Join us here at Sports Physio Ireland on the 1st December 2017 for our 6th educational seminar for health professionals.

The seminar will be hosted by Mr Paul Kirwan who will be discussing the management of the achilles tendinopathy.

Paul Kirwan is a Chartered Physiotherapist and Clinical Research Fellow with over 20 years of clinical experience. Currently, he works as a physiotherapist in Connolly Hospital Dublin in an advanced practice role in Rheumatology/MSK and is completing his PhD through the Royal College of Surgeons in Ireland. His research is investigating the role of Glyceryl Trinitrate and exercise in the treatment of midportion Achilles tendinopathy (the NEAT trial).

Paul also works in private practice and with Bohemians FC. He graduated from Trinity College School of Physiotherapy in 1994. After this he worked in numerous hospitals in lreland, the Middle East and the United States gaining experience in treating a wide variety of MSK conditions and treating recreational to professional athletes as well as non sporting individuals. He became a Certified Strength and Conditioning Specialist (CSCS, NSCA) in 1999.

He returned to Ireland in 2003 and commenced working in Connolly Hospital with the Rheumatology team. While here he commenced working as an advanced practice physiotherapist working alongside the rheumatologists as a first point of contact clinician, and has also completed training in injection techniques.

He completed his MSc in Sports and Exercise Physiotherapy at National University of Ireland, Galway in 2009 graduating with first class honors and was awarded the Mary Sullivan Gold Medal for best student in discipline over the course of his Masters degree. He was awarded a prestigious HRB research fellowship in 2014 to complete his PhD, which he is currently pursuing in RCSI with a special interest in tendinopathy.

Paul has presented research nationally and internationally, and won a research award from EULAR in 2014, this was the first time an Irish physiotherapist has received this prestigious award in recognition for his work in this field.

If you have any questions, please don’t hesitate to contact us at info@sportsphysioireland.com.

We look forward to welcoming you into the clinic on the 1st December.


Achilles Tendinopathy in Runners

Unfortunately Achilles pain can become the bain of many runner’s careers. Whether you are an elite or a recreational runner it can affect you.

Achilles pain can come on acutely or more gradually with a seemingly insidious onset. Acute pain with a loud audible pop is known as an achilles rupture, and one which is difficult to miss. This article will deal with the less acute, grumbly tendons namely- achilles tendonopathy.

 

What is a tendinopathy?

A tendinopathy is a change is the tendon’s structure. When we overload the tendon, and do not allow it sufficient time to heal the tendon develops a ‘stress shield’.

Unlike what was commonly believed previously, there is not inflammation going on, and so the shift from tendonitis to tendinopathy

 

Tendinopathy can be divided into 3main stages

  1. Reactive- acute,painful, swollen, tender tendon following rapid increase in load(mileage, hills, speed)
  2. Dysrepair-follows on from the acute phase, tendon structure starts to change
  3. Degenerative- chronic, common in the older athlete, thickened with nodules. There is risk of rupture at this stage.

 

What to do?

What to do, will very much depend on stage your tendinopathy is at:

*Reactive stage/early dysrepair*

 

Reduce load

Decrease your running load. This may mean  full rest when the tendon is particulararily angry. You need to be pain free at rest and during walking before you consider running.

When you commence running again bear the following in mind- pain should not go above 3/10 pain. Allow adequate rest between runs (24hrs+). Pain should resume to pre run level by 24hrs post.

Purchase a heel Cushion. These can be bought for approximately 7 euro from Murrays Pharmacy. The small elevation the cushion gives you, ensures you avoid compressive load on the tendon which is provocative for the tendon.

 

Pain Relief

Consult with your GP/Pharmacist regarding pain relief. Anti-inflammatory medications have been shown to be of benefit in managing tendonopathies, despite there being no inflammation.

 

Increase strength

During the reactive stage, exercises such as heel drops are likely to aggravate the tendon. Opt instead for isometrics. Perform these on 2 feet on a step. Go up onto your tip toes, then return to neutral( rather than going into full heel drop) Aim to build toward 10-15reps and 3 sets of these.

 

Avoid the following:

Stretching

Although it may feel like this is what the tendon needs, stretching can compress the tendon and aggravate it more.

 

Very flat shoes/pumps

As with the stretching, flat shoes can aggravate pain with compressive loading

 

**Late dysrepair/degenerative**

 

Increase your strength

Unfortunately you can have a reactive tendonopathy going on alongside a degenerative tendinopathy. In this case management is similar to above.

 

With a more chronic degenerative tendonopathy you can start to increase strength training more without aggravating symptoms. You can progress toward eccentric exercises which ‘strengthen and lengthen’ the tendon such as heel drops

 

Gradually increase your mileage

As a general rule, increase your cumulative mileage by no more than 10% per week.

 

Address weaknesses elsewhere along the kinetic chain

As with many injuries, the area you feel pain may not be the source of your problems. Get assessed by a physiotherapist to address any weaknesses you may have. Runners need to perform strengthening exercises at least once weekly to  prevent and treat injury.

 

Listen to your body

If you have a painful achilles which fails to improve with rest, get it looked at. Don’t ignore your symptoms.

 

Ellie Hartnett, MISCP 


                   

 


Achilles Tendon Injury – What Rehab is Forgetting

The Achilles tendon is at risk of injury with high load. Runners have a 15 times greater risk of Achilles rupture and 30 times greater risk of tendinopathy than sedentary individuals.

The Achilles tendon is the thickest and strongest tendon in the body. The three calf muscle attach to the heal via the Achilles tendon.

“Overcoming what was deemed impossible is what I will take with me and cherish the most…That (coming back from injury) will be the number-one thing that stands out because I wasn’t even able to walk.”

– Donovan Bailey (Olympic 100 m sprinter talking about his rehab for his Achilles tendon rupture). After rehab he ran sub-10 seconds for the 100 metres.

Out of the 5 clinicians in Sports Physio Ireland, two of us were unfortunate to have suffered Achilles injuries. Myself a partial tear and Joey Boland a tendinopathy.  Depending on the severity of the injury the road to recovery is slightly different. The outcome of rehabilitation is positive, however, with us both returning to our representative sports. The partial tear taking slightly longer to adapt to return to play.

Recognising and Correcting Running Form Mistakes

Overuse Achilles tendon injuries (tendonopathies) can arise with increased training volume or intensity. This happens because the load is too much for the tendon to withstand. Decreased recovery time between training sessions may also be a factor. The combination of stiffness (especially in the morning) and pain at the back of the heal is a key sign of Achilles tendinopathy. Pain often reduces during activity and may be pain-free during training only to come back with a vengeance a few hours later. Continuing to train through this causes the structure of the tendon to weaken and puts you at an increased risk of rupture.

As well as looking at injury to the Achilles itself, it is important to determine the causes of the injury in the first place. Injury is often linked to calf tightness or weakness and ankle joint stiffness. Abnormal lower limb biomechanics has been shown to cause torsional stress through the tendon. Weakness around the ankles can cause a whipping like action on the Achilles. A change in playing surface or footwear or poor footwear should also be considered.

Tendons take longer to adapt to training due to their poor blood supply. Rehabilitation takes longer than muscular injuries and is generally in excess of 3 months. Rehabilitation should include loading the tendon appropriately and correcting of predisposing factors that were linked to the injury. Progressing to plyometric and sports-specific activities when the ability to withstand load increases. `

When running approximately 5 times your body weight goes through your foot as you land. The Achilles needs to be strong enough to withstand this force before you go back to running, jumping and landing. Rehabilitation often does not put enough weight through the structure during closed change activities before progressing to running. Heal raises with 15-20 kg, Reverse lunges with greater than 20kg, Squats of greater than 20kg and SLDL of 20 kg should be a realistic expectation for everyone before returning to play or their chosen activity. Distributing the weight through two separate dumbbells makes this achievable for those who struggle with upper body strength. When thinking about the high level of repetitive load that goes through the body when running these weights are not that heavy and are what the body needs to adapt.

Soft tissue therapy including mobilisation and  fractioning across the tendon are useful in improving the glide of the tendon in it’s sheath. As stickiness around the tendon is often associated with injury to the tendon.

Return to activity should be gradual.

Activity should be resumed only when local tenderness has settled and weights during rehab exercises achieved.

If long distance running is not the main aim then I would argue that the repetitive loading of that nature should be avoided. If sports are the main aim then interval running should be the focus. This is the nature of the activity they are trying to return to and also allows the tendon brief recovery periods.

Catherine Simpson

MISCP, MSc Sports Medicine

www.sportsphysioireland.com

Check out our social media

https://www.facebook.com/sportsphysioireland

https://twitter.com/sportsphyirl