Sports Medicine/Achilles Tendon Injury
QUESTION: I am Aakashdeep Singh, 21yrs old and I have been suffering from Achilles Tendonitis for quite a long time now. I got this injury last year due to over stressing it by running up hill without enough stretching plus over training (squats) in the gym .
I have been taking all the measures since then to prevent the injury from recurring. I took NSAIDs along with Chondrotin Sulphate( collagen type I) for it to recover faster. Along with medications, I do tend to stretch my tendon on a regular basis but I'm still not so sure whether I'm ready to lift weights again ( Upper body training is still in progress with lower weights).
So, I wanted your suggestion regarding this matter, as to when should I start lifting weights again? Should I go for lower body training now or wait for little bit longer?
Thank you for your time. Looking forward to hear from you soon.
ANSWER: Hello Mr. Singh!
Thank you for writing me, and it hope to be able to find a solution for you. When you were running up the hill, normally you would use both legs, but you said you felt an injury to your Achilles Tendon on one foot (right or left?). The same type of injury occurred when you were doing squats, as when running up the hill.
The Achilles Tendon is a thick tendon which is attached under the heel, and follows the heel to the back of the foot up to attach to the Teres Muscle (calf). As a review, all tendons in the body attach the muscles to the bone. When you injured the Achilles, you over-stretched it , and tore some of the fibers in the tendon. They have never had a chance to heal, and every time you stress it, more micro-tearing happens. As happens in many cases, the heel plate becomes stuck within the joint, and cannot move. With the tendon attached to The heel, every time you put stress on the foot, ie: running, lifting, jumping, etc., it affects the Achilles.
The measures to help prevent more injury is not quite the correct measures to use. NISAIDS work on the pain centers of the brain, and collagens don't necessarily go to an injury, but are distributed throughout the body. With this in mind, my suggestion would be to eliminate all types of athletic endeavors which put stress on that foot. In the meantime, ask around to all your friends and family to refer to you the name of a GOOD Manual Therapist, or a Chiropractic Physician who specializes in Sports Medicine, to look at the foot. He would know by feeling the underside of the foot whether the heel is jammed in the joint. He can release this so the Achilles is not entrapped, and can move with the heel properly. After a year of constant irritation of the Achilles, it might take a couple weeks for it to heal properly.
The physician will wrap the foot to protect the Achilles, and help it to heal faster. See whom you can find, and trust them to know what to do in your case. Please let me know how you are doing, and I really hope you can find a good doctor to do some manual maneuvers to fix the heel, which will allow the Achilles to heal.
Good luck to you,
Dr. Patricia Arthur
---------- FOLLOW-UP ----------
QUESTION: Greetings Sir
Thank you for your response regarding my questions. Unfortunately both of my legs have been affected by tendinitis.
I'm not taking any drugs for now, I'm allowing it to follow the natural course but I do regular micro stretching of soleus, glutes and hamstring muscles.
A friend of mine suggested to go for paraffin wax therapy (I went for three days) but I don't know whether its the right way to go about.
Also I keep applying Ice packs to reduce inflammation if there is any.
I go for walks whenever I can for about half an hour though.
I would love to find a chiropractor and a physiotherapist in my locality but sir the problem is I'm in Nepal (studying here) and there aren't much possibilities available.
I can't go back to India until summer vacations( which starts after two months). I don't feel right to drag this problem for too long.
The pain is certainly reducing from what it was initially but I'm still not confident to work upto my optimal levels.
The pain had subsided to a large extent but I guess I reinjured the tendons by putting a lot of stress on them( I used to just attend classes). I'm confused and afraid to take any risks for now.
I wanted to ask you, can this pain be psychological I mean may be the body is trying to protect the injury so that I don't do anything stupid?
I will get a few more investigations done to find out more about this problem.
Anyhow thank you for your time and knowledge. It feels so good when you hear it from the right person.
Thanking you once again.
Looking forward to hearing from you soon.
Thank you so much for writing back with more information. Unfortunately, I have no idea what the little country of Nepal has for medical care, so we will try to do this between the two of us.
First of all, as I said in the previous letter, no medication will help this problem. Secondly, I have no idea what a wax therapy will do to the foot and ankle, but can't quite believe it will hurt it, and thirdly, some ice wrapped in a damp cloth would be beneficial, especially if you have over-stressed the tendon.
Also, don't believe for one moment your pain is psychological! What you have done to the tendon and muscles are REAL, and you have gone too heavy and too fast, causing micro tears in the connection of the tendon to the soleus muscles. I'm not quite sure what you mean by "micro-stretching". of the soleus, hamstrings and gluts? Actually, if you can walk slow for about a half hour.......without any pain........you are doing very well. Do you have access to a pool?Swimming is the best overall exercise you could do at this point. Another thing you can try if you can find some elastic .........or stretch bandages....which you could wrap around the ankle, foot and lower leg to give support, and this would be optimal. Only use these bandages when you are going for your walks, then remove them. To lift weights, do squats, work up to your optimal level cannot be done now, and I would wait until you returned home to find the doctors I have suggested. Two months of walking, and swimming would be the best things you can do now.
If you happen to find a doctor that might be over-aggressive, and try to persuade you to get a couple shots of steroids into the tendon, I want you to run....not walk......to the nearest door to leave! This would be the worse therapy for you ever! Now we have suggested a few things for you while in Nepal: The damp ice around the back of the foot for approx. 30 minutes; The slow walks for half an hour; Swimming for half an hour; No stretching, no lifting, and use an elastic bandage if you can find any. If you are lucky to find any, just wrap it in a Figure 8. Something like start at the bottom of the foot, go around and up to the ankle, around the ankle and down to the foot again. Depending on the length of the bandage, try to do this maneuver several times around the ankle to the lower leg, then back down to the foot again. If you can find a Pharmacist, he might be able to help you with the bandage...NO DRUGS!!
Please let me know how you are doing, and just remember, you only have two months to go, and with proper treatment in India, you will be able to get back to lifting very soon.
Thank you for writing me, and I look forward to knowing how you are doing.
Dr. Patricia Arthur