subject: Do You Want a Pain Free Achilles Tendon? [print this page] Do You Want a Pain Free Achilles Tendon? Do You Want a Pain Free Achilles Tendon?
Painful heel defects have not only concerned Achilles the mythical hero of the Trojan war - it is described that Achilles tendon injuries account for 7-9% of all health problems in runners. Achilles tendon problems can disturb men and women of all ages, however today I'll center on the cluster of pathologies that seem to affect the 25+ year olds - the widespread but debilitating Achilles tendinosis. You could have by this time seen from your doctor or physio that the term tendinosis has replaced the commonly used term tendinitis, as the 'itis' element means that the pathology has a component which is inflammatory.
It is presently known through numerous of studies on the pathology of chronic tendon defects that inflammation is not the primary dilemma, but degeneration is the big factor in pathology. The newest and finest research indicates that as the tendon degenerates due to compressive forces of the heel bone, new blood vessels develop into the location around the degenerated location. The objective of these new blood vessels is to fuel new tendon growth in the regions immediately neighboring the degenerated tendon. It is these blood vessels that actually create the discomfort chemicals that we finally feel. It usually takes a period of time for the blood vessels to infiltrate in the affected area which means that by the time we feel soreness, the problem has most likely been there for months - we just have not sensed it yet.
A number of smart doctors have used what are referred to as sclerosing shots into the blood vessels (Polidoconol being the most popular). The goal of these injections is to 'kill off' the blood vessels so the discomfort diminishes. However, without correction of the precipitating factors, the painful foot invariably comes back as the blood vessels regrow. The backbone of persistent Achilles tendon management has been the Hakan Alfredson 'eccentric' training program. Rumour has it that Dr Alfredson was a long term sufferer of Achilles tendinosis. In his tremendous frustration at not being able to treat himself he believed he would probably be better off working the tendon with the intention of snapping it. He could then have it surgically fixed and 6 months later would be without problems. So he walked into the gym and carried out heavy sets of calf raises in the hope of snapping the poor Achilles tendon. What happened? It got better. This then spurred a great deal of studies into how 'eccentric' exercise benefits tendon injuries. The readers digest version as to what 'eccentric' exercise does is that it stimulates tendon cells to lay down more collagen and create a functionally better tendon (the process for those who want to google it is called 'mechanotransduction'). The degeneration stays but the remainder of the tendon gets stronger to 'offload' the degenerated spot.
So what is 'eccentric' exercise? It's not push ups performed by a crazy scientist but it corresponds to how muscles are able to maintain tension whilst being strained. In the scenario of the Achilles tendon, it's where one raises up on tip toes and lowers oneself down with control. The calf and Achilles are getting longer but still have tension. And the secret with the 'eccentric' system is to keep it eccentric. Don't be concerned about lifting yourself up onto tip toes again using your calf, use your other one or use both together. It is the lowering part which has the valuable effect. The common method sets off with the injured person on flat surface. They come up on both tip toes then take away the good side and lower using the affected side. They do 3 sets of 15 reps every day, twice per day. Once this is attainable, they can proceed onto a step and increase the amount of stretch applied to the calf/Achilles at the bottom of the movement. This routine will typically need to be done for 3 months before you can relax and do it every second day as safeguarding.
