At all times of the year Melbourne-Victoria is a city and state full of people with high enthusiasm for fitness and wellness. Melbourne offers many great training hot spots such as Albert Park, the tan and Gardeners Creek not to mention the highly visited Alpine regions. There are certain times of the year when we see an influx of patients presenting to clinic with similar conditions. Often it coincides with an event, or in the weeks just before an event such as the Melbourne Marathon. One of these injuries is Achilles tendon pain. Often patients describe an increase in exercise or training volumes, or a change in their exercise intensity and environment(Becker, James, Wayner, Osternig, & Chou, 2017; Rosengarten et al., 2015), especially if their chosen activity is running. If you suspect you have developed some tendon pathology, you might be experiencing the following symptoms: 1. the tendon aches 2. the ache stays isolated 3. it feels like it warms up with exercise 4. when on the cool down, or later that day and for the following days the symptoms may have increased 5. If present for a long period of time, the tendon might have thickened Tendon pain/symptoms can present in people of different ages, but is most common in people over the age of 40. Tendon symptoms can arise under different exercise loads and can vary in degrees of symptoms severity. If you fit this clinical picture a Melbourne CBD physiotherapist can help manage your symptoms by: 1. Addressing your training and strength program 2. Provide you with information about your symptoms and what to avoid (rubbing or stretching the tendon, consecutive running days at high intensity) (Cook, 2018). 3. Teach you how to progress your loads after finding an appropriate baseline level of activity that the tendon can handle(Pizzolato et al., 2018). 4. Show you how to keep symptoms at a relatively low level with specific types of exercises(Rio et al., 2016; Rio et al., 2015). 5. Introduce strength exercises when the tendon is slightly less painful to build strength, capacity and ability to handle faster activities such as running (Cook & Purdam, 2012; Silbernagel et al., 2007). As a physiotherapy clinic renown for working with a range of runners, be it recreational to Olympic standard, Achilles tendon symptoms is a presentation that we successfully treat. Often we find patients presenting claiming that exercise intervention hasn’t worked, which is is said to occur in about 45% of patients(Malliaras et al., 2018). However, a common factor in these patients is that they don't understand their pathology, have rushed their rehab, or have not taken their rehabilitation far enough which has resulted in missed rehabilitation components prior to return to exercise / running (Alfredson, 2017; Becker et al., 2017; Cook & Purdam, 2012; Franettovich Smith, Honeywill, Wyndow, Crossley, & Creaby, 2014). We completely understand that time away from the chosen activity can be frustrating, especially when everyone else is still out there exercising. However, when given a individualised plan to empower the individual, the rehabilitation process will not seem as daunting. Tendons require patience and persistence! Nick Cross and Todd Anderson Melbourne CBD Physiotherapy and Sports Medicinetherapy and Sports Medicine Alfredson, H. (2017). Persistent pain in the Achilles mid-portion? Consider the plantaris tendon as a possible culprit! Br J Sports Med, 51(10), 833-834. Becker, J., James, S., Wayner, R., Osternig, L., & Chou, L. S. (2017). Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. Am J Sports Med, 45(11), 2614-2621. Cook, J. L. (2018). Ten treatments to avoid in patients with lower limb tendon pain. Br J Sports Med, 52(14), 882. Cook, J. L., & Purdam, C. (2012). Is compressive load a factor in the development of tendinopathy? Br J Sports Med, 46(3), 163-168. Franettovich Smith, M. M., Honeywill, C., Wyndow, N., Crossley, K. M., & Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Med Sci Sports Exerc, 46(3), 594-599. Gabbett, T. J. (2010). The development and application of an injury prediction model for noncontact, soft-tissue injuries in elite collision sport athletes. J Strength Cond Res, 24(10), 2593-2603. Malliaras, P., Rodriguez Palomino, J., & Barton, C. J. (2018). Infographic. Achilles and patellar tendinopathy rehabilitation: strive to implement loading principles not recipes. Br J Sports Med, 52(19), 1232-1233. Mallows, A. J., Debenham, J. R., Malliaras, P., Stace, R., & Littlewood, C. (2018). Cognitive and contextual factors to optimise clinical outcomes in tendinopathy. Br J Sports Med, 52(13), 822-823. Pizzolato, C., Lloyd, D. G., Zheng, M. H., Besier, T. F., Shim, V. B., Obst, S. J., . . . Barrett, R. S. (2018). Finding the sweet spot via personalised Achilles tendon training: the future is within reach. Br J Sports Med. Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med, 50(4), 209-215. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med, 49(19), 1277-1283. Rosengarten, S. D., Cook, J. L., Bryant, A. L., Cordy, J. T., Daffy, J., & Docking, S. I. (2015). Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med, 49(3), 183-187. Silbernagel, K. G., Thomee, R., Eriksson, B. I., & Karlsson, J. (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med, 35(6), 897-906.
Shin splints or shin pain when running?