The Most Common Mistake in Self-Treating Achilles Tendonitis

I encountered three people in the past two weeks that were all self-treating Achilles tendinitis.

They all were getting worse.  

They all were making the same mistake.

This is my public service announcement for the week.  Many of us employ the treat by consensus plan.  We consult Dr. Google.  We ask friends.  We call family.  We listen to trainers that a friend of a friend’s aunt knows.  I know I do it.  Apparently, some of my friends do as well.  Adding to that, we have the voice of our fourth grade gym teacher in our head; “no pain, no gain”.

The consensus/group think treatment for Achilles tendinitis seems to be:  stretch till it bleeds.  

The calf muscle group is often tight and needs to be stretched.  However, overstretching can irritate an injured muscle or tendon.  If the pain is where the tendon inserts onto the heel, you can start to weaken the insertion point.  My little art project:

Relaxed muscle fibers

Stretched muscle fibers

Torn muscle fibers

BACKGROUND SIDE BAR:

Sometimes a tendinitis is actually a tendinosis.  Tendinitis is more of an inflammatory type process.  A tendon gets irritated from overuse and as the body tries to go through the healing process, it gets stalled in the inflammation phase.  Inflammation is a normal part of healing an injury.  It becomes a problem when the process does not continue and move beyond that phase.

Tendinosis is a little different.

From Wiki:

This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis….^[1] Classical characteristics of “tendinosis” include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells which has challenged the original misnomer “tendinitis”.^[2]

How would I treat it?

1. Ice can be very useful, especially if it is a new pain.  Use caution after icing:  you just decreased blood flow to an area that sustains a great deal of force when you walk.  If you ice, plan on watching TV or reading for a while after.  (ice 10-20 minutes)
2. Heat can feel really nice.  It can also be helpful in relaxing the area before stretching. (heat 10-20 minutes)
3. Stretch gently.  In the beginning, it may be easier to stretch sitting down.  Place a towel or belt around you forefoot and gently pull back, stopping when you start to feel a pull in your calf.  (Hold 30 seconds 2-3 times; 2-3 times a day)
4. Eccentric loading exercise sounds much more complicated than it is.  Stand near a counter for safety.  Raise up on toes of both feet.  Pick up the foot that is not hurt.  Using just your injured leg, slowly lower your heel back to the floor.  Repeat.  You may only be able to do a few at first because it causes a strong contraction but because the muscle is lengthening, it is seems cause a different result than just doing a bunch of heel raises.

Please talk to your doctor about calf pain.  There are other things that can cause the pain.  Identifying the source will make treatment much more effective and efficient.

 

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