What causes this lump on my achillies tendon: Is it tendonitis?
With our Coronoavirus lockdown beginning to ease a bit now, we are seeing many of our clients hitting the gym for the first time in a few months.
At Complete Podiatry, we understand this is a very dangerous time for many clients and we are starting to see injured clients pour into the clinic for help with their tendon problems.
Starting exercising back at the same level of intensity that we finished with after a break is one of the biggest risks for injury in a tendon.
Mentally, we know we should be able to do what we are planning, however, while we are inactive, we lose condition in the tendons.
This then makes us vulnerable when get back to our activity again and we work as hard as we THINK we should be able to do.
Hello, tendon injury!
Is it tendonitis or tendinopathy?
For many years, most episodes of tendon pain have been diagnosed as tendonitis.
The suffix -itis refers to inflammation and swelling of the tendon.
Typically, treatment for tendonitis had been focussed on anti-inflammatory medication and time away from exercise and activity.
Recent research, however, has focussed attention on the true cause of tendon pain.
Rather than being inflammatory in nature, it seems the changes that are occurring are more of a degenerative process caused by a sudden change in the loading of the tendon.
If too much load is applied too quickly (for example, a sudden increase in activity levels or a return to the gym after time away) our tendons can get damaged.
This damage will lead to abnormal function, changes to the micro-cellular structure, a lower tolerance for stress in the tendon, pain and abnormal thickening
These degenerative changes are more correctly called Tendonopathy.
Tendons need to be loaded correctly to stay healthy
Tendons love to be active and stressed as this helps to keep them healthy and functioning properly.
Tendons are impressively complex structures that need to be able to perform three tasks.
- They need to be strong enough to tolerate a high static load
- Tendons need to be able to move while having a load applied to them
- They need to be able to store and explosively release energy.
These three functions allow us to move, walk, hop, run and jump.
How to treat tendinopathy
Treatment for Tendonopathy should follow the following 4 basic principles for treating any musculoskeletal injury:
- manage pain
- reduce damaging stress in the tissue
- improve the health of the tissue and
- make the tissue stronger
As a Podiatrist, probably the most common cause of Tendonopathy I come across is Achilles Tendonopathy.
In this condition pain can occur in the middle of the tendon (mid-substance Tendonopathy) or where the tendon joins the heel bone (insertional tendinopathy).
Treatment of Achilles Tendonopathy must vary depending on where the degenerative changes are occurring.
Our management plan for treating Tendonopathy is always individually tailored to the client and the tendon yet will usually follow the below steps:
- Accurately diagnose the tendon problem (including requesting Ultrasound investigation)
- Develop a plan for managing pain in the tendon using isometric strengthening exercises and ice
- Reduce the damaging load in the tendon via strapping, activity and footwear modification, gait retraining and appropriate orthotic intervention
- Improve the health of the tendon via manual therapies such as Shockwave Therapy, tool-assisted massage and dry needling.
- Once pain and strength improve, modify exercises to stress the tendon while moving
- Prescribe exercises to work on explosive power (plyometric exercises)
The management of Tendonopathy needs to be a long term project that requires a commitment from both you and our Podiatrists to follow the treatment regime to make sure you return to your gym work as strong as you can.
Healing doesn't occur in a straight line (unfortunately!)
There may be ups and downs with your tendon pain along the way and that is really normal.
What we request is for our clients to let us know how they're feeling so we can adjust their plan accordingly.
During treatment for tendinopathy, we work with our clients on multiple areas that contribute to their pain.
This will include reducing stress on damaged tissues, hands-on treatment and exercise rehabilitation.
Sometimes progress moves quickly, and other times they sometimes might feel they have hit a plateau.
What's important to know is that we need to trust the process as changing the plan too much usually has a negative result on recovery.
However, we are always there to listen to our clients and strongly encourage them to let us know how they are feeling as we will always take this into account with what we do.
What we do outside of the clinic is just as important as what we do within it - What clients do at home will go a long way to getting them better, faster!
Need More Help?
At Complete Podiatry, we have seen too many clients that have suffered from inattentive health practitioners who prescribe an exercise program then tell them to "give them a call" if things are not settling down.
Tendon pain can be treated effectively but It takes teamwork!
Our team of highly trained and well-equipped Podiatrists love working with people just like you to help you reach your goals.
My challenge for you then is to take the first step to fix your tendon pain now and book a time with one of our Podiatrists so you can get back to living your amazing life, from the feet up.
Yours in helping to build amazing lives from the feet up,