Achilles Tendon Tears: Are you at Risk?

The Achilles tendon is the largest and strongest tendon in the body, but unfortunately the aging tendon undergoes various changes that put it at risk for injury. Some changes that increase with age include decreased collagen density, decreased glycosaminoglycans and water content, decreased tensil strength and increased stiffness.

A study of 891 ruptured tendons in humans revealed 97% of the changes were degenerative in nature and about 50% of them were Achilles tendons.

How can you keep your Achilles tendons healthy?

Know your risk factors associated with Achilles tendon disorders and schedule an appointment for a physical therapy evaluation to determine the likelihood of your developing an Achilles tendon disorder and to learn research proven treatment strategies to help strengthen and avoid surgical repair.

Risk factors include:
-abnormal dorsiflexion (increased or decreased ability to flex foot)
-abnormal subtalar range of motion (increased or decrease foot joint mobility- pronation or supination)
-decreased plantar flexion strength
-abnormal tendon structure
-medical conditions associated with Achilles tendon disorders: diabetes, obesity, high blood pressure, high cholesterol

Treatment:
Studies have shown and proven that eccentric exercises with a focus on slow and controlled movement is an extremely effective nonsurgical method to treating Achilles tendonitis/tendonosis. Below are some helpful exercises for anyone dealing with symptoms or has been diagnosed with this very common injury.

Eccentric Heel Drop on Step: (Achilles Tendon Strengthening)
Begin this exercise with both feet in a neutral position with only the forefoot on the step
Perform a toe raise with both feet
Remove the unaffected leg from the step and slowly lower the affected back to neutral, keeping knee straight
Perform 3 x 15 repetitions twice a day. This is maintained every day for 12 weeks.
As soon as 2 x 15 repetitions twice a day can be done pain free, the load should be increased.
Progression:  Loaded Eccentric Heel Drop on Step–now add weighted dumbells to increase difficulty and to build strength

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Running in Minimalist Footwear

by Dylan Bartley, MSPT

You may have heard of the class action lawsuit against the Vibram FiveFingers that resulted in a settlement. If you’re a runner who tried the iconic FiveFingers shoes and developed an injury such as plantar fasciitis or achilles tendonitis, this may be sweet validation for you. If you’re one of the many people who used them and loved them either casually or as a running shoe, then maybe you’re left wondering, is it just a matter of time before I develop an injury? Should I go back to those cushy, supportive Brooks shoes my Podiatrist said I should use? Are all minimalist shoes such as the Nike Free and the New Balance Minimus risky to run in? In 2013 we saw sales of minimialist footwear stop their climb and begin to decline, replaced, of course, by sales of motion control shoes and stability shoes.

Well, let me shed a little light on some of those questions. Let’s start with anatomy: there is a variability in the morphology of our ankle bones that predisposes one towards having a low or a high arch. Structurally some of us have the type of arch that wants to collapse and pronate while others are just blessed with a normal or high arch that supinates well. And there is a fourth category: those that have a structurally normal or supinated foot but when they stand and move, they pronate and collapse too much. Let’s call them functional pronators. A knowledgeable physical therapist should be able to assess what kind of foot you have exactly and guide you through the process of choosing footwear.

If you are in the first category of structural pronators, then you may not fare well in your attempt to run in minimalist shoes. There are just too many biomechanical forces to overcome when your foot hits the ground and eventually your tendons and ligaments get strained. Using a stability shoe or motion control shoe or orthotic placed in a minimalist shoe will reduce your risk of injury. Your level of strength and conditioning (or simply personal preference) determines which of those shoes will work best for you. If you are genetically blessed enough to have a neutral, supinated, or functionally pronating foot, then you may be able to slip some minimalist shoes on and get your foot in shape. You can rely on your foot’s ability to naturally pronate and absorb the shock of landing without over-taxing your soft tissues.

By the way, I say “get your foot in shape” because the wean-in process with this kind of thing is real. That is, of course, why even people with perfect arches often get injured when wearing Vibram FiveFingers. Those of us with sedentary jobs or feet that have been living the life of luxury supported by rigid orthotics and supportive running shoes will have an even greater challenge. Functional pronators may need extra time to strengthen their foot muscles. It can take anywhere from 6 months to a year to really build up enough strength to wear a minimalist shoe for an entire 10k or just walking around town all day. There are so many fine motor intrinsic muscles in your foot like the flexor digiti minimi brevis that you probably have never been asked to use unless you were a modern dancer or you grew up walking barefoot in Africa. So be patient as you gradually increase the distance of your runs in minimalist shoes. Wear them half the day at work, and bring a cushy old pair of shoes to switch into at lunchtime. Alternate wearing your minimalist shoe on short runs while wearing supportive shoes on long runs. And listen to pain. See a physical therapist to help diagnose and treat even minor injuries before they become chronic, severe ones. Stretch after your runs and employ a little self-massage and strength training to help your body through any strains. Your new and improved feet will thank you.

Ski Tips From Jonny Mosley

Skiing with Olympic gold medalist, Jonny Moseley during a “ski with a pro” day in Tahoe certainly shines as a highlight for 2013. Hopefully, you too can benefit from these helpful tips our local ski star.unnamed1. “Be one with your ankles” Control your skis through your ankles rather then using the brute force of your knees and hips.
2.  Arm positon: Swing your arms in front of you as you jump up in the air.  When you land, notice how your arms land in front of you in an active position.  This is where your arms belong when skiing.
3. When you plant your pole, “flick your wrist” out at a 45 degree angle (Jonny learned this from another fellow ski Olympian).
4. Pull your uphill ski back with your hamstring, keeping your tip in contact with the snow.
5. “Thrust” your pelvis through the turn to prevent sitting back on your skis.
6. Keep the tibia angles the same on both skis.