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Common injury for runners and shutters

HOW do you know if you have Achilles Tendinosis? You will feel pain or soreness over the back of the heel at the lower part of the leg.

Sometimes you will notice that the tendon is swollen and thickened. The tendon will also have a feeling of stiffness that comes on gradually and continues to worsen. The greatest pain usually occurs after periods of inactivity.

Therefore, you will tend to experience pain on the first few steps of walking in the morning and when getting up after sitting for long periods of time. Activities, such as running or jumping will aggravate the pain. Achilles tendinosis usually occurs in the 35-45-year-old age group and is common among non-athletic people.

What Causes Achilles tendon injury ?
The most common causes of Achilles tendon injuries are overuse, misalignment, improper footwear, medication side effects, and or accidents. In many cases a combination of multiple causes leads to the injury.

Clinical evidence suggests that misalignment of the lower limb due to foot problems such as flat feet and over-pronation is a common cause in Asia.

Achilles tendinosis is a problem with irritation and inflammation of the large tendon at the back of the leg. It tends to occur in middle-age recreational athletes due to overuse. The overuse causes small tears within the tendon and inflammation that lead to pain and swelling. If left untreated the tendon can rupture.

On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure. The Achilles tendon is susceptible to injury due to it having a limited blood supply in the area 2-6cm above the heel bone. As such, healing of the tendon is often slow, due to its poor blood supply.

Each year there are estimated to be at least 200,000 Achilles injuries in US alone, which accounts for roughly five to 10% of all athletic injuries.

An Achilles tendon rupture is a more severe form of injury. A rupture is a partial or complete tear of the Achilles tendon. Typically it comes on suddenly, sometimes a popping sound is heard and often, walking is not possible. A full rupture is a more severe, but less common injury than a partial rupture.

Treating Achilles tendon injuries
The first thing you need to do is visit your doctor to accurately determine if you have an Achilles tendon problem.

A joint or sports injury specialist is likely to be the best person to consult. If your symptoms are severe or have not improved with earlier treatment, your doctor may want you to get an X-ray or Magnetic Resonance Imaging scan to determine how severe the problem is.

Once properly diagnosed the treatment for mild Achilles tendon problems includes rest, pain medication and stretching exercises. Rest can be done in two ways- complete rest and relative rest. Complete rest involves no sports participation and little day-to-day activity.

Relative rest means keeping active and changing your sports activity. A great idea is to go swimming or cycling instead of running, to allow the tendon some rest. Stretching of the calf muscles is very important and needs to be done daily for 10-20 minutes.

You will need to make sure your shoes are supportive and well-cushioned and play sports at a more relaxed pace. Early treatment works best and can prevent more injury.
Take note though, even mild cases can take weeks to months of rest for the tendon to repair itself.

Two effective therapies for a quicker recovery from Achilles problems are eccentric strengthening exercises of the calf muscles and extracorporeal shockwave therapy.

Eccentric strengthening should be done daily or every other day. The exercise is a calf raised on a stair or on a machine in a gym. Start slowly using just your body weight doing three sets of 10 or 15. When the exercise can be done without pain, gradually increase the number of repetitions and number of sets.

Concentrate on the calf lowering part (the eccentric part) rather than raising part of the exercise. Make sure to fully stretch the Achilles tendon on each repetition. You should only do these eccentric calf raises after you have already done some other exercises.

Shockwave therapy is a new treatment favoured by professional sportsmen and women. A world-class sporting organisation that uses it is the AC Milan football team.

Shockwave introduces a series of high-energy sound waves (shockwaves) to an area of injury. When the shockwave reaches an area where muscle meets bone a tremendous amount of energy is released which aids healing.

The treatment initiates an "inflammation-like" response from the body leading to increased blood circulation and metabolism in the injured area. The shockwave helps break down scar tissue and aid the body's natural healing processes.

Treatment for more severe problems, such as a ruptured tendon, may include surgery or a cast on the leg.

Post-surgery, you will need to undertake extensive physical therapy and rehabilitation to make the lower leg strong and flexible again. The tendon will take from three to 12 months to properly heal.

In conclusion, although Achilles tendon problems can be debilitating, with care and by using the latest treatments you can make a return to sports and other activities. Make sure to get treatment as early.


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