Exercises for Achilles tendinosis rehabilitation

YOUR INJURYAchilles tendonosis is a condition thataffects the lower end of your Achillestendon which connects your calf muscleto your heel. It involves degeneration ofthe tendon and is common in men. The symptoms include:

• a gradual onset of pain during andafter exercise over the tendon

• stiffness in the morning

• pain when you do a heel raise It is important that this injury is notallowed to become a long-term problemwhich may lead to permanent tendondamage.

WARM UP & WARM DOWN

When injured it is particularly importantthat you warm up with a fast walk (at apain free pace) for 3-4 minutes beforeyou start your exercises. This increasesyour circulation and helps prepare yourmuscles for the activity to come.

When you have finished your exercises itis also important to allow your heart rateto slow down gradually by ending thesession with a gentle walk for 3-4minutes.

Promoting Health Through ExerciseACHILLES TENDINOSIS

Heel bone

Achillestendon

Attachment of Achillestendon to heel

Diagram showing the ankle andAchilles tendon

©1999 Primal Pictures Ltd

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USEFUL RESOURCES

• SportEX Medicine magazinewww.sportex.net

• The Organisation of CharteredPhysiotherapists in Private Practice -www.physiofirst.org.uk

• General Osteopathic Council www.osteopathy.org.uk

• The Sports Massage Association www.thesma.org

• The Osteopathic Sports Care Association www.osca.org.uk

Treating inflammation with PRICE - immediately after injury and for 3-5 days afterwards

Tissue injury usually involves damage to small blood vessels that results inbleeding at the site of injury. This bleeding leads to the five main signs ofinflammation: heat, redness, swelling, pain and loss of function. The inflammato-ry reaction is necessary as it is part of the natural healing process. However thebody tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid containsa protein that turns into replacement ‘scar’ tissue. Too much scar tissue may prevent the structure returning to normal function with reduced flexibility andincreased risk of re-injury. The advice below should be followed for 3-5 daysdepending on severity. It can be remembered by the acronym PRICE.

� PROTECT - Protect the injured tissue from undue stress that may disruptthe healing process and/or cause further injury. Make sure the mode ofprotection can accommodate swelling.

� REST - This reduces the energy requirements of the area, avoids anyunnecessary increase in blood flow, ensures protection of the area andoptimises healing. For example using slings, crutches or static rest (ie.sitting or lying down).

� ICE - The ice helps constrict the blood vessels thereby limiting bleedingand reducing the accumulation of unnecessary scar tissue. Crushed icewrapped in a damp towel (to prevent ice burn) is best (ice cubes can bewrapped in the cloth and smashed against a wall to crush the cubes).Ice should be applied immediately after injury for 20 minutes every 3-4hours or no more than 5-10 minutes at a time on bony areas.

� COMPRESSION - Simple off-the-shelf compression bandages such asTubigrip™ and adjustable neoprene supports are adequate. It is impor-tant to ensure the bandages are not too tight to cause pins and needlesor any loss of feeling around the joint.

� ELEVATION - Lowers the blood pressure and helps limit bleeding andencourage drainage of fluid through the lymphatic system.

When following PRICE it is also important to avoid HARM, hence the saying:‘Give PRICE and avoid HARM’.

these are counter-productive to PRICEtreatment}

AVOIDH – Heat (eg. hot bath,sauna)A – AlcoholR – Running M - Massage

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The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept noliability for any loss, injury or damage howsoever incurred (including negligence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

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PRACTITIONER CONTACT DETAILS

Stretching exercises

1Gastrocnemius stretchTake the position shown

to the left, with feet pointingforwards and heels in contactwith floor. Bend the frontknee and straighten the backknee keeping your head upand pelvis/hips forward. Youshould feel a stretch in yourcalf muscle area.

2Soleus stretchKeep the same position as

the previous gastrocnemiusstretch but bend the back kneewhile keeping the heels on thefloor. Again you should feelthis stretch in your calf area,although this exercise stretchesa different muscle to that instretch 1 above.

4Tibialis posterior stretchCross the unaffected leg in front

of the affected leg, keeping theheels on the ground. You should feela stretch in the back of your calf.

Strengthening exercises

Progression speedYour therapist will advise you on the speedyou should progress with your exercises.Progression is not just about being able to dothe exercise but to do it correctly, with appro-priate control. If at any time you feel pain ordiscomfort, stop the exercises and consultyour therapist.

TreatmentAfter exercising aim to apply ice2 times for 15 minutes with onehour in between.

PATIENT ADVICE

Exercises for Achilles tendinosis rehabilitation

Guidance for stretching exercisesHold all the stretches for 20 seconds each and repeat them three times on each leg.

gradedreturn tosport

3 x 15 doubleheel raises

3 x 25doubleheel raises

3 x 15single heelraises

3 x 25single heelraises

3 x 15withweights

3 x 15 dynamicpush offs

3 x 25dynamicpush offs

Your rehabilitation programmeThis exercise programme has specific exercises to stretch tightmuscles and strengthen the muscles around the ankle as well asimprove dynamic control and ankle joint position sense (proprio-ception). In order to achieve proper rehabilitation of your injuryit is important to ensure the exercises are performed with goodtechnique. Poor practice leads to poor performance and potentialstrain on your injury. This leaflet includes some exercises to helpin your rehabilitation.

3 x 25withweights

3 x 15 fast with weights

3 x 25 fast with weights

3Flexor hallucis longus stretch

Again in the same position asabove, bring your back footforward and place your big toeagainst your heel so that itstretches your toe upwards. Themuscle you are stretching isattached to your toe.

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