Achilles Tendon Pain

When you hear the word Achilles, you think of a Greek mythological hero, or you  may also think of the bottom of your leg.
 
The achilles is a tendon that connects your calf muscle to your foot / ankle. 

WHY WE GET THE PAIN –
As with most tendonopathies, they usually occur due to overload. Where there is a repetitive strain and load without enough rest or recovery.
I myself am currently dealing with an Achilles tendonpathy as I was silly enough to run the first 13 days of 2021. Varying from 5-15km runs, without any rest or recovery has put me in this position today where I get to rehab my own achilles. 
 
 
The last thing a runner wants to hear is to stop running all together. We need to manage the load going through the tendon to allow healing and reduce aggravation. One of the first questions we should ask ourselves is, “What has changed?”. Something has changed a sudden increase in load, a sudden increase in speed, a sudden increase in hills, a sudden increase in kilometres, a sudden change in gym work out, shoes, surface etc. A sudden change normally precipitates an injury.  So it is important to identify this issue and modify your training load. 
 
Treatment –
 
Your Osteo will look at your foot and gait to assess any dysfunctions.
Work through the ankle joint to mobilise the area as well as some soft tissue/dry needling work through the calf muscles.
They will Also prescribe you with appropriate exercises and come up with a management plan to modify training load appropriately. 
 
RECOVERY TIME – 

Tendons typically take longer to heal than a muscle strain, as there is a poor blood supply. 
With appropriate strengthening & recovery you are looking at 3 weeks to 3 months.

CALF STRAINS

Anatomy

Calf strains are a commonly injured muscle for athletes. In sporting terms it is also referred to as ‘the old mans’ injury’ as it is more often seen in athletes passed their prime and over the age of 32

In many such cases the injury is caused through sudden eccentric overstretch, ie. The muscle is contracted yet lengthened forcibly and abruptly.  An example of this is when an athlete plants their foot and looks to explosively push off.

The most common place to incur this injury is at the musculotendinous junction of the gastrocnemius: roughly halfway between the knee and the heel.

A calf strain may also be more likely in athletes who have tight calf muscles.

Prevention

  • Having good calf strength
  • Thorough warm ups and muscles that are stretched and not ‘tight’
  • Learning the proper technique for exercise and sporting activities. This will decrease stress on all muscles, including calf muscles
  • Undertaking training prior to competition to ensure readiness to play
  • Undertaking fitness programs to develop strength, balance, coordination and flexibility
  • Gradually increasing the intensity and duration of training
  • Allowing adequate recovery time between workouts or training sessions

Lower Back Disc Bulges – 5 Helpful Exercises

I’m sure you have all heard of the term ‘Disc Bulge’ when it comes to your spine, but do you know what it actually means?

A disk bulge or herniated disc occurs when some of the soft jelly in the centre of the disc slips out past the tough exterior.

 Disc bulges are most common in the lower back (Lumbar region) but can occur anywhere from the neck to the low back.

WHAT ARE THE SYMPTOMS –

Lower Back Pain

Numbness, Tingling or pins and needles in Legs

Leg Pain, or Weakness associated in Leg

Rest, Exercises and rehabilitation are often the most important parts of recovery from a herniated disc. Doing gentle activities and exercises will strengthen the muscles that support the spine and reduce the pressure on the spinal column. This will also promote joint mobility in the spine and assist to reduce the disc from re-aggravation.

  1. Spinal Decompression

 – 30 seconds to 1 minute 5 every hour.

2.Cobra Stretch

 – 3 x 10 – holding for 15-30 seconds

3. Cat + Camel Stretch  3 x 10

4.Knee Hugs –

5.Childs pose –

Waking with a Sore Foot?

Waking up with a sore foot?

Been running a lot lately and the bottom of the foot starts to hurt at the beginning of a run and goes away?

Feeling tender on the “arch” of your foot?

Have you answered YES to any of these questions?

You might have Plantar Fascitis or Plantar Heel Pain.

What is Plantar Fascitis?

Plantar means sole of the foot and fasciitis means inflammation. When put together you have inflammation of the fascia on your foot. This fascia is a band that originates from your heel and continues until your mid foot, then slowly divides into 5 bands to each of your toes.

Where is the pain located in Plantar Fascitis?

Normally most of the pain would come from your heel and it would feel tender in your arch of your foot.

Did you know?

When we are walking that fascia absorbs 1.1 times your body weight and when you are running it doubles to 2.5 times!

What are the risk factors of Plantar Fascitis?Plantar Fasciitis

1. Pes cavus (claw foot) or pes planus (flat foot) deformity

2. Excessive pronation (rolling) of your foot

3. High impact / weight bearing activities such as running, jumping prolonged standing

4. Poor fitting shoe

5. Elevated weight (High BMI)

What can I do to help Plantar Fascitis?

1. Calf strengthening

2. Stretch your calf and arch

3. Towel crunches with your toes

4. Talk to your osteo about the use of an intervention such as an orthotic, fascitis fighter aid or a fascia sock!

Our resident exercise and footy guru, Dr Daniel Castellano

City Osteopathy

Ankle Sprains

Ankle sprains are of the most common biomechanical injuries that we can sustain in our sporting lives. An ankle sprain occurs when the ligaments that uphold the structural integrity of the ankle joint are stretched beyond their normal barrier causing the fibres to undergo microscopic tears.

Anatomy

There are two main groups of ligamentous structures that hold the ankle joint together. These are the medial and lateral ligament complexes (inside and outside of the foot respectively). In the majority of sporting scenarios that result in an ankle injury, the ankle will roll outwards, resulting in an ‘eversion sprain’ and damaging the lateral complex. This occurs more commonly than an ‘inversion sprain’ (rolling inwards) due to the strength of the medial complex.

Within the lateral complex is the anterior talofibular ligament (ATFL), which is found to be the weakest and most commonly injured ligament.

Signs and Symptoms

Following an injury to the ATFL ligament, we can expect:

  •  Pain to occur immediately at the time of injury depending on the severity of the damage. This pain can present in local tenderness in the area or more vast throughout the entire foot. Our body creates pain as a way of restricting our movement in order to maximise healing potential.
  •  Swelling of the ankle joint over the site of injury as the body begins the inflammatory healing process.
  •  Inability to weight-bare threw the joint whilst standing, walking, running or jumping, depending on the severity of the sprain. 
Osteopathic Treatment 
Following the occurrence of an ankle sprain, best practice suggests resting the ankle for the first 48-72 hours and applying the PRICE protocol (protection, rest, ice, compression and elevation). 
From this point, an Osteopath will begin by assessing the severity of the injury through a thorough examination of the ankle and all anatomical structures which may have been affected in the injury. 
If indicated, the Osteopath may refer the patient for imaging to rule out potential fractures amongst other more sinister injuries.

Treatment of the ankle will include techniques including soft tissue, myofascial release, joint articulation and manipulation with an aim to restore the ankle to it’s normal function. Lymphatic drainage techniques may also be used to reduce the swelling within the ankle.

Following treatment, your Melbourne osteopathy will prescribe management exercises for the patient to perform in their own time to progress their rehabilitation.

 

Author: Dr. Kristian Ciciulla (Osteopath)

City Osteopathy

 

References

Eisenhart, A. W. (2003) Osteopathic Manipulative Treatment in the Emergency Department for Patients with Acute Ankle Injuries. The Journal of the Osteopathic Association.

McGovern, R. P., & Martin, R. L. (2016). Managing ankle ligament sprains and tears: current opinion. Open access journal of sports medicine, 7, 33–42. doi:10.2147/OAJSM.S72334

Melanson, S. W., Shuman V. L. (2019) Acute Ankle Sprain. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/

Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012). Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic reviews, 4(1), e5. doi:10.4081/or.2012.e5