LET’S FIND OUT 

You’ve  just come into the physiotherapy clinic with a script stating that you have Achilles tendonitis. You know it must be this because it hurts at the back of the heel area (maybe a little bit above the heel).  It really hurts after a run and sometimes even into the next day if your run is more than a certain distance. It often feels a bit tight and sore at the start of your run, but it seems to get better as the run progresses. And boy is it sore when you press on the area or it touches something. 

This is the story that you tell the physiotherapist. You may be asked a few more questions regarding how far you typically run or how long you have been running. 

As a physiotherapist I could ultrasound the sore area over several visits or give you some eccentric exercises and teach you some stretching. But what I really want to know as a therapist is why? Why is it just happening on one side of your body? What is happening at your pelvis?; your foot?; and even into your back that might be contributing to this problem.   

A COMMON PATTERN 

I’ve  noticed with Achilles tendon pathologies is that there is often one hip (pelvic bone) that is higher when the person is standing. There is more muscle tension in the muscles running up one side of the spine that may be pulling the pelvis up. The foot then has to supinate (roll outwards) to achieve heel strike. The outer calf muscle (gastrocnemeus) often has a ropy band in it (indicative of a shortened muscle).  This can also create a loss of movement/mobility at the calcaneus (heel) joints. Other times the heel joints are stiff because of past ankle sprains (even up to 20 years prior) where there was no treatment administered. 

TREATMENT 

How I might treat this is by releasing the tight ropy muscle bands (using my preferred method – IMS or intramuscular stimulation). Go to www.istop.org for more informaiton on IMS. Then I would use my manual therapy skills to restore joint mobility where needed (this may include the ankle and foot as well as the sacroiliac joint or SIJ). Friction massage to the tendon can be helpful if there is a bump. Clinically, what I have noticed is that if the tenderness seems to get less as the area is rubbed, it is likely a tenodonopathy (no inflammation but rather a change in the quality of the tendon collagen).  Eccentric exercises have been reported in the literature to be effective in the treatment of tendon problems.  These are when exercising the muscle you lengthen it rather than shortening it. Proper stretching (watching the heel position as many people turn the heel in at the back when stretching) of the calf muscles can also be beneficial. 

IF YOU’RE MOTIVATED 

Check out:  

1.www.istop.org 

2. If you are a physiotherapist, there are a couple of upcoming video/teleconferences on the use of electrophysical agents and the Achilles tendon issues.  Go to the PABC website for more information at: http://www.bcphysio.org/app/index.cfm?fuseaction=pabc.ubc 

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