Spring 2010

Metamorphic Massage Newletter

Achilles Tendinosis: Triathlon Injuries

Nikki Nichols LMP, RN,BSN

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In This Issue

Achilles Tendinosis

"A couple months ago, Chris told Alan as he was wrapping and elevating her ankle (* performing RICE treatment), I felt a mild discomfort in my heel. But, being an avid runner, I just couldn't stop running. I ran with the pain for over a month until it was too much for me. By then, my Achilles tendon, near my heel, got so bad I could hardly stand or walk. Unfortunately, I had caused a lot of damage to my Achilles tendon. It was a devastating time! I had a very promising cross country running career that I basically blew. When the pain started, if I had stopped running and gotten treatment, I could have been great, now I can only run short distances".

'Tis the season for running, Cross country, track and field, Triathlons: (105 triathlons are scheduled in WA between now and mid October)-are you training for or competing in an event? If so, be sure your body is in top condition so that you'll have more fun and fewer injuries. Achilles tendinosis accounts for about 11 % of all running injuries. In the U.S, there are over 230,000 Achilles tendon injuries per year. (Tendinosis is generally a degeneration, rather than inflammation, of the fiber structure of the tendon thus tendinosis is a more accurate term than tendinitis)

WHERE IS THE ACHILLES TENDON?

The Achilles Tendon attaches the heel bone to the two, major, powerful muscles of the lower leg, the Gastrocnemius and the Soleus. Together they produce a huge mechanical force providing the power in the push off phase of the gait cycle and changing the angle of the foot when walking and running.

WHAT CAUSES ACHILLES TENDINOSIS?

There are several potential causes of Achilles tendinosis:

• Degeneration of tissue;
  
• Previous injuries-heel pain, foot pain, problems with calf muscle strength;
  
• Tightness or weakness of the leg, knee, hip, or back;
  
• High or low arches;
  
• Uneven leg lengths;
  
• Alternating between high (2") heels and exercise shoes;
  
• Overpronation - the foot rolls inward when running or walking-so the inside part of the heel gets worn down;
  
• Antiobiotics in the Fluoroquinolone family - including the commonly prescribed Ciproflaxacin;
  
• Sudden increased amount or intensity of training - speed, longer distances, steeper hills;
  
• Cold wet weather can make the socks wet and cold and add to Achilles problems

SYMPTOMS:

Pain and possibly swelling.
Pain when standing on toes and when stretching the tendon.
Pain often occurs near the heel where the blood supply is the poorest, thus the area is most likely to develop an overuse injury.

TREATMENT:

Achilles Tendinosis may take several months to heal.
Begin treatment when the symptoms start so further damage may be avoided.

• Reduce volume and intensity of training. Avoid hilly terrain.
  
  
• *RICE - (Rest, Ice, Compression, Elevation)
  
  
• Stretching:
  Eccentric strengthening of the leg muscles, particularly the calf muscles.
  Calf raises on a stair or using a calf raise machine in a gym.
  Start slowly using just your body weight doing three sets of 10 or 15. When this can be done without pain, gradually increase the speed, number of repetitions per set, amount of weight, and number of sets. Do daily or every other
  
  
• Proper fitting shoes
  Orthotics (heel lift - if appropriate)
  
  
• Anti-inflammatories-tho may have limited benefit since AT is not generally inflammatory
  
  
• Pillow under leg when lying down
  
  
• MASSAGE:

Goal: To decrease tension on tendon fibers: use compression broadening strokes to calf muscles and longitudinal stripping

Massage leg, knee, hip and back-each of which may have an effect on the tendon

Cross fiber friction to stretched tendon at area of tenderness followed by passive and active movement to increase circulation

Ice massage - increases blood flow to area

Call Nikki for a massage

OTHER TRIATHLON INJURIES

Some other injuries that one could encounter as a triathlete; and articles about those injuries, which appear in my website at are:
Plantar fasciitis (foot pain) November/December 2008: running
Thoracic Outlet Syndrome (shoulder/arm pain) February/March 2009: cycling
Patellafemoral syndrome & Patella tendinosis (knee pain) June/July 2008: cycling
Carpal tunnel syndrome (wrist pain) Summer 2004: cycling
Rotator cuff injury (shoulder pain) August/September 2008: swimming

Metamorphic Massage
transforming injuries into wellness
and
helping athletes achieve peak performance

Nikki LMP - provider of massage at 3 Olympic Games
WA Sports Massage Team - active member for 15 years
Certified in Orthopedic Massage

Call or e mail to schedule a massage.
Nikki Nichols LMP, RN, BSN
Metamorphic Massage
206-499-4281
Nikki@metamorphicmassage.biz