Chondromalacia of the Patella Tendon

Chondromalacia - Dreaded Runner's Knee

Chondromalacia, known as “Runner’s Knee”, is one of the most common sources of knee pain for athletes over 20 years old.  The patella injury involves the patellofemoral joint, where the patella (kneecap) and the femur (thigh bone) interact.

Chondromalacia is the pathology that takes place when the articular cartilage on the back of the kneecap becomes irregular and damaged.  Because the back of the patella is now not the smooth and firm surface it usually is, it can damage the distal femur articular cartilage surface.  Much like a damaged pulley, the stresses that are placed on the moving surfaces being loaded become a source of patella pain.

Healthy articulating surfaces in the human body, including the patellofemoral joint, have 3 times less resistance than a wet ice cube on ice!  Think about that for a minute. This simple yet amazingly efficient system of transferring forces over joint surfaces allows 400 pound men to run and jump with minimal damage to the joint…..until that articular cartilage becomes damaged.

The back of the patella has a medial (inner) facet and the lateral (outer) facet that both come into contact with the medial and lateral condyles on the distal femur bone.

What Happens When You Have Chondromalacia

In between the two facets is the intrafacet ridge which glides in the trohclea groove located between the medial and lateral condyles of the femur or thigh bone.  Patella injury can result in damage to any combination of these articular contacts or the patella tendon itself.

With activity, the patella may not glide or track in the proper manner with knee flexion and extension.  With abnormal motion, damage to the surrounding tissues and/or the cartilage on the underside of the patella or distal thigh bone can take place.

The vastus medialis muscle, the most distal and medial of the quad muscles, will usually become weak with any patella injury.  With this inner quad weakness and resulting tightening of the outer knee structures, the patella tends to shift too far laterally or to the outside.

Younger Athletes and Osgood Schlatters

With younger athletes who have not physically matured enough to close their growth plates, they are susceptible to Osgood Schlatter disease.  Osgood Schlatters is a condition where the insertion of the distal patella tendon is elevated.  It significantly changes the tracking and movements of the kneecap.  Because of the alterations with the wear patterns of the backside of the patella, excessive articular cartilage damage occurs and patella tendon quickly becomes symptomatic.

Signs and Symptoms of Patellofemoral Pain Syndrome

  • A visible (atrophy) and functional quadriceps weakness when compared bilateral.
  • May have discomfort/pain in the anywhere around the patella with prolonged sitting and activities involving resistive knee extension such as running and jumping.
  • May have a history of Osgood Schlatters disease or patella injury.
  • Swelling sometimes occurs after activity.
  • A palpable grinding/clicking sensation from behind the kneecap with leg extension that may or may not be accompanied by pain.
  • A Q-angle greater than 20 degrees.

Professional Treatment for Chondromalacia & Osgood Schlatters

  • A product like the Trigger Point Quadballer is a great therapy option to relax the quad and increase the knee range of motion
  • Biomechanical analysis to assess the lower extremities bilaterally to determine if there are specific mechanical issues that are contributing to the Chondromalacia.  Common factors are:
    • Leg length discrepancy
    • Poor flexibility
    • Excessive pronation or supination
    • Quad weakness
    • Weak abdominal musculature
  • Consistent use of rollers and massage to the entire thigh area including the lateral thigh, groin and hamstring muscles.
  • Implementing aggressive quad strengthening exercises that are pain-free with minimal patella crackling or noise present.  To accomplish this, the types of exercises, the specific range of motion and the amount of resistance must be closely monitored to safely improve strength without increasing the symptoms.
  • Full flexibility of the lower extremity and low back.  The hip flexors, the IT band, the calves and, believe it or not, the big toe are the most overlooked areas for athletes who are not successful in overcoming this patella injury.
  • Warming up the knees are often overlooked but it is priceless with this injury.
  • Aggressive manual therapy and modalities to decrease the pain while increasing the mobility of the soft tissue associated with the patella.
  • Ice, ice, ice….immediately after any activity.

Questions a Pro Athlete Would Ask about Chondromalacia

To ensure you are treated like a smart professional athlete with a patella injury or Chondromalacia who wants to safely return to his/her sport, you’ll want to ask your sports medicine specialist the following questions:

  1. Are you certain of the diagnosis?
  2. Do I need any other tests to determine the extent of this injury?
  3. How badly damaged is the cartilage on the back of my kneecap and are there any activities that I need to avoid as I rehab this injury?
  4. What are my options with treating this injury?
  5. What factors do you consider to be the main reasons for my injury and, more importantly, need to be addressed with my rehab?
  6. Quad Weakness
  7. Poor Flexibility
  8. My Sport(s)
    1. Who do you consider to be the expert patella rehab specialist in this area?
    2. Do you have a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips To Help You Heal And Reduce Knee Pain

  • Be Farsighted – Chondromalacia is often the result of a biomechanical problem that needs to be corrected.  Look above, below, behind and in front of the kneecap to find the source(s) for the pain..
  • Change Now & Stay the Course – Most factors for patella injuries don’t just go away.  Plan on finding the problem, making the necessary changes and then maintain those changes for the long haul.
  • Be Honest With Yourself – Look closely at your workouts for the past 3 months and ask:  “Did I change too much too soon?”  Increasing the workload too fast is a common problem with athletes suffering from acute patella injuries.
  • Ice is Your Friend – Here we go again…….Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate. You’ve heard me say this many times throughout MRF, however I can’t stress the importance enough. You need ICE and lots of it. Also, if you have a child with Osgood Schlatters, make sure he/she is icing properly.
  • Father Time Has a Bum Knee – As we age our flexibility naturally decreases unless we work at it.  Consistently maintaining out flexibility is the key while joining a yoga or Pilates class is the ideal solution.  Start stretching NOW and take a lot of stress off your knees, patellas and low back so you can make this patella pain a thing of the past.

How Professional Athletes Successfully Treat Knee ITB Syndrome

Running With ITB Syndrome

Iliotibial band syndrome (ITBS), or Illiotibial band tendonitis, is a frustrating and troubling injury.  Because of it’s common mechanism of injury involves repetitive knee flexion and extension, it is often associated with runners.

Personally, ITB syndrome has proved to be one of the most difficult injury that I’ve dealt with as an athlete.

The IT band is a sheath of dense fibrous connective tissue which originates on its upper end to the tensor fascia latae muscle on the upper outer thigh.  The ITB extends down the lateral thigh and inserts into the outer surfaces of both the fibula and tibia bones of the shin. The function of the IT band is to help extend the knee joint, externally rotating the upper leg along with abducting of the hip.

Illiotibial band tendonitis is usually a result of the ITB being inflamed with excess friction of the ITB passing over the lateral epicondyle (the bony ridge on the outer distal thigh bone) of the femur (thigh bone).  With a repetitive knee movement like running or secondary trauma, the rubbing of this tissue over the hard bony ridge will result in inflammation and movement discomfort.

Signs and Symptoms of Runner’s Knee/Iliotibial Band Syndrome

  • Pain on the outside of the knee above, at or below the lateral knee joint line.
  • An increased tenderness with palpation(note: palpation is a method of clinical examination using gentle pressure of the fingers to detect growths, changes and unusual tissue reactions)of the iliotibial band.
  • An inability to squat through a full range of motion because of lateral distal thigh pain and weakness.
  • Knee pain normally aggravated by running, particularly downhill.
  • Pain during flexion or extension of the knee with both the foot on and off the ground.

How to Professionally Treat Iliotibial Band Syndrome

  • Apply cold therapy with ice bags, ice massage or ice bath.
  • Rest the knee and lower extremity from running, quad strengthening and painful activities.
  • Implement self myofascial mobilization and massage techniques such as rolling the thigh, lateral thigh and calves.
  • Aggressive flexibility of the IT band and the entire lower extremity including the ankle, great toe and low back.
  • Lateral knee and thigh massage is an effective treatment to reduce painful ITB tightness.
  • Assessing leg length and foot biomechanics bilaterally.  It is common to trace the source of lateral knee pain to a leg length difference or excessive pronation involving one leg.(Pronation means that the feet roll inward and cause the ankles to turn in.)
  • A thorough analysis of the athlete’s training program

Asking the Right Questions With Lateral Knee Pain

When faced with runner’s knee or Illiotibial band tendonitis, the wise professional athlete who wants to safely return to his/her sport and avoid further injury will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis?
  2. Do I need an MRI to rule out any other problems?
  3. What are the best options with treating this injury?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert knee rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips For Successful Iliotibial Band Treatment

  • Minimize the Damage – Illiotibial Band Syndrome is not an injury that you can just grit your teeth and run through.  Be smart early and avoid creating additional injuries.
  • Look Elsewhere – IT band tendonitis is often a result of a mechanical problem elsewhere.  Look above: hip & low back…..or below:…arch, ankle or great toe.  Don’t forget to look at your shoes!
  • Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • Lighten up, Coach! – An athlete suffering from IT Band Syndrome is usually training very hard.  A common theme with this injury is that you do not have enough recovery time during the week or you are progressing too aggressively with your workouts.  Getting your coach, which sometimes refers to YOU, to work with you on this is a key step in getting this painful injury in your rearview mirror. A thorough analysis of your athlete’s workout plan is a great start.
  • How Long? – This may be one of the toughest injuries to put a recovery timeframe on.  The downtime from lateral knee pain associated with IT Band Syndrome is significantly reduced if you treat the injury early and modify painful activities while treating the injury as noted above.

How To Recognize And Treat Achilles Tendon Ruptures

Achilles Rupture

Your Achilles tendon is a strong tendon in your body.  It connects the calf muscles (made up of the gastrocnemius and soleus) located in the back of the lower leg to the back of the heel. The Achilles tendon can partially tear or completely rupture. It is more common for individuals over the age of 35 to suffer a complete rupture of their Achilles tendon than a younger athlete.

Achilles tendon ruptures are frequently associated with a previous history of a prolonged inflammatory condition.  Significant Achilles tendon injuries are commonly the result of an aggressive acceleration movement using the lower leg and/or rapid change of direction activities.

Signs & Symptoms of an Achilles Tendon Rupture

  • A sudden sharp pain as if something hit you in the back of the leg.
  • A sudden snapping sound accompanied by an intense but short-lived pain.
  • The inability to push your foot downward or raise yourself up on your toes while walking.
  • The presence of a divot or gap felt along the usual location of the tendon.
  • A significant amount of swelling and surprisingly, minimal pain, in the back of the lower leg.
  • A positive result for Thompson’s test.

How to Treat a Torn Achilles Tendon

  • Apply ice to the area with an ice bag, ice massage or, ideally, an ice bucket.
  • Avoid walking on the ankle.  Until the severity of the injury is determined, walking on this injury may result in additional damage which can significantly prolong the recovery time.
  • Elevation of the ankle and lower leg will limit the swelling and decrease the pain.
  • Seek sports medicine consultation immediately. Confirming the diagnosis early is very important.

Questions to Ask About Your Torn Achilles Tendon

Even if you’re not a professional athlete, your goal should be to treat your torn Achilles tendon both safely and efficiently. To emulate the smart professional athlete with an Achilles tendon injury who wants to safely return to his/her sport, ask your sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do we need to do an MRI to determine the extent of the injury?
  2. What are my options with a conservative (without surgery) rehab plan and with a surgical approach?
  3. With both options, what can I expect for the next 3, 6 and 9 months?
  4. If your son or daughter where in my situation and had the exact same injury as I do, what would you recommend them to do?
  5. If surgery is my best option, how many of these types of surgeries do you do per year?  Who do you consider to be the expert Achilles surgeon in this area?
  6. Who do you consider to be the expert Achilles rehab specialist in this area?
  7. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips You Can Apply to Recover More Quickly

  • Know what you’re dealing with – To quickly get a clear diagnosis and plan, it’s better to have this type of an injury evaluated by an orthopedically-oriented medical specialist compared to a general medical professional.
  • Start treating it early – There are many factors such as walking boots, surgery and early weight bearing plans that must be addressed within the first couple of days after an injury if a full recovery is expected.
  • Know Your Plan for Today & Tomorrow – Be realistic about your activity plans for both your short term and the long term.  Being on crutches for a month or two is never ideal for anyone but if in doing so it considerably improves the likelihood that you will be a happy and active athlete for the rest of your life, DO IT!
  • Think like a Pro – Most high-level athletes with a complete Achilles tendon rupture decide to have their tendon surgically repaired.  The outcome is usually better than the conservative approach, which usually takes longer to heal along with a slower rehabilitation schedule.
  • Expect a Marathon Recuperation Period– The recovery time is considerable for this type of an injury.  Generally speaking, with a surgical repair the recovery time is approximately 6 months.  With the conservative or non-surgical approach, the recovery time is usually closer to 9 months.

Osgood Schlatters: Managing Youth Patella Pain

Painful Osgood Schlatters Disease

He has this huge bump below his knee, his doctor says he’ll grow out of it but it hurts him all the time.  What should we do?’ his mother said, frustratingly seeking an answer.

Following a fund raising golf tournament recently a good friend of mine came to me looking for a clear answer for a strange injury with a bizarre name.  Her athletic teenager had an overly large bony lump just below his right knee.  He was 16 years old, still growing and she was understandingly concerned about her son’s knee.

Osgood Schlatters Disease is an orthopedic disorder that results in an enlarged tibial tuberosity just below the front of the knee.  The tibial tuberosity is the lower attachment of the patella tendon.  Because of the excessive forces generated by the quadriceps (muscles located in the front of the thigh) muscles, the load is transferred to the patella (kneecap) and directly to the tibial tubercle on the tibia (shin bone).

Patella injuries are usually a mechanical injury.  In a simplistic manner, when these muscles are contracted, the forces are applied to the tibial tuberosity and the knee is extended.  That’s the easy part.

A growth plate is typically a location at the end of most long bones.   At a growth plate, a cartilaginous ring allows for the growth of the bone.

Chondromalacia is commonly associated with many types of patella injuries.

Here comes the interesting part…..a growth plate is located at the tibial tuberosity.  Therefore, when an active teenager creates excessive forces at the knee with activities such as jumping, squatting, running, trauma,…etc., the rate and the direction of the growth at that tibial growth plate can easily be altered.  Hence, the bump gets larger and more painful.

Patella injuries are successful resolved when addressed promptly. With an early onset of Osgood Schlatters, if the young athlete rests the area for 2-4 weeks and avoids the specific sports activities that worsen his pain, his symptoms will resolve themselves.

Osgood Schlatters and chondromalacia are similar in the fact that when these conditions occur, the athlete is typically predisposed to having symptoms in the future.  With Osgood Schlatters, when the athlete stops growing and his growth plates mature or “close”, the athlete has much less problems with the injury other than the cosmetic appearance and mechanical issues of an enlarged tibial tubercle.

Suggestions to Alleviate Osgood Schlatters Pain

  1. See his doctor to clearly diagnose this problem and to “rule out the bad stuff.”
  2. Ice his knee after every workout and competition.
  3. Become a flexibility machine.  My advice on flexibility: start young and stick to it.
  4. Avoid aggressive leg strengthening exercises and agility work whenever possible.
  5. Rest the knees.  A little rest now will help him avoid missing large chunks of time later.

I think this young man will do well if he follows this advice.  The Osgood Schlatters will quiet down in time.  Meanwhile, the enlarged tibial tubercle will probably not return to its normal size.

As with most sports injuries, the earlier you address the problem the quicker they quiet down.  Being smart now will ensure that you will be active and healthy later!

Bulging Disc of the Low Back

Understanding a Lumbar Spine Bulging Disc

Lumbar Spine Pain

It seems that most non-medical people understand more about their computers and smart phones than they know about their good old friendly back.  With that being said, it demonstrates the irony of this information gap when statistics show that 80% of us will suffer from low back pain sometime in our lifetime!

The lower part of our lumbar spine has 5 strong and stabile bones called vertebra.  These vertebra stack on top of each other with intervertebral discs smartly located between each vertebra.  These lumbar disks have two functions:  Spacers and shock absorbers.

Each disc is thick and quite dense to protect the bones of the lower back while allowing for a very functional lumbar spine.  Inside each disk is a jelly-like nucleus called the nucleus pulposus with the very outer ring of the disc reinforced with the stabilizing structured called the annulus fibrosus.

When the lumbar spine is injured or put into a poor posture for a prolonged period of time, many things can happen to become the source of pain and limitation.  For the purpose of this article, let’s look at when the disc becomes the reason for someone having a bad back.  Unfortunately, a bulging disc is too commonly the reason for low back pain and managing a damaged disk may be one of the most important physical challenges that you face in your lifetime.

Bulging discs in the lumbar spine cause significant pain in the low back, buttocks area, groin and lower extremity.  Because of the complexity of the interactions with all the bones of the lumbar spine, disks of the spine, nerves of the spine and bones of the pelvis, the wide arrange of symptoms and treatments can greatly vary.

“Bad backs” can obviously be related to any part of the lower or middle back.  When the lumbar disk’s annulus fibrosus is damaged, the contents of the disk including the nucleus pulposus can be forced outward between the vertebra.  The spinal cord and its peripheral nerves that supply the trunk and lower extremity.  This bulging of the disc is the main reason for pressure on the nerves as they exit the lumbar spine and create nerve symptoms into the regions of the body that the nerve innervates.

Spinal stenosis (narrowing of the spinal canal), bone spurs, spondylolysis, spondylolisthesis and herniations of lumbar discs can be other medical factors that can contribute to Lumbago or low back pain.  A thorough exam by a medical physician is the best starting point for anyone with pain, numbness and/or weakness extending down an extremity from the spinal canal.

Signs & Symptoms of a “Bad Back”

  • Low back, buttock and/or lower extremity pain, numbness and/or weakness, which may be intermittent or constant.
  • May experience pain with standing after prolonged sitting or laying down.
  • May be associated with lateral shifting of the torso away from the painful side.  This is a postural compensation that known as listing.
  • In severe cases, abnormal knee and ankle reflexes can occur.

Professional Treatment for a Bulging Disc of the Lumbar Spine

  • Rest on a firm surface in a non-weight bearing position that completely eliminates the symptoms.  This is best done by lying in a supine (face-up) position with pillows placed behind the knees.
  • Ice bags placed on your back while lying supine or prone (face down) with a pillow placed under the stomach.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • Core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid positions that create low back pain commonly associated with spinal stenosis.
  • The application of heat in the form of a hot tub, heating pad or hot packs should be SLOWLY implemented only when the main symptom is “stiffness” or when there is a need to increase blood flow in the low back/hip area to “get things looser” for activities.  The introduction of heat too early or too aggressively will quickly worsen the symptoms and prolong the recovery time for a bulging disk.
  • Back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises while avoiding a kyphotic (slouched back position) curve of the low back which would assist in the posterior migration of the lumbar disc……not something that you want!
  • Some severe or chronic bulging discs may require an epidural injection from a physician

Questions a Pro Athlete Would Ask

A smart professional athlete with bad back who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do I need an MRI to rule out any other problems?
  2. Do you think I can manage this bulging disc with rehab without having surgery?
  3. With my bad back and knowing that I want to remain very active and healthy for a long time, what activities do I need to avoid/modify to accomplish this outcome?
  4. In your opinion, what three (3) factors (for example: flexibility, posture, body weight, severity of my injury, fitness level, activities, occupation, Ab strength, and attitude) are most important for me to focus on with my rehab?
  5. Who do you consider to be the expert low back and bulging disc rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips

  • It’s all in the Curve – Posture, posture, posture!  If you you’re your lumbar disk to stay in it’s happy place, focus on your posture.  If you maintain the “hollow curve” (lordotic curve) or sway back posture during all activities, the lumbar disc is naturally pressed forward and away from the nerves.
  • Flexibility Makes Your Back Sing – The looser the muscles are of the low back, hips and legs the less work the back has to do to do anything.  It’s that simple.
  • “I Threw My Back Out (fill in the blank)!” – Few people throw their back out lifting a car off their crazy cousin.  Most people damage a lumbar disk with innocent motions like picking up the newspaper or putting on a shoe.

SIMPLE MOVEMENT + SLOUCHED POSTURE = LOW BACK INJURY

  • Make a List – Anyone with a chronic bad back can tell you what helps and what hurts their back.  Do your homework and know the reasons before your back becomes chronic.  Make a list of:
    • What Makes my Back Better
    • What Makes my Back Worse?
  • When Will I be Painfree? – 80% of the population have low back pain sometime in their lives.  Bulging discs, low back strains, herniated discs, spondylo and ligament sprains are just a few examples of injuries that can cause low back pain.  Treating a lumbar bulging disc early and properly is just what the doctor ordered to keep you active and pain-free.

Achilles Tendonitis

Understanding Achilles Tendonitis

Common Location of Achilles Tendonitis

Achilles tendonitis is a common injury associated with the presence of inflammation and scar tissue of the largest tendon in the body. The Achilles tendon is located above the ankle in the back of the lower leg. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus). Its main function is to transfer power to the ankle during the push off phase of the gait cycle while both walking and running.

Achilles tendonitis is commonly described in the literature as Achilles tendinopathy. The presence of scar tissue and degenerative changes of the tendonous tissue often accompanies the inflammation. A decrease in the elastic qualities and a reduction of the tendon fiber strength is a common finding with athletes older than 30 years of age with Achilles tendonitis.

Achilles tendonitis can be either acute, meaning occurring over a period of a few days, or chronic, which occurs over a longer period of time.

The location of the inflamed tissue can be anywhere along the tendon form the calf muscle or where it attaches to the heel bone or calcaneous bone. Because of the daily stresses place on that area of your body during a normal day of walking and being active and a less than adequate blood supply, the healing of the Achilles tendon is often slow.

Expanding on what was stated earlier, it’s important to understand that the two muscle of the “calf” merge together to form the Achilles tendon before it anchors or inserts into the calcaneus bone. The Gastrocnemius in the larger and more superficial muscle and it originates above the knee. The Soleus is the deeper and shorter muscle that does not cross over the knee joint.

Therefore, whenever Achilles heel pain is being treated, the two calf muscles need to be involved if long-term pain control is the objective.

Signs & Symptoms of Achilles Tendon Pain

  • With milder cases of Achilles heel pain, the localized pain in the Achilles at the beginning of exercise will decreases as the athlete warms-up.
  • The onset of pain can be as fast as within minutes or a gradual increase in symptoms over a period of days or weeks.
  • Symptoms such as pain, stiffness and calf weakness typically decrease with rest.
  • Tenderness noted anywhere along the tendon with palpation and with activities.
  • Prolonged period of inactivity such as in the mornings or after sitting for a long period of time will result in significant Achilles tendon pain and stiffness.
  • Palpable knots or lumps in the Achilles tendon are common.
  • Tendon “squeaking” can often be felt with ankle motion.
  • When performing a one-legged toe raise with the knee completely straight, pain in the tendon, weakness in the calf and limited range of motion in the ankle is demonstrated.
  • Swelling or thickening within the tendinous sheath is common.

Causes of Achilles Heel Pain

Achilles tendonitis is typically an overuse injury. The basic cause of an overuse injury is when a person does “too much to soon”. With that being said, other factors can contribute to inflammation of the largest tendon in the human body:

  • Altered or improper footwear for both activities and work environments.
  • Changes in training surface firmness and inclines such as hills.
  • Rapid increase in activity volume and/or intensity.
  • Insufficient recovery time between workouts.
  • Various arch and foot pathologies such as fallen arches, excessive pronation, hyper-supination or poor toe alignment.
  • Weak calf muscles
  • Tight calves and Achilles tendons
  • Stiff ankles due to arthritic changes.

Professional Treatment for Achilles Tendon Pain

  • Avoid the activities and footwear that are linked to the symptoms. These two issues are classic factors with Achilles tendonitis.
  • Place a ¼ – ½ inch heel lift in both shoes whenever walking more than 50 yards.
  • Avoid prolonged barefoot walking.
  • Massage of calves, arches and front of ankles to promote a decrease in Achilles tendon and ankle stress with motion.
  • Improve arch and toe flexor strength with activities such as marble or rock pickups and towel curls in a seated position.
  • Perform daily calf rolling treatments for the calf and peroneal tendons (lower outside of the shin) but not on the Achilles tendon itself is a beneficial way to promote the healing of Achilles tendonitis. The most effective technique is to warm up the tissue prior to treatment and while slowly rolling the areas noted above, slowly breath comfortably while consistently moving the foot in a large circular pattern.
  • When at least 75% of the pain is eliminated with walking, initiate toe raises to strengthen the calf muscles. Start with double legs on a flat surface and progress to single legs on an uphill incline. Between strengthening sets, perform a 20 second “duck walk” which is a straight legged walking technique on the heels with the front of the foot off the ground. This crazy looking exercise an effective drill that I like to use to both enhance the strength in the front of the ankle and prolong the stretching of the Achilles tendon and calf.
  • Stretching of the two calf muscles is important for long-term reduction of Achilles tendon pain. Wall pushes or slant-board stretches should be performed with both the knees straight and the legs bent to address both muscles and the Achilles tendon. Key Tip – Adjust the angle of your foot to keep the stretch pain-free while performing five (5) slow breaths to promote a relaxed elongation of all the tissue being stretched.
  • Compression of the calf during activities to maintain warmth and improve blood flow.
  • Ice your Achilles tendon and calf muscles in a moderately stretched position. Ice bags/veggie, ice cup or ice bucket will work.

Questions a Pro Athlete Would Ask

A smart professional athlete with Achilles Tendonitis who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. What are the main factors to why I have Achilles tendon pain?
  2. Do I have abnormal foot/arch/subtalar joint biomechanics that need to be addressed with an orthotic?
  3. Do I have a leg length difference of greater than 1/4 inch?
  4. Am I a candidate for a cross friction massage on my Achilles tendon or will that form of treatment be too aggressive?
  5. Who is the best physical therapist in this area to rehab with for my Achilles heel pain?

Elite Sports Medicine Tips

  • Look Around – This Achilles tendon pain is probably more a result of somethingelse than just an isolated inflammatory issue with your tendon. Look at everything from your shoulder levels to your core strength to your ugly toes for clues.
  • Why Now? – What triggered the flare-up now, Detective? List the activities and factors that you changed in the last month and you may be shock to see the reason(s) looking right at you!
  • Rubberband Man NOT – I watch my young son stretch and bend like Stretch Armstrong. We are probably not as flexible as we need to be so do something every day to stretch your shoulder, back and legs.
  • Check Your Sole – Compare the wear pattern on your favorite shoes. Do the soles look different from one side to the other?
  • Avoid Hills…For Now – As you return to your activities avoid hills for the first couple of weeks. Whether running, walking or on a bike, hills will apply excess stress on the calves and Achilles tendon.