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Don’t Let Your Achilles Tendon Be Your ‘Achilles Tendon’!…How To Fix The Pain.

Achilles tendon injuries commonly affects people who subject their feet, legs and body to alot of repetitive pounding and quick dynamic pushoffs.  Over the years, I’ve participated in many different running and jumping sports…basketball (my first love!), karate, track & field (junior high triple-jump champ!), and most recently taekwondo at All Star Martial Arts.  In the past 2 months, things have started to take their toll on my 40 years young Achilles tendons and I’ve entered the early stages of injury…which has served as a stimulus for me writing today’s bog post!

But I’m not going to talk about my Achilles tendons because I’ve only just started doing some self-treatment on it.  Instead, let me share the story of one of my patients, David.

David is a 50 year old, transportation business owner who still enjoys taking part in his favorite past time: soccer.  He plays in a local Aurora mens’ league throughout the year both indoors and out.  It’s how he stays fit and how he beats the stress of work and life.

Back in May, David came by my Richmond Hill chiropractic clinic on the referral of a teammate who had seen me previously for successful treatment on his shoulder pain.  David told me that he had gradually developed pain in both of his Achilles tendons over a period of 2-3 months.  He experienced quite a bit of stiffness in the morning getting out of bed that would loosen up somewhat after moving around.  But during the workday, there would always be some low grade stiffness.  He continued to play soccer despite what he called the ‘minor irritation’, but would definitely feel more stiff and sore the next day.  Lately, the pain had become more constant and he had to resort to talking some Advil before soccer games.  He knew it was getting progressively worse and figured it was time to get it fixed.

David’s symptoms were pretty consistent with most folks who come to me for treatment of the Achilles.  It often occurs in ‘older’ athletes and is of a gradual onset with achiness, stiffness and soreness being the early warning signs.  However, once it becomes severe, each step you take can be very painful.  Three types of Achilles injuries are possible: insertional, paratenonitis and non-insertional.

The least troublesome of the Achilles tendon overuse injury is paratenonitis. This injury represents an inflammatory reaction in the outer sheath of cells that surround the tendon. The first sign of this injury is a lump you can feel that forms a few inches above the Achilles attachment. Treatment for Achilles paratenonitis is to reduce the swelling with frequent ice packs.  Wearing a night brace can also be effective with paratenonitis because tissues immobilized in a lengthened position heal more rapidly.

If the paratenonitis gets worse, it may eventually turn into a non-insertional Achilles tendinosis. This injury involves degeneration of the tendon approximately 2-4 cm above the attachment on the heel. Because this section of the tendon has such a poor blood supply, it is prone to injury and tends to heal very slowly.

Insertional tendinitis refers to inflammation at the attachment point of the Achilles on the heel. This type of Achilles injury is extremely difficult to treat and typically occurs in high-arched, inflexible individuals, particularly if they possess a Haglund’s deformity.  Because a bursa is present near the Achilles attachment, it is common to have an insertional tendinitis with the retrocalcaneal bursitis.

As the body tries to go through the repair process, fibroblasts or collagen producing cells create different types of collagen during different stages of healing.  However, because most people do not give the tendon adequate time to remodel and heal by not appropriately engaging in relative rest, a repeated series of small partial tears begin to form and actually act to ‘over’ lengthen the tendon.  And typically what we see is a unequal increase in the range of ankle dorsiflexion (pointing toes towards the head) on the injured Achilles side.  This is what was exhibited in David’s case.

I mentioned the need for ‘relative’ rest.  With David, that meant several weeks off from the ballistic sport of soccer while he actively engaged in exercise that would assist recovery and proper remodeling of the Achilles tendon…much to his chagrin.

One particularly effective treatment protocol is to perform heavy-load eccentric calf muscle exercises.  Research has shown that these exercises have been repeatedly shown to be highly effective in the management of non-insertional Achilles injuries.  The next time your family doctor recommends trying a cortisone injection for the Achilles pain, tell him you’ll try eccentric exercises instead…cortisone injection have been shown to lower the stress necessary to rupture the Achilles tendon.  You can kiss your sport season goodbye after that!

Another thing I got David to do were some closed kinetic chain tibialis posterior muscle exercises.  A weak tibialis posterior muscle can cause compensatory stress placed on an already overworked Achilles tendon.

Besides aggressive strengthening exercises, another effective method I used with David is a form of deep-tissue massage called Graston Technique.  This technique involves the use of stainless steel instruments scraped over affected tissues.  Many of my patients fondly refer to them as “Dr. Keith’s medieval torture tools”.   The theory behind this type of aggressive massage is that induces microtrauma that stimulates fibroblasts to accelerate repair of tissues in the extracellular matrix (e.g., collagen, elastin and proteoglycans).  Using laser therapy after a Graston session also helps with pain improvement and tissue healing.  Lately I’ve also been experimenting with kinesiology tape on the Achilles and other muscle injuries…it’s that stuff you see the Olympic beach volleyball players wearing.  Neat stuff.

7 weeks after starting treatment, I cleared David to return to play.  He’s happy soccer player once again. 🙂

Now it’s my own turn.  Admittedly, sometimes it’s hard to follow the doctor’s advice!  I can’t engage in ‘relative’ rest quite yet.  I have 3 more weeks of training until my Taekwondo black belt test on August 18th…after that I will gladly engage in some rest!!!

Send any questions you may have to:   drtse@meridianspineandsport.ca!

Your soon-to-be-black-belt-in-Taekwondo chiropractor,

Dr. Keith

 

 

Chiropractic ‘Self-Defense’ Tips for Your Ankles and Feet

We’ve reached the last of my ‘Self-Defense’ tip series and the final area I will discuss today is the ankle and foot where your body makes contact with the ground about five to ten thousand times per day!  Talk about taking a pounding!  (BTW, that’s a picture of me doing Karate at age 12)

Any time you take a step, you want to make sure that foot is planted stable and secure and that’s even more important if you participate in any athletic activity.  If this first link in the kinetic chain is weak, if something is off in the way that the bones, joints, nerves and muscles work in unison to move you around, then the forces that travel up through the foot and ankle will likely cause some sort of lower extremity injury.  It could be plantar fasciitis, medial tibial stress syndrome or ‘shin splints’, an ankle sprain, a stress fracture or maybe even a neuroma.  Also, if the kinetic chain is not working properly, your performance in your chosen sport will suffer.   You could lose 10 yards on your golf swing, run the 100m a full second slower or lose some control on your curve ball pitch.

Before we get into how to prevent some of these common injuries from happening, let’s look at the basic architecture of the ankle and foot.  Borrowing from the field of carpentry, the ankle joint is referred to as a ‘mortise’ joint…a space that something else fits into.  The two long bones of the lower leg called the tibia and fibula create a squarish space that houses the main ankle bone called the talus.  In the foot, there’s 26 bones, 33 joints, 107 ligaments and over 7000 nerve endings.  That’s some crazy complexity!  Yet it works in perfect harmony to support the entire weight of your body and even up to 8x your body weight when running or jumping.

So what can you do to preserve the integrity of this intricate ankle/foot system?  Try implementing the following:

  1. Wear properly fitting shoes – it sounds so simple, yet people regularly chose fashion over fit.  Alot of people will buy shoes that are a bit too wide, too narrow, too tight, have too high of a heel, etc simply because it looks good or even because they got a good deal at the Buffalo outlet mall!  Remember what I said earlier, your feet take at least 5000 steps a day!  Comfortable fitting shoes that support your body weight is essential, not an option!
  2. Wear the right shoes for the job – I remember when cross-trainer shoes became the fad back in the 80’s.  I think duo-sport athlete Bo Jackson (remember him???!!) was the Nike athlete that was used to promote them.  These days, shoe technology is pretty advanced such that cross-trainers are a decent choice.  But if you are more than the occasional athlete, you really need to wear shoes specific to your activity or sport.  They were designed with a specific purpose in mind and to give you optimal biomechanical support.
  3. Consider a shoe insert if you have chronic foot or leg problems.  Start with a less expensive over-the-counter option from Shoppers Drug Mart or even Costco has some neat Dr. Scholl’s orthotics.  If that doesn’t help, consider a custom made pair of orthotics which are specific to your foot shape, function and problem.  Keep in mind, that not everyone needs orthotics.  Your foot problem can often be alleviated by correcting muscle imbalances in the lower extremity.
  4. Stretch, Strengthen & Balance – if you are serious about being proactive with foot, ankle and lower leg health, you really need to address all three of these.  Stretch and massage the plantar fascia, achilles tendon, calf muscle and shin muscle.  Strengthen the inverter, everter, plantar flexor and dorsiflexor muscles of the ankle joint as well as the deep muscles of the foot.  Work on balance and proprioception exercises that affect the foot and ankle.  These may sound unusual or confusing but you can often find some good videos on Youtube that demonstrate how to do them.  In fact, I will be producing some soon on our own Youtube channel so stay tuned.  Otherwise, it’s definitely good to consult your local chiropractor or physiotherapist for advice on this!

Many of your body’s aches, pains and injuries can be prevented and alleviated on your own but you have to have the discipline to do it!  Review and implement the tips I’ve presented today and in previous Self-Defense blog entries and you should find your body will feel healthier and be less painful.

If you have any questions feel free to call us here at Meridian Wellness or drop an email to me at drtse@meridianspineandsport.ca!

Your friendly, Richmond Hill chiropractor,

Dr. Keith

 

 

Chiropractic ‘Self-Defense’ Tips for Your Knees

Knee pain and knee injuries are extremely common in the general population.  Tears to the anterior cruciate ligament (ACL) are common in turning/twisting sports like skiing, soccer and football.  I have three friends in their early 30’s who all had ACL surgery last year alone!  Menisus tear are also very common and affect jocks, couch potatoes and moms alike.  These can often brew from years of overuse, poor biomechanics in sports or just silent deterioration of connective tissue.  And let’s not forget our good friend, osteoarthritis.  I’ve had some patients present with this even in their late 20’s….so it’s never too early or late to develop arthritic knee joints.

The knee has two basic movements: flexion and extension.  However the joint also allows for a bit of internal and external rotation that is insufficient enough to protect it from some of the torquing forces that get placed upon it in life and sporting activities.  Our knee muscles function to propel our bodies forward in movement and also help cushion the impact of movement.  The best way for you to help keep your knees healthy is to maintain the balance and strength of those supporting muscles.

Here are some quick chiropractic tips on how to prevent knee injuries and maintain good knee health:

  1. Avoid prolonged squatting, for example while gardening or doing housechores.  Extreme flexion of the knee places alot of stress on the cartilage and connective tissues in the knee joint.
  2. Ladies, avoid heels that are over one inch as much as possible.  The change in angle alters your centre of mass and subsequently puts more stress on the front of the knee joint and tendon.  The occasional wedding or dinner party will warrant something high but keep them in the closet day-to-day.  Your knees, hips and back will thank you for it down the road!
  3. Don’t prop you feet up on a table or ottoman without some kind of support under your knees.  Just like extreme flexion is bad for your knees, hyperextension of the knee in this ‘relaxed’ position is also not advisable.
  4. Don’t sit with one leg tucked underneath you or sit on the floor with your legs to the side.  There is too much rotation torque applied to your knees in these positions.  It was fine when you were a kid but now that you are older and less flexible, those joints can’t handle it!
  5. Runners will kill me for saying this but I’ll say it anyway!  I don’t advise running as your main form of exercise or fitness because it is simply too much pounding on your knees and rest of your body.  There are a lot of other way to stay fit or lose weight that don’t create such a toll on your body.  At the very least, try not to run more than every other day, run on softer surfaces and cross-train on your off days.  Competitive runners…keep doing what you’re doing because I know you won’t listen to me anyway!
  6. Wear properly fitting athletic shoes for whatever sport you participate in.  This also means that you shouldn’t wear running shoes to play soccer or basketball in, nor should your wear basketball shoes to run in.  Shoes are designed for specific purposes and are best used in the appropriate court, field or pavement.
  7. Lose some weight if necessary.  In climbing stairs, an extra 50 lbs of weight translates into over 150 lbs of extra pressure on your knees!
  8. Invest in a foam roller to perform self-myofascial release in key muscles such as your quads, hamstrings, ITB and calves.  By releasing excessive soft tissue tension around the knee joint, there will be less pressure on the joint when doing any activity.

When looking at knee pain, the common conditions you may hear thrown around at the office, in the gym or at home include:

  • ACL/MCL/mensicus tears,
  •  Jumper’s Knee, Runner’s Knee, Patellofemoral Pain,
  • IT band syndrome,
  • quad/hamstring pull,
  • knee arthritis

Whichever one of these you may or may not have, you should always see a qualified health professional to have it assessed properly.  Most of the time rehab therapies, manual treatments and properly addressing muscle imbalances will help you get back to normal in short order while surgery and injections should only be viewed as last resorts.

What is the best medicine?…PREVENTION!

Dr. Keith