Host: Dr. Scott Jablonka (Carolina Movement Doc)
Season 3, Episode 3
Episode Summary
This episode focuses on Achilles tendonitis and the different aspects of its management.
In this episode, Dr. Jablonka describes the Achilles tendon, and explains the causes of tendonitis, how it occurs, and the role of physical therapy in addressing it.
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Top Takeaway
- “Cadence does matter when we’re running.”
– [Dr. Scott Jablonka] - “After about five hundred miles or so on the same set of shoes, it is typically recommended you look at getting a new pair.”
– [Dr. Scott Jablonka] - “The best way to prevent a running injury is ‘never run’; that’s stupid.”
– [Dr. Scott Jablonka]
Episode Highlights
- [00:40] Today’s topic is Achilles Tendonitis.
- [03:07] Anatomy of the Achilles Tendon.
- [06:50] Differentiating Achilles Tendonitis from other similar cases.
- [09:17] Two main types of Achilles tendonitis
- [12:31] Why cortisone injections are not recommended.
- [13:00] Three methods to aid recovery at home.
- [16:25] Treatment of Achilles tendinitis
Episode Notes
Achilles tendon
Formerly called the Calcaneal tendon based on its position around the heel or calcaneus, the name “Achilles tendon” was coined from a myth about the Greek god Achilles.
The tendon is a strong fibrous cord in the back of the lower legs that attaches the lower leg muscles to the calcaneus. It is responsible for pushing the body forward when walking or running. It can be severely painful when inflamed.
Sprinter and stroller muscles
The two muscles that act on the Achilles tendon are the Gastrocnemius and the Soleus.
The Gastrocnemius muscle is a pair of bulky muscles behind the legs that we use in sprinting, also called the Sprinter muscles. The Soleus muscle is just below the Sprinter muscles. It is also called the Stroller muscle because it is active during low-intensity movements.
These two muscles help push off the feet, propelling the body forward.
Achilles tendonitis
The two primary forms of Achilles tendonitis are mid-portion tendinopathy and insertional tendonitis.
- Insertional Achilles tendonitis occurs at the point where the tendon joins the calcaneus behind the heel. It is more common in middle-aged and elderly patients.
- Mid-portion Achilles tendonitis occurs about 2 cm above the heel bone, often associated with a significant increase in physical activity, especially in athletes.
Strengthening the Achilles tendon
Check for Achilles tendinitis at home by testing the ankle and foot flexibility. How far can your knee go past your toe with the foot flat on the ground? If it does not go at all past the toes, this is a sign of a likely problem.
Some ways to help are:
- Eccentric Heel Raises: this is the gold standard for building the overall integrity of the Achilles tendon, sprinters, and stroller muscles. Eccentric means the muscle is contracting but lengthening.
- Strengthening the whole backside muscle chain, including the back thigh muscles and some trunk muscles. Exercises that help with this are hip thrusts, glute bridges, deadlifts, landmine push presses, and others.
- It is also advisable to check your footwear because much older ones can affect your walking and running mechanics.
Depending on the severity, full recovery may take up to between three months to a year, but significant recovery would have started much before then. Cortisone Injections are strongly discouraged because the catabolic effect eats away good tissue.
Recovery
The first line of treatment for Achilles tendonitis is a physical therapy consultation to assess and create expectations for recovery based on a treatment plan.
Electro Dry Needling is immensely beneficial, especially for pain that still comes up. It provides pain reduction and increases blood flow to the issue.
Another is cup therapy or myofascial decompression, where cups are placed on a particular tissue. That part of the body is taken through a series of strengthening activities while the cups are on. This procedure will decompress the tissue, allowing for the fluidity of the lower leg and reduced pain.
Another approach is Kinesiology tape which reduces the pain from the area and helps improve exercise performance. However, it is not a permanent fix.
Additionally, Eccentric loading helps, and then Isometric contractions, where there is contraction but no shortening or lengthening, are highly effective, and studies have suggested that they reduce pain from tendonitis.
Additional causes of lower leg pain
The Achilles tendon is not the only cause of pain at the back of the lower leg. Other types of pain include Posterior Tibialis Tendonitis and Peroneal Tendonitis.
- The posterior tibialis tendon is the most important in supporting the foot arch. Hence problems with the tendon can result in collapsed arches alongside pain behind the foot.
- Peroneal Tendonitis involves the Fibularis muscles, muscles on the side of the leg which control movement of the foot and ankle joints.
With pain in the leg, it is necessary to differentiate Achilles tendonitis from others. Seek a physical therapist because such pain could result from a combination of all three.
As a physical therapist, Dr. Jablonka offers continued care even after patients return to full physical activity. The goal is to ensure the reduction of injuries through professional support and guidance.
Reach out to Dr. Jablonka on Instagram to be featured on the podcast. Patients can also reach out to him through his website.
Resources
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