoes as it would occur a bit randomly and there was no issue while wearing the shoes.  I noticed mine because I left my shoes on a trip to visit family and didn't get them back for 6 weeks.  my achilles finally got better and then once I got the shoes back it came back.  FWIW - they were solomon trail running shoes.

This would likely have been due to a compressive force through to the achilles. 

Dan Cheetham

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#14 Re: ankle Achilles problem
January 11, 2019, 07:17:23 pm
Placing an increased tension load on a tendon that has got 'injured' that way is illogical especially in the early stages of recovery.

Meh, Iím not sure the stages of healing model applies well this directly to tendonopathy. If your at the point of eccentric exercises of 180 reps a day which will place a stretching load on the tendon depending on how there done anyway. Plus logic doesnít really come into doing something cos a running physio said so in his blog. Itís just a trial and error thing unless youíve just had an acute rupture of course! Why not try dry needling or those funny injections of your own blood whizzed round or a vasodilator patch or ultrasound. Kitchen sink approach thereís as much good evidence for one as the other.

Ps thatís not actual advice just me being a knob 😉

sheavi

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#15 Re: ankle Achilles problem
January 11, 2019, 07:46:59 pm
Placing an increased tension load on a tendon that has got 'injured' that way is illogical especially in the early stages of recovery.

Meh, I’m not sure the stages of healing model applies well this directly to tendonopathy. If your at the point of eccentric exercises of 180 reps a day which will place a stretching load on the tendon depending on how there done anyway. Plus logic doesn’t really come into doing something cos a running physio said so in his blog. It’s just a trial and error thing unless you’ve just had an acute rupture of course! Why not try dry needling or those funny injections of your own blood whizzed round or a vasodilator patch or ultrasound. Kitchen sink approach there’s as much good evidence for one as the other.

Ps that’s not actual advice just me being a knob

Yes I can tell ;). The Alfredson Protocol takes the tendon through a fuller ROM, it doesn't try to apply a static compressive stretch.  The treatment would be guided by the patients pain response anyway and would be adapted accordingly.  Of course there is healing with a tendinopathy but not in the so called traditional sense.  My purpose in replying to the OP was to offer some guidance from a physio perspective and to try and help although that's obviously limited.  As stretching was advised by some folk I thought useful to say otherwise as the evidence, to date, and what we know about tendinopathies in terms of type II collagen fibre changes, means it is likely to be detrimental.  I used to advise stretches to my patients until the evidence said otherwise.  Of cause the OP can do what he wants :).

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#16 Re: ankle Achilles problem
January 11, 2019, 09:55:05 pm
Anecdotal n=2...

My wife and I both had recurring achilles issues from new shoes at different points.  Both specific running/hiking shoes, but the issues was really hard to directly relate to the shoes as it would occur a bit randomly and there was no issue while wearing the shoes.  I noticed mine because I left my shoes on a trip to visit family and didn't get them back for 6 weeks.  my achilles finally got better and then once I got the shoes back it came back.  FWIW - they were solomon trail running shoes.

This would likely have been due to a compressive force through to the achilles.

Indeed you are probably correct.  However, neither of us EVER noticed any compression of the tendon while wearing the shoes walking, hiking or running.  My point was for Rich to also look at any other changes that may have lead to the tendonitis flaring up. 

Dan Cheetham

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#17 Re: ankle Achilles problem
January 11, 2019, 10:10:29 pm
Alfredson Protocol

I canít believe someone named an eccentric stretching regime after themselves 😂


T_B

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#18 Re: ankle Achilles problem
January 12, 2019, 07:47:05 am
Anecdotal n=2...

My wife and I both had recurring achilles issues from new shoes at different points.  Both specific running/hiking shoes, but the issues was really hard to directly relate to the shoes as it would occur a bit randomly and there was no issue while wearing the shoes.  I noticed mine because I left my shoes on a trip to visit family and didn't get them back for 6 weeks.  my achilles finally got better and then once I got the shoes back it came back.  FWIW - they were solomon trail running shoes.

This would likely have been due to a compressive force through to the achilles.

Indeed you are probably correct.  However, neither of us EVER noticed any compression of the tendon while wearing the shoes walking, hiking or running.  My point was for Rich to also look at any other changes that may have lead to the tendonitis flaring up.

Or possibly the Ďdropí (height difference between the heel and toe) of the shoes. Common issue with runners moving to lower drop shoes, as the achilles is lengthened more the lower the drop. That said Salomon shoes donít tend to have a particularly low drop. But I agree, a change of footwear might irritate or compound a problem.

nick63

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#19 Re: ankle Achilles problem
January 12, 2019, 08:26:24 am
More achilles stuff but on rupture so not sure stop relevance.

https://www.bmj.com/content/bmj/364/bmj.k5120.full.pdf

duncan

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#20 Re: ankle Achilles problem
January 12, 2019, 10:27:53 am
Rich, the swelling "a few inches " above your heel. How many inches? And any idea how it started? Footwear is often an contributory factor - change in rise as suggested above, cycling in non-supporting shoes, or from simple direct irritation - but doesn't seem like if you think Karate is the issue.

It could be tendinopathy, in which case heavy load dynamic exercises into pain is standard approach. Eccentric (heel drops) are popular and may be better than concentric-eccentric (heel raise-heel drop). Standard texts suggest not stretching.   

Monitor pain response: should be painful during exercise (up to ~5/10, more than just a slight ache/soreness), should be no worse the following morning, should gradually ease over 4-6 weeks.

Could also be inflammation/irritation of the tendon sheath or one of the bursae - hence question about the site of swelling -  this is less likely to be helped by heavy load eccentric exercises.

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#21 Re: ankle Achilles problem
January 14, 2019, 08:06:45 am
Abstract only but concludes heavy eccentric calf training is probably  best treatment for Achilles tedinopaphy
http://owl.li/frak30niz2e

rich d

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#22 Re: ankle Achilles problem
January 14, 2019, 10:04:44 am
Rich, the swelling "a few inches " above your heel. How many inches? And any idea how it started? Footwear is often an contributory factor - change in rise as suggested above, cycling in non-supporting shoes, or from simple direct irritation - but doesn't seem like if you think Karate is the issue.

It could be tendinopathy, in which case heavy load dynamic exercises into pain is standard approach. Eccentric (heel drops) are popular and may be better than concentric-eccentric (heel raise-heel drop). Standard texts suggest not stretching.   

Monitor pain response: should be painful during exercise (up to ~5/10, more than just a slight ache/soreness), should be no worse the following morning, should gradually ease over 4-6 weeks.

Could also be inflammation/irritation of the tendon sheath or one of the bursae - hence question about the site of swelling -  this is less likely to be helped by heavy load eccentric exercises.

This is where it is
I've started some massage - which is very painful at the start and then dies away, and some heel drops. At the moment I'm doing the runners stretch as my calf is very tight. I cant think of any shoe changes, I was guessing that my increase in intensity in karate on the run up to my black belt grading was what had pushed it over the edge.
I've been using this stuff after searching on the recommendations here
i'll give it a few weeks and see how it goes. Thanks for the input guys

rich d

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#23 Re: ankle Achilles problem
January 14, 2019, 11:33:39 am
remembered how to post pictures, the swelling is where I'm pointing to, and the pain is on either side of the swelling


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#24 Re: ankle Achilles problem
January 14, 2019, 01:54:05 pm
Unless that's perspective distortion I'd say the problem is that your ankle's been run over by a cartoon steamroller.