In the past we have seen quite a few soccer players and other field sport athletes, such as football players, who have come in to have their ankle pain treated. This is not surprising as there is a lot of accelerating, decelerating, stopping, cutting and pivoting in these sports, often leading to ankle sprains and strains. Aside from common ankle sprains, there are those ever lingering, recurrent pains at the back of the ankle. One condition commonly causing these pains is Achilles tendinitis and later tendinosis.
What is the Difference Between Tendinitis and Tendinosis?
Tendinitis means tendon swelling, and “itis” is inflammation. With the initial injury to the tendon there is swelling for 14 to 21 days; once the swelling has slowed down the condition moves into the “tendinosis” which is the mechanical breaking down of the tendon. Research by Karim Khan, PhD has proven that the only way to cause a recovery from the mechanical breakdown is to stimulate the tendon mechanically to stimulate growth of the tendon to repair itself. If you do not do the heel drop program, there is a good chance you will have chronic Achilles tendinosis that will slow you down for a long time.
The Achilles tendon at the back of your lower leg attaching to your heel is the biggest tendon in the body. Inflammation or micro tearing of the tendon leads to a weakened tendon, causing the athlete to experience recurrent pains that don’t seem to go away, even after a long period of time when a strain should have healed. Athletes will complain of the tendon’s tenderness to touch, commonly 2-6 cm from the heel; redness, swelling and stiffness, thickening of the tendon in the back of the ankle, pain with repeated toe pointing or standing up on the toes, stretching the calf muscles, pain with jumping, accelerating and stopping abruptly when running.
How is this condition caused? Causes can include a one time injury from a sudden push off or stop of the ankle, or landing from a jump with a feeling of sharp pain, and sometimes hearing a “pop or snap”. It can also be caused by repetitive overstretching or overuse training in running and jumping activities. Previous multiple ankle sprains can cause ankle joint laxity and biomechanical problems in the ankle, leading to excessive strain on the tendon and subsequent tendinitis/tendinosis.
How can it be treated? Inflammation should be initially treated with icing, rest and modification of activities. Taping and proper footwear can also help prevent the injury from getting worse. The tendon then needs to be progressively stretched and strengthened so that it can be strong enough to withstand the forces put on it from running and jumping. If it is not fully strengthened, it may re-tear and become inflamed again. Full recovery can take 6-16 weeks. Please feel free to email or call us if you have any further questions. Book an appointment if you are currently experiencing these symptoms. The sooner this injury is treated, the higher the success rate. We look forward to meeting you in the clinic.
- Heel Drops
Heel drops are a set of exercises designed to strengthen the calf muscles and the tendon attaching the calf muscle to the heel bone (Achilles tendon). Nose Creek Physiotherapists believe by doing the exercises described below, the calf muscle is made to work while it is contracting and while it is being stretched. Physiotherapists refer to this unique form of exercise as eccentric loading and this is different from most strengthening programs. It more closely simulates the actual movements and loads during sport and exercise.
Why Heel Drops?
One of the main reasons that full recovery from injuries such as Achilles tendinosis is difficult is because the calf muscles often remain weak after injury. Strength does not return on its own, and inadequate strength is one of the causes of injury. Therefore, Physiotherapists know that correcting any weakness is a very important part of recovery from and prevention of injury.
Even if the strength of the calf muscle/tendon unit is normal (meaning strong enough for normal daily activity), your Physiotherapist will caution that it may not be strong enough for exercise activities. The heel drop program has been designed to mimic the type of loads experienced during exercise, so it is known to be effective when used in a Physiotherapy program for someone returning to sports, which includes running.
How do you do Heel Drops?
Nose Creek Sport Physiotherapists point out that the important components of this program are your body position, the speed of the exercise and the progression.
Stand with your feet shoulder width apart, with the balls of both feet over the edge of a step. You can use a handrail for balance, but not support. Next, ensure your toes are pointing straight ahead (don’t toe-in or toe-out). Rise up on your toes and lower your heels below the level of the step.
The program has two speeds which mimic the load that the legs experience during exercise. To begin with, you go down and up at a slow, comfortable speed. Later you begin to do fast drops, meaning you should do the drop very quickly. At the bottom of the drop your movement should stop suddenly, so that you feel a jerking or bouncing sensation. Then, raise slowly back up.
Your Nose Creek Sport Physiotherapist knows that many people at first are a bit apprehensive about doing these quick drops. However, you will find that once you begin you will gain confidence quickly. This is the most important part of this Physiotherapy program, so press ahead!
There are two parts to the progression; the build up and the maintenance.
Start by 3 sets of 20 repetitions of the slow drops. This means that you do 20 drops, wait a minute or two, then do 20 more, recover, and then do the 3rd set of 20. Continue doing this every day. After 14 days, you can move to the next stage. When doing the single leg exercises be sure to exercise both left and right sides.
By using your own body weight on one or both feet, and by varying the speed, there is enough change in resistance over the program that you don’t need to use weights. This entire Physiotherapy program is easy to do because it doesn’t require any equipment!
Build Up Exercises
3 sets of 20 repetitions daily Both legs slow 14 days Both legs quick drop, slow up 14 days Single leg slow 14 days Single leg quick drop, slow up 14 days 56 Days Total
Once you have reached the single leg quick drop level for 14 days, switch over to the maintenance program. Physiotherapy requires you to perform the last stage every other day. Then, continue with the maintenance program as part of your regular exercise routine. To maintain strength, decrease the single leg quick drops to every other day. You should also stretch before and after doing the heel drops, and ice the area if painful.
Then drop down until stretch felt and repeat 3 sets of 20 reps. First 2 weeks drop slowly until no symptoms felt in tendon then, progress to fast drops for 2 weeks.
Then progress to one leg once 2 legs fast drop is symptom free. Start with one leg slow then again progress to one leg fast drops.
This is best done on a stairwell on the last step, where you can hang onto a railing.
- Towel Exercise
Pushing towel by extending toes
Pulling towel by retracting toes
Ankle up motion start position
Ankle up end position works front shin muscles.
- Ankle Up and Out Motion
Start neutral position.
End range position.
Up and in motion start position.
End range position.
- Stretches for Lower Leg and Foot
Gastrocnemius – superficial muscles stretched with back leg straight.
Soleus- deeper muscles stretched with leg bent.
Arch muscles stretched with toes on wall then lean your knee towards the wall.
- Standing One Leg Balance