Running Injuries

Why you should STOP stretching your Achilles Pain!

I see people with achilles pain stretching their achilles constantly. 

The problem with this is that tightness is just a sensation. Often people feel tight in the calf because of the position they stand in all day long.

Likewise if you have pain, the body is going to protect you from going through any extreme range of motion for safety reasons. So it provides a sensation that encourages you to stop. 

Below is a picture of a common posture or position that many people stand in often.

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As you can see, the hips are forward as compared to the lateral portion of the ankle joint. So if your hips and your ribs flare forward you are essentially leaning forward on the balls of your feet. In order to prevent yourself from falling forward, you calf muscles have to contract in a lengthened position to hold you upright. 

So in other words you calf muscles are always on. So just by position, this individuals calf muscles are already on stretch.

The other reason you should avoid stretching an achilles injury (especially the closer it gets to the insertion on the heel) is because a tendon injury implies the the tissue/tendon is compromised. We all know that muscles are elastic. So I like to use the analogy of a rubber band. If you stretch a rubber band too much it becomes weaker. Furthermore, if the structure of the rubber band is compromised, it doesn't hold up to well to aggressive stretching. So why would you treat your muscles this way?

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This image I think explains a lot about how the structure of your heel (calcaneus) impacts the achilles tendon. And why if you have consistently been stretching your tendon it can cause friction against the bone....

More than likely you need to introduce a strengthening program. This is done through an appropriate range of motion depending on your presentation. Addressing some positional faults as well, which we eluded to earlier would just be icing on the cake.

To learn more about how we can help you with this process, apply for a free discovery session.

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About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Alfredson Protocol for Achilles Tendinopathy

If you have ever experienced an achilles injury or dealt with chronic achilles re-injuries or tendinopathy chances are your physician may have recommended something called the Alfredson Protocol.

This is an aggressive loading program with the intent of building back the strength and capacity back up in the tendon so that it can withstand normal daily movement as well as the activity levels your more than likely looking to regain. 

The Alfredson Protocol consists of 2 exercises performed for 3 sets of 15 reps that would be repeated 2x per day (which is a total of 180 reps every day). 

This is one of the exercises below. There are ways to make this activity easier or more challenging depending on the clients symptoms, strength, and skill level.

Now I know what you are thinking....thats a lot of reps, and that is probably going to hurt!

The reality is that this is a protocol which is standardized for research purposes. Many people do not do well with this aggressive approach. This approach is modified or altered depending on location of achilles pain as well. The exercises for mid achilles tendon pain are different than insertion (or at base of heel).

Having seen numerous achilles tendon cases before, we at On Track Physio have found that while this strengthening approach certainly works, we also need a menu of exercises to choose from which allows the client to perform the activity comfortably. 

Depending on your case and presentation we may also recommend less repetition or utilizing a heavier weight. This very much depends on the person.

Likewise, to make things even more comfortable, we have found that utilizing soft tissue techniques in conjunction with this will allow you to perform the exercise more comfortably. Below is a picture of cupping, which applies a distraction force to the tissue. This sensation seems to work better than compressive massage techniques possibly because achilles tendinopathy tend to be a repetitive compression based injury. In some instances we will perform dry needling, but not always.

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The more comfortable you are able to perform the exercises, the more likely we can continue to progress the exercises and perform them on a daily basis. On a daily basis is a very important part of this process, which is why once we determine the correct exercise for you, it's just a matter of doing it. We do not need to see you very often, we just need YOU to do the exercise daily and remove or modify the aggravating factors (something we will also help you do). Our goal is never to stop you from being active, however we may need to modify things slightly so that it gives the tendon a chance to recover.

To learn more about how we can help you with this process, apply for a free discovery session.

Ann Arbor, Mi

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

How To Stay Active and Recover from Achilles Tendinitis

Achilles tendinitis is a common complaint in the active population. It starts becoming more common with people in their early 30s or 40's, but can certainly impact people of all ages.

It tends to develop for a variety of factors. Usually the onset is associated with some type of quick spike in activity levels. Something such as increasing mileage of a run, or summer starting and you jog outside on different terrain, etc. It could have also been the addition of playing another sport or including more dynamic movements in an exercise program.

Either way, looking at the activity levels over the last month usually (not always) gives you a better idea of what may have predisposed the area to aggravation if it wasn't first gradually exposed to the task over time.

Once you are in pain or dealing with an achilles issue the game starts to change. As usually just resting and icing does not seem to alleviate the problem. If it would, you would notice relief in 3 weeks or less.

The other problem is that maybe you did get quick relief from resting, but you continue to re-injure or aggravate the issue when you try to resume your normal activities.

Aside from activity modifications that do not place as much dynamic demand on the achilles, the second order of business is to start building strength and capacity back up into the tendon.

After an achilles injury or strain happens, the tendon itself is weaker and does not have the loading tolerance it used to have.

We address this through the Alfredson protocol. The alfredson protocol is a well researched exercise protocol that helps with achilles tendon injuries. The one caveat is that this is a pretty aggressive and demanding exercise program and is not appropriate for everyone. Being too aggressive with this protocol can cause a lot of extra unnecessary soreness. 

We have treated a number of these cases over the years and found ways to make the exercise easier or harder based upon the clients skill and injury level. Furthermore, we have found great success with modifying the load and reps to what is correct for the particular individual. 

On top of this, we perform various soft tissue treatments in conjunction with the exercise program. The purpose of this would be to allow for more comfortable performance of the exercises. We tend to favor cupping for this but other methods may certainly be used as well. 

In total, most clients do not see us more than 1x per week for this issue. In some more extreme cases we go 2x per week until the pain is more under control.

To learn more about how we can help you recover FASTER from this issue, sign up for a free discovery session below.

Bonus content: Why you should avoid stretching Achilles Tendon Injuries

 

Ann Arbor, Mi

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About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Why Your Knee Hurts With Squats and Stairs

Pain in the front or side of your knee?

Clicking or popping around the kneecap?

Don't be so quick to blame the knee! We see this all the time at On Track Physiotherapy. Client comes in with knee pain and has difficulty with squatting, stairs, etc. 

Often times people think that this is a knee issue. When quite often it actually has more to do with the hips and foot than anything. 

When people think about the knee, many believe that it just bends and straightens. When in reality there is actually a decent amount of rotation that is normal and should occur at the knee with various different tasks. 

This is because you hips and ankles have more degrees of freedom than the knee. Move your ankle or hip around for a moment. Then move you knee. Notice how many more options are available to the ankle and hip.

This puts your knee "a.k.a the middle man" at the mercy of the hip and ankle. Your body is like a tetor toter, if one end moves, the opposite end is going to do something as a result. 

So if you hip or ankle do not have the motion necessary to accomplish the task, it causes the knee to work overtime.

If your hip and ankle don't have stability and control, then the knee takes the brunt of the stress.

Your body needs controlled motion available throughout the lower extremity to distribute forces and start feeling better.

Listen to the video above, as I explain this in more detail. 

Real Solutions For Knee Pain| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Stop Achilles Tendinitis and Foot Pain BEFORE it causes another Problem

Have you ever heard someone say that after they hurt such and such body part that all of a sudden a whole slew of other injuries started?

I hear this all the time, and there is a lot of truth behind it. Especially when it comes to the foot and achilles tendon!

You see the foot is the body’s first line of defense to absorb and transmit force, your achilles tendon plays a major role in this. The foot hits the ground first thing in the morning and with every step you take during the day it must absorb and transmit force. However, when injured this capability becomes impaired.

So what happens when you have achilles pain? The body says “next man up”. Meaning your knee, hip, and back on either side start to take the brunt of the impact. If you do this repetitively, there is a pretty good chance something will start getting a little cranky.

I’ve treated a variety of Achilles injuries. Runners with chronic Achilles pain, partial tears, and post-surgical clients. I can tell you from firsthand experience that individuals who have been dealing with this for a prolonged period of time tend to have other issues as well. Most common tends to be the opposite hip from working overtime, but it could manifest itself in other forms as well.

 Achilles Tendon Injury (bottom)

Achilles Tendon Injury (bottom)

Often times the problem with these individuals is that they have been performing the same stretches over and over again for months on end without much improvement in symptoms or overall ability because that is what their doctor, PT, or Chiropractor told them to do.

Stretching could be part of the solution. However, chances are if you have not made improvement by now, then that is not the answer. Remember how I said the Achilles tendon's job is to absorb and transmit forces? Well stretching does not necessarily accomplish this mechanism. Think about a rubber band. The more you stretch it, the more it becomes loose and decreases its ability to create force or tension. The same concept applies to your tendons. Don't get me wrong, they need a baseline level of flexibility, but more does not necessarily mean better.

The solution? Creating useful stiffness and strength in the tendon so that it has the resiliency to absorb force all day long when you are walking, going up/down stairs, jogging, or playing a sport.

You have probably seen a calf raise before. This exercise, especially done at particular tempos and angles proves to be effective for a lot of people. However, a lot of times people will have pain with this activity so it makes it really hard to progressively load the tendon.

At On Track Physical Therapy we also utilize a method called blood flow restriction training. This allows us to make strength gains with very low loads of resistance. Research has also shown how it can increase human growth hormone (this hormone has been known to improve tendon recovery).

Another method for pain reduction used is Dry Needling. Which has been shown to improve pain in the short term. Allowing us to effectively strength train the tendon in a more pain free environment.

Finally, if you are an athlete, you need to progressively start including dynamic exercises and drills that will ultimately translate to sport by improving your body’s ability to efficiently transmit forces. Such as the exercises below:

 

For free tips on how the pros recover faster from injury, click the picture on the left. If you'd like to get help AS SOON AS possible then enquire about a FREE discovery session below.

 

 

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.