Friday, 4 February 2011

Achilles Injury and Pain

Since moving to Cardiff in November I have started working with Athletics. A lot of these athletes train from 10 - 14 sessions a week which means that a lot of strain is being put through their bodies on a regular basis. If you are a runner you need to run quite a few miles per week in order to get the results you need, and everyone knows that running puts a lot of force and strain through the legs in particular. Tight and sore hamstrings, gluteus, quadriceps and calves muscles are a common complaint for a lot of runners, which is not surprisingly considering all the miles they need to handle and deal with. Tight calves is present in a lot of people with Achilles problems which is what I wanted to talk about today:

The Achillies tendon is a common injury site for a lot of runners. Most people know where the Achilles tendon is as it is easily identified just above the heel bone. Underneath you can see a picture of the Achilles tendon. The Achilles tendon is attached onto heel bone and runs up to the biggest muscle group in the back of the calves; the Gastrocnemius. So the Achilles tendon is a continuation of the calf muscles allows us to transfer power from the calf muscles to our ankle and foot. The Achilles tendon is active in pretty much any movement we do and it is for a reason it is the strongest single tendon in our body.

This is taken from Dr. Harry Gouvas MD, PhD - The Acillies Tendon is the yellow part on the picture
Several injuries can happen to the A. Tendon whith the most severe one being complete rupture of the tendon. I have not personally come across that injury, but I know several athletes (fotballers) who have sustained that injuries and I have seen videos of it happening and it is not a pretty sight! Anyway today I would focus more on overuse problems such as Tendinitis/Tendinosis or Tendinopathy! First I would like to specify in simple terms the difference between the two/three commonly used terms:

Tendinitis: Means that there is inflammation present!

Tendinosis: Means degeneration without inflammation!

Tendinopathy: This is just a general term which doesn’t specify the type of injury

With any overuse injury it is the accumulation of smaller tears and wear down of the tissue that causes problems. In a lot of the tendon “diagnosis” there is a discussion whether there actually inflammation present, hence why a lot of people keep mixing the terms. In a lot of cases there may not be any signs of inflammation present (swelling, redness), but the athlete can still have a degeneration of the tendon which causes pain.

The annoying and sometimes very frustrating thing about tendon injuries in general is that they have poor blood supply which means they can take a long time to heal. There are several things that can be done in terms of conservative treatment such as ultrasound, sports massage to calves, friction massage to the tendon and probably one of the most important things to start is eccentric calf loading rehabilitation program. Eccentric loading means a lengthening of the calf muscles and tendon and I have also attached some pictures underneath to show you what eccentric loading is in practise. A 12- week program of eccentric calf loading 3x 12 repetitions 7 days a week can be a starting point for this type of training. I have added some references towards the end of this post if you want more explanation. 
Lower down with the painful leg (This is Andy Syke's calves and you can check out his blog here:

Push of with the opposite leg (this just shows the starting position)
Although there are some (although maybe not a lot) research and promising results on this type of training, it is definitely worth a try! Remember with any injury; seek professional help and advice prior to starting any treatment or intervention!

Hope you found it useful! Have a good weekend everyone!

1. J.D Rees, A.M Wilson and R.L Wolman, Current concepts in the management of tendon disorders, Rheumatology 2006

2. E. M Roos, M Engstrom, A Lagerquist and B Soderberg, Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy- a randomized trial with 1-year follow-up, Scandinavian Journal of Medicine and Science in Sport 2004

3. M Fahlstrom, P Jonsson, R Lorentzen and H Alfredson, Chronic Achilles tendon pain treated with eccentric calf-muscle training, Knee Surg Sports Traumatol Arthrosc 2003

Monday, 31 January 2011

Celtic Cup 2011

This weekend I was lucky to be selected to be a part of the Welsh team to provide sports massage to the Welsh athletes at the Celtic Cup at NIAC (National Indoor Athletic Centre). On Saturday I went to Park Inn Hotel in Cardiff where I met the athletes and staff for the first time. We had a nice meeting about the day ahead and went for some dinner afterwards. It was nice to meet everyone and I looked forward to getting started on Sunday.

On Sunday I went to NIAC for 10 am. I work alongside another masseur called Jonny Lodowski. The English team’s physiotherapist and the Scottish team’s soft tissue therapist were also based next to where we were so it was an interesting day where I got to speak to some knowledgeable people. Since I was part of the Welsh team this weekend that meant it was a lot quieter for us compared to the previous events I have done recently, but I still managed to help a few athletes. It was still a good experience where I got to meet a lot of nice people.

Of course I need to say that the Welsh team won the first overall title at senior level  which was great! Well done everyone! You can read more about the cup here:

And here is a nice picture of the team including staff

In summary I think I can say Good Job (with american accent) which was a phrase that was heard often during the day on Sunday:)