Achilles tendon Rehab/Prehab

[FREDERIC DUPONT]

I hurt my right Achilles while running two weeks ago (acute tendinitis), and immediately underwent some physio work (ultrasound & electric short waves); it is better now, but still a bit tight. I try to keep it warm as much as possible (I agree with Coach Sommer comments about his preference for heat vs. cold for Achilles healing)

I've always had fragile Achilles; I had several tendinitis and frequent pains doing T&F (sprint and high jump) in my late teens and '20es... fast forward 25 years, I ruptured my left Achilles (full rupture) 3 years ago (fully healed now, albeit the left calf is much smaller than the right!)

What would you suggest for a complete healing of this injury? What sort of stretching, low impact exercises, etc...

What do gymnasts usually do to prehab their Achilles for the strenuous work on the mats and the jumps?

Thank you very much

Fred

[FREDERIC DUPONT]

I have found top info in this thread http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=8062 with two wonderful posts from Slizzardman, thank you

I still would like pointers and directions towards exercises that I could do to safely rehab and restore function and ability.

Thank you.

[Blairbob]

Volume heel/toe raises, ankle circles with theraband, etc.

[FREDERIC DUPONT]

Ahhh, thank you Blairbob, I'll start that at once.

[FREDERIC DUPONT]

I've been doing ultrasounds and electrowaves therapy for a bit over 3 weeks.

I also do ankle circles, negative calf raises and calf stretches with supported BW.

So far, zero improvement.

Volume heel/toe raises, ankle circles with theraband, etc.

Blairbob, I do unloaded heel/toe raises (in the air) in volume, but maybe I am doing it wrong...

Should these be loaded?

BW might be too much at this moment (My Achilles gets upset with too much walking!)

How to do these more precisely, and what sore of result progression should I expect?

Thank you for your kind help.

Fred

[Nic Branson]

Also get a foam roller and check and re-check triggers for both legs including hip flexors, ITB, outside of your calf and gluteus. For some added mobility get a wooden dowel or something similar place it on the outside of your foot while in a half kneeling position. It should be next to you little toe. Now while keeping your heel down and the stick vertical move your knee out and around the dowel and as far forward as you can while keeping the heel down. Do these for reps.

Manual massage of the the area and the bottom of your feet.

For this type of problem three weeks is also nothing really. You're talking something that could take months, over aggravating it early on will also set back the healing possibly. Be very patient here.

[DiGiTaLdAzE]

Well, this thread is a bit old but I have had a bit of personal experience with Achilles Tendonitis. I have been a runner for many years, and have suffered tendon issues on a few occasions. A couple of years back I met someone who recommended the following regimen--I used it 2 years ago on a moderate bout of Achilles Tendonitis with very good results. His approach was to alternate between hot and cold in one treatment session. For example--5-10 mins. ice, and then 5-10 mins. heat. This cycle is repeated 3 to 4 times in one session. This regimen should be repeated several times each day, every day until the injury has healed, or at least until it shows signs of improvement. His idea was that this causes the tendon to contract and expand returning flexibility. Resume the activity that caused the tendonitis slowly. In my case, I started by running the distance between two phone poles, and then walking the same distance. The next run I ran twice that and walked the same. After maybe 4-5 runs i resumed normal running. Also, with running, not only volume but faster pace also dramatically increases the stress level on joints and connective structures. So keep pace very moderate at first.

With tendonitis it is key to catch it early, stop what caused it, and begin treatment right away. If only one of heat or cold were used I would agree that heat is better. A few years ago I had a very stubborn case of tendonitis is my elbow. I thought to myself that tendons have poor blood supply and because heat draws blood to the injury site it would promotes healing.I did not have a heat pack, so I started holding it directly under the hot water (near to the shower head) for at least 10 mins. minutes every time I showered. After a couple of months it was completely cleared up. A heat pack of some kind would no doubt be a better alternative, but heat involving the use of a liquid is most effective. A hot water bottle works well.

[Rik de Kort]

His approach was to alternate between hot and cold in one treatment session. For example--5-10 mins. ice, and then 5-10 mins. heat. This cycle is repeated 3 to 4 times in one session. This regimen should be repeated several times each day, every day until the injury has healed, or at least until it shows signs of improvement. His idea was that this causes the tendon to contract and expand returning flexibility.

I think the most important reason that it works is because you're continuously forcing blood in and out of the area, so you're clearing up waste and getting fresh nutritients to the tendon so it can heal quicker.

Not an expert at all on these kinds of things, though.

[Alessandro Mainente]

this is a summary of my notes from my speciality university course

1-try to correct the biomeccaich problem of your training

1a-not run on hill or mountain

1b-decrease intensity, duration, uncorrect programs, hard surface, bad shoes

1c-start a cross combined training with swim and cyclette

1d-correct the functional overpronation

1e-use something to reduce the problems due to the posterior rubbing

2-start to do stretching before and after training

2a: towel strecth: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body, keeping your knee straight. Hold this position for 30 seconds and repeat 3 times.

2b standing soleus streth: stand facing a wall with your hands at about chest level. With both knees slightly bent and the injured foot back, gently lean into the wall until you feel a stretch in your lower calf. Once again, slightly toe in with the injured foot and keep your heel down on the floor. Hold this for 30 seconds. Return to the starting position. Repeat 3 to 5 times

2c: raise your toes: stand in a normal weight-bearing position. Rock back on your heels so that your toes come off the ground. Hold this position for 5 seconds. Repeat 10 times. Do 3 sets of 10 reps.

2d: balance on a single leg before on a smooth surface than put the tip of your foot on the edge of a stair then balance at different angles

3-Non steroideal anti inff but NO cortisone injections because it can cause impairment and rupture of achilles tendon

4-crioteraphy after training

5-correct the asymmetric problem between inferior bodyparts (if necessary), don't use an overcorrection beacause it can aggravate the situation

6-if the sympthons persist more than 5-7 weeks with this teatrement maybe is necessary use cam boot or a mobile boot plaster for at least 3-6 weeks

7-slow progression of the activities you do before injury:

-swim

-run in a deep winmming pool with a life vest

-bycicle

-walk

-eccentrich exercises to gain strength in achille's portion

-very very ligth run

8-the strengthening in eccentrich phase can condition the tendon and let it to be less sensitive to overweigth. by the way these exercise must not be made until the patient is without pain since at least 3 weeks

8a-lift yourself up into the tips of the fingers in thw swimming pool

8b-plantar flexion against therabands and progress into therabands with more resistance

8c-multiple sets of exercise with lilgth weigth (10kg) at the leg press

i hope it helps to you

[Rik de Kort]

4-crioteraphy after training

Just to clarify, this means using ice.

[FREDERIC DUPONT]

Hey, I've missed that!

Thank you very much for the great advice, I highly appreciate you guys took the time

I am doing a lot of heel/toe raises, ankle rotations and calf raises during the day; also calf stretches and negatives very slow calf raises (lowering) in full ROM.

To the delight of my dog, I restarted long walks, and added a few hundred meters very slow jog on grass.

One area is still painful to pressure (when I moderately squeeze it between index and thumb), but it seems better than it used to; I vigorously rub the area for a minute at a time 2-4 times a day; I also apply heat (soft water bottle) for one or two hours a day.

I'll go through the advice provided in detail, and adjust my rehab accordingly.

The most difficult part is pacing the rehab and adjusting things "by the seat of my pants"... There is a battle going on between the desire to do more & the fear to overdo things!

[Joshua Naterman]

Hey, I've missed that!

Thank you very much for the great advice, I highly appreciate you guys took the time

I am doing a lot of heel/toe raises, ankle rotations and calf raises during the day; also calf stretches and negatives very slow calf raises (lowering) in full ROM.

To the delight of my dog, I restarted long walks, and added a few hundred meters very slow jog on grass.

One area is still painful to pressure (when I moderately squeeze it between index and thumb), but it seems better than it used to; I vigorously rub the area for a minute at a time 2-4 times a day; I also apply heat (soft water bottle) for one or two hours a day.

I'll go through the advice provided in detail, and adjust my rehab accordingly.

The most difficult part is pacing the rehab and adjusting things "by the seat of my pants"... There is a battle going on between the desire to do more & the fear to overdo things!

Good!

With your injury history, that massage is going to be very important. I'd say this order for max effect:

1) massage

2) 2-3 rounds of ice and heat, alternating a few minutes of each, ending with heat.

3) whatever your rehab work is

4)3-5 rounds of ice and heat, ending with 10-20m of heat.

Make SURE you're getting protein prior to this so that your body has what it needs to make repairs as the fresh blood gets flushed into and out of the capillary beds.

Rik is right, one of the main benefits of hot/cold contrast cycles is the flushing of waste products and the influx of fresh blood.

You need to try and get the whole lower leg + foot though, smaller areas won't give the same effect. A shower with a hand-held showerhead on a hose is ideal for the hot water part, bucket of ice water is good for the cold.

[FREDERIC DUPONT]

8 months of relentless efforts down the drain!

I was doing great with running & had even started with jump rope at very little volume; I really thought I was over with this, and BAM!, I participated in two black belt gradings with 6 fights on Oct 23rd and another 6 on Nov 25th, and I am back to square one with an injured Achilles!

This has really brought the morale below the zero line!

Even walking is hard today!

[Joshua Naterman]

8 months is not that much with a severe or long-time injury that hasn't had surgical correction. You may need to have that thing checked out, just to make sure there isn't a partial tear somewhere that is too big to heal on its own.

As long as that's not the case, make this:

8" thick CLEAR water reservoir. Glass is best, but if you have something else then use that. Plexi works but glass is to be preferred. This only has to be wide enough to cover the part of your body that is being treated. This is a water filter, and its function is explained below.

Next, go to Wal-mart and buy one of their flexible desk lamps for 15 bucks and cut off the metal shroud just in front of the bulb socket (or at least cut two slits down to the same point so that you can bend them out to give a little extra space to the bulb). A hacksaw works. I have inspected the components, and they are all good for 660 Watts. If you're concerned, you can shine light into the bulb socket to verify the wattage. They have stickers that say only use 40 watts, but that's because the metal will heat up and could cause a fire. By removing the metal, this is no longer an issue.

Finally, buy a 250 watt heat lamp from Home Depot for 10 bucks. Screw it in, point at achilles, and move it to a distance where you can just barely feel medium warmth on the achilles tendon. You can do sessions of 30 minutes, and then take 15-20 minute breaks. The more time exposed to the infrared you get, the better. Clinically, this is used with the water filter for 8 hours per day and reduces healing time of ACL surgeries by 60+% and keeps new pain receptors from forming. It's quite nice, very cheap, and very effective.

These bulbs are mirrored inside, which is why it's not a particularly big deal if you want to cut the shroud into two halves and bend them apart a bit to make room for the bulb.

If you build the water filter, you can ignore the rest time and just let your body soak in as much as it can.

If you don't build the water filter, you should go by the posted times.

The way this works is by directly energizing the molecular bonds in enzymes and proteins so that the protein synthesis reaction rate increases.in the connective tissue.

The water filter removes the frequencies that energize water, so your cellular fluids can act as an effective heat sink because they are not being energized directly.

Without the filter, you will need to take breaks to let the cells cool down. Remember that, because I think that this is the option most people will use.

[Fluidity]

Joshua......THIS IS GENIUS I am totally going to try this. By the way didn't you mention in a previous thread that ARPwave machnes are really useful? Would you recommend something that is cheaper? I remember some other galvanic/DC therapy tools being available.

Along with that I would recommend extremely slow calf/shin raises with TUT, and try doing it with a tempo of 808 or 10-0-10 until it gets really hard for you. Also can you walk on the balls of your feet? On your heels? On the side of you feet? On the insides of your feet? If you can do any of these, WITHOUT ANY PAIN AT ALL, I would recommend doing a 1-2 minute walk on each portion of the foot I mentioned. The you can extend the walk to 3-5 minutes or more if you would like,however build up the volume from 1-2 minutes progressively. Along with this eat a good amount of protein and carbs after doing this, and water.

Here is a video of some good ankle prehab/rehab

see if you can do any of them.

Also here is another one, and this has some other good exercises as well,

And finally look at this thread and look at what Coach Sommer has to say about ankle prehab/rehab.

https://www.gymnasticbodies.com/forum/topic/371-ankle-prehab/

[Jeremy]

Josh, do you mean 250 watt "bulb" at Home Depot?

Why would you need 2 lamps?

[FREDERIC DUPONT]

Hey, wonderful replies and help here, thanks a lot.

 

- I had an MRI done last April that did not show any degenerescence or injury (no cracks, tears, fraying, delimitation, nodules, etc...)

- I just had an echography done here and it also shows nothing! (T'was funny, because I did that in the Chinese Hospital, and, of course, the waiting room was full of the women carrying the next generation... The staff that only sees pregnant women by the millions, was curious to find out what this tall foreigner was doing there, & I think the docs had never examined anything outside of foetus LOL... There were a few people wanting to keep the pics of their future newborn, but they were denied; I think it is because for many reasons it is illegal in China to disclose the *** of the baby... they'll have to start the photo album at birth.)

 

I am going to see a surgeon in France tomorrow; maybe he'll be able to see something on the images that the Chinese docs may have missed.

 

Then I'll have an arthroscopy done on my left shoulder to repair the supraspinatus tendon.

 

Joshua, this is great advice; I think I can use a small aquarium filled with water as a filter; I can place the lamps underneath & keep my foot/ankle over it.

The lights you are suggesting, are they bathroom heating sunlights, or IR lights like the ones used in farms to warm the piglets ot chicks?

I think I can also find IR diodes here... would that work? Should I pay attention to the frequency?

Or maybe I could obtain some therapy IR lamp 

 

Which would you use?

 

Thanks.

[Joshua Naterman]

Fred:

 

diodes = garbage IMO. They aren't powerful enough.

 

250W bulb is what you're looking for, you will probably find that they are the same thing as what is used for both the chicks and in bathrooms They certainly CAN be, though the bathroom usually has a red filter while farm use tends to let the full spectrum of visible light through as well (I think, but am not 100% sure).

 

Josh, do you mean 250 watt "bulb" at Home Depot?

Why would you need 2 lamps?

yes.

 

2 lamps would be to hit multiple areas.