I did a blog on Achilles tendon pain (please check those articles to educate yourself about Achilles tendon pain) in one of my earlier blogs and personally I love the topic of lower limb tendon pain. I love the work by Jill Cook and Craig Purdum who talk about tendinopathy in depth and the way the pathology presents. Injury to the Achilles tendon or knee tendon are often seen in the active population, I seen a lot of Achilles tendon pain and the pain can last for quite a while. Most people are aware of the pain but not sure what to do about it. When the pain gets worse, people often rest and stretch the calf muscles hoping that the pain and dysfunction go away. This can help for a short period of time but often when the person begins to run again, or play whatever activity they might play, the tendon pain comes on again with use and more so after activity when they have cooled down. This is at the early stages of the pathology and when it gets worse, you will not be able to take part in any activity.
So, once you know you have Achilles or knee tendon pain (please go and see a qualified health care professional for accurate diagnosis and treatment options), there are some things you should not do.
- Rest completely. Resting will not increase the chances of the tendon to take load and the muscles attaching to the tendon will also get weaker. You have to progressively load the tendon with what it can tolerate and progress from there.
- Have Passive treatments. Treatments such as a massage, acupuncture, shockwave therapy may give you short term pain relief but the pain will return once you re-continue the activity that made you feel the pain.
- Ignore your pain. Pain is telling you that the load on the tendon is too much. You have to modify training load so you don’t overload the tendon and then strengthen it progressively so it can handle a full training session again.
- Massage the tendon. Massaging the tendon can irritate the tendon more, it may give some people a temporary relief but the pain will come on again once the tendon is loaded during running or jumping. It is best to massage the attaching muscle instead like the calf muscles which attach to the Achilles tendon or the thigh muscles which attach to the knee tendon.
- Stretch your tendon. Stretching your tendon can add compressive loads to your tendon especially for example at insertional Achilles tendinopathy which can worsen your pain. You are better massaging the tight muscles.
- Have injections. I know people who love the idea of an injection making everything better so they don’t have to go through actively managing their condition but life is not so simple. Research has shown that injections have not shown to be effective and I wouldn’t recommend anyone having an injection without first trying an 8-12 week exercise program aimed at loading the tendon.
- Take short cuts with rehabilitation. Shortcuts will lead to failure and you will not have correctly loaded the tendon as it should be. Research has shown that it can take up to 3 months to build the strength and capacity back again so you need patience and perseverance and it will help you in the long run.
- Not know what high loads are for your tendon. The highest loads for your tendon is when it used as a spring such as when sprinting, jumping and changing direction. These are the loads you would want your tendon to tolerate again without pain so start with a strength program and then progress through with spring like exercises.
- Get worried by imaging. Results from MRI imaging can frighten people and especially with the words used by your doctor can make you reluctant to load the tendon. There is good evidence that a pathological tendon can tolerate loads when gradually increased.
- Ignore advice by a qualified health professional. Listen to the advice of a professional who has experience in correctly diagnosing these injuries and correctly treating these injuries.
Inspired by Professor Jill Cook!!!
