All these years, I have been guiding patients through their injury processes, recovery and rehabilitation, and then it happens, I get injured! Not the little niggle that stops you for a couple of days – but the dreaded Achilles tendon! Read on to see if the physio helped the physio!
Seemed like such a good idea – a charity event doing 5km a day for 50 consecutive days, starting on the 1st January 2014 – ooh what a great way to start the new year I thought! At that time, my running was progressing really well, I felt great, was losing weight, I was discovering myself as me again rather than Ella, Chloe, Zack and Josh’s mum ( yes, 4 kids under 9… that’s another story!).
5km was a short run for me, so I thought it would really progress my training – the ‘rules’ were, you could cover the 5km a day by running, swimming, cycling, walking, skipping, forward rolls (you get the picture?!), and a couple of times a week you were ‘allowed’ do 10km a day to have a ‘rest day’.. woo hoo, what’s not to love right?!
My clever husband (also a physio), wisely said to be careful and warned of an ‘opathy’ type injury, and if I recall I actually laughed (oops!) – did I heed him? Of course not!!
All started well, but early on, not helped by cold or wet conditions, and most of my runs being at 5.30am, a niggle developed in my right achilles, just the kind that you’d have to stop mid run and stretch off, but quickly recovered. I didn’t run every day, I did a bit of cycling and walked the school run a few times ( 3 miles there and back) – but my children didn’t need to do that milage.. in the winter!
Rest wasn’t an option – I’d secured hundreds of pounds of sponsorship from kind and generous family, friends and patients… so I continued, trying strapping and heel wedges to offload, and plodded on.
By day 50, mid February, my achilles was screaming at me – they say our bodies come to us in whispers, and if we don’t listen, it screams… well I can verify that! I rested for a couple of weeks and tried to pick it up, but the pain, swelling and stiffness just worsened – I was unable to run, walk uphill, wear flat shoes, and the grumpier, and wider I became!
According to statistics, between 40 and 60% of runners will experience acilles tendinopathy at some point, as it is typically associated with overuse and distance running. There are so many factors influencing the onset, and subsequent recovery of this condition, and physios should be best placed to manage it effectively – practitioner, heal thyself!
In the acute phase, we treated it with rest, anti-inflammatories, resting night splint, strapping, ultrasound and acupuncture. This gave good short term relief but little carryover.
Research tells us that with a lot of tendon problems, there is little evidence of inflammatory changes, so a ‘tendonitis’ is actually more ‘tendinosis’ and should be treated as such. With this knowledge, rehabilitation and loading is the key.The Achilles tendon is the largest and strongest tendon in the body, and typically a tendinosis or tendinopathy doesn’t make the tendon weak, but it makes it difficult to tolerate loads.
Initially I needed k- taping to help but progressed with some hiccups with the alfredson eccentric protocol, which helped pain but not my function. These specific exercises help to gradually increase the load on the tendon by focusing on eccentric work before concentric.
We had addressed core stability (or lack of!) and biomechanics and addressed these with pilates and orthotics ( I have always been a pronator – or feet rolling in position) to help control what was happening at ‘ground level’, and my foot joints including big toe were all ok ( if your big toe does not extend enough this will load your Achilles )
Do I have a happy ending? 15 months on I am able to do 25 minutes of walk/run which is a huge accomplishment! The first time I managed 10 minutes of walk for 1 minute/ jog for 1 minute about a month ago I felt absolutely ecstatic! A far cry from zooming a 10 km run before work but like I tell my patients when it comes to rehab – you have to start on the bottom rung of the ladder and work slowly up! I come downstairs on a morning like a little old lady and if I have to get up in the night to see to one of the kids, it’s not clever, and I have 2 rather large nodules at the back of the Achilles. I feel jealous of anyone running, and I am determined to get back to it, and even more so, now spring has well and truly sprung. I am currently awaiting a scan to check the patency of my Achilles, but feel I need no other intervention currently other than perseverance, and taking my own advice! ( if you are a physio, or know a physio, we are notoriously good at giving advice, but not so good at applying it to ourselves!!)
Collagen synthesis and repair in tendinopathy can take 12-18 months so patience is the key!
I have learnt quite a bit on my injury journey ,it has highlighted the need to keep up to date with current research and evidence ( and things have changed significantly over recent years), but mostly I have found the old art of patience!! And I have sooo much more empathy for my patients!!
If you’d like to know more about Achilles rehab or would like an appointment, email me at email@example.com or call 07983643835
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I will hopefully update you with a positive outcome in the coming months! Happy running!