Mick's Achilles Tendon Blog.....

Last month I wrote a blog on how to safely start an exercise program as part of new year resolutions. Hopefully, that blog was useful to you and you’ve remained injury free for January.

If the festive season extended into January for you and you’re starting your exercise plan now and/or “Feb-fasting”, its best that you read my previous blog (https://www.melbsportsmed.com.au/news/introducing-mick-hughes-and-his-new-years-resolution-blog). For those that have been exercising well and injury free for January, I want to quickly touch on a hot topic in the world of sports medicine and physiotherapy – Tendons.

There has been a vast amount of research published in the last 5 years on tendon pain. This is great news for you, as we are now starting to get a better idea as to how best effectively treat this condition. A great example of this is, is this news article on Channel 9 news on the weekend - http://www.9news.com.au/health/2016/01/29/18/00/melbourne-scientists-develops-treatment-for-tendon-pain. Unfortunately there doesn’t seem to be a magic pill yet that will magically resolve your pain, but we are certainly starting to see that strength training is a “non-negotiable” component in its management.

One of the most common complaints that we see in the clinic, not long after someone starts a running program or a boot-camp program, is Achilles tendon pain. Before I go any further, importantly, this blog relates to mid-portion Achilles tendon pain, not insertional Achilles tendon pain. There is a very big difference between the two and their management. Even with mid-portion cases, there are different ways to treat the tendon depending whether or not your tendon is in a reactive stage, disrepair stage or degenerative stage. There is also the question as to why your Achilles tendon has become overloaded - remember, it's the victim, not the culprit. And don't even get me started on whether you're an in-season athlete or an out-of-competition athlete; so please be reminded that this post should not substitute a thorough subjective history and clinical examination by a Sports Doctor or Physiotherapist.

Mid-portion Achilles tendon pain is characterised by pain, swelling and tenderness within the mid-portion of the Achilles tendon (2-6cm above the heel) that typically onsets when you start exercising, resolves for the most part of what you're doing, and then becomes painful again when you cool down. The best available evidence for treatment is the "Alfredson's eccentric heel drop protocol". In a nutshell, the protocol gets you do two types of heel raises over the edge of a step, twice a day for three months. For you with insertional Achilles tendon pain, this protocol will worsen your symptoms, that is, why you need to be properly assessed before embarking on this program.

There is now level one evidence (the best) that supports a rival protocol. Researchers have found that doing a heavy, slow resistance (HSR) training program of straight leg heel raises, seated heel raises and straight leg heel raises on a leg press machine for three months was equally effective as the Alfredson's protocol. The beauty of research was that the subjects got the same results training three times per week, instead of twice a day. This is an absolute win for those of you that have issues with exercise compliance, but the downside is that you'll need to have access to gym equipment to get the results. 

So there you have it, very solid research that backs up strengthening as a first-line treatment option for mid-portion Achilles tendon pain. The only thing you have to decide is, do you lift heavy weights in the gym 3 times per week for 3 months? Or do you perform the Alfredson's protocol at home twice a day for three months? The choice is yours, but the results are the same!

If you are having injury concerns or simply want to improve your performance, Mick is currently available for consultation at The Melbourne Sports Medicine Centre on Monday, Wednesday and Friday. He has recently moved to Melbourne from Newcastle and brings with him considerable experience and interest in the treatment and management of the adolescent athlete.  He loves the challenge of injury prevention/minimisation strategies, and is a keen observer of biomechanics that are related to knee, hip and lumbar spine complaints. He also has interests in the following areas:

  • Soft tissue injury rehabilitation - particularly the calf, groin and hamstring.
  • The knee – confident in all aspects of knee injury prevention and post-op rehabilitation of     ACL, meniscal problems, all arthroscopes, stabilisations and TKR.
  • Lumbar spine stress reactions/fractures.
  • Tendinopathies.

Read more about Mick, the author of this article, here.

You can book online here to see Mick or alternatively phone 9650 9372.