When people come to see me with their injuries and health problems, it is usually because they have exhausted every other option. Achilles tendon injuries are near the top of the list of reasons for paying me a visit. These injuries tend to be very poor healers. The reason given most times is that this tendon has no direct blood supply to expedite healing. There may be another reason why Achilles tendons fail to heal: The injury may not actually be to the Achilles tendon; but to one or more muscles immediately adjacent to it. Of course, recovery will be poor if the wrong part is being treated.
If the first diagnosis is of, say “Achilles Tendonitis”, the tendency for all who may subsequently become involved in your treatment is to blindly continue down the Achilles pathway, even when the results are disappointing. One reason why this may happen is the medical hierarchy and ACC claims setup makes it difficult for a therapist to
challenge the original diagnosis and to treat a problem that is different to what is recorded in the official paperwork.
challenge the original diagnosis and to treat a problem that is different to what is recorded in the official paperwork.
As a slight aside; a popular treatment for Achilles tendon pain is to prescribe “concentric stretching”. A concentric Achilles stretch is typically done by standing with the balls of the feet on the edge of a step so that the heel can be slowly lowered, thus stretching the back of the leg while under loading from the body weight. Extra weight can be applied by shouldering weights. How this actually gives relief to Achilles pain remains a mystery, although there is much speculation.
The real reason concentric stretching sometimes works (partially), is not because of anything it does to the Achilles; but because it is stretching and strengthening the muscles that are immediately adjacent to the Achilles and which may be the real cause of the pain and disability.
These muscles are the Peroneus Brevis and Flexor Hallucis Longus (Please refer to the two images to see their exact locations in the lower leg). When viewing the back of the lower leg directly from behind (Refer to the “Leg - Posterior Superficial View) you will appreciate how easy it is for an injury to either, or both of these muscles to be confused with the Achilles or lower calf.
The first clue that the injury may not be entirely to do with the Achilles is to understand how the injury first arose. For example: If there was pain the day following walking or running up a very steep slope, then there is a high possibility that the muscle that flexes the big toe (flexor hallucis longus) was strained. This will be felt as slight tenderness and swelling under and to the inside of the Achilles. If the person had been running or walking over uneven, or side-sloping terrain then the muscles that prevent ankle inversion (peroneus longus and peroneus brevis) may be strained. If this is the case, there will be a hint of tenderness and swelling under and to the outside of the Achilles.
Treatment of either of these conditions of chronic strain consists primarily of deep tissue massage. This may be quite painful on the first few occasions; but there should be a marked improvement by the 3rd or 4th session and normal exercise well underway. Each hour long session needs to be spaced about a week apart and include the entire musculature of both lower legs, even if only one leg is affected.
Other measures, in addition to the deep tissue massage, may include fitting Formthotics Shock Stop heat moulded inner soles and exercises to strengthen the foot and calf muscles. Seldom, if ever, are custom orthotics required for this kind of pain. In most cases where orthotics have been fitted previously, some relief to ankle pain is experienced by replacing them with a pair of Shock Stop inner soles.
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