Ann Arbor Physical Therapy

4 Achilles Tendon Injury Recovery Tips

Complete Achilles Tendon Treatment Guidelines

One of the most common injuries I treat for active individuals in Ann Arbor, Mi is Achilles Tendon issues.

That could be an Achilles Tendon Rupture, Achilles Tendinitis, or Achilles Tendinopathy. All are slightly different in their mechanism of injuries but all have the same milestones and goals to progress through in order to experience a full recovery. Obviously a rupture will take a longer time frame to recover than a tendinitis or tendinopathy scenario (but that's probably a topic for a complete separate post).

***Be sure to pay special attention to step #3 as this is often missed by many rehab clinicians and strength coaches

The first step into the process is understanding pains influence on the problem as well as anatomy and biomechanics influence on the problem. These are two separate issues, as often pain does not correlate directly with the amount of tissue damage present. This makes it important to understand the guidelines of pain (what is okay to work though and what is not okay to exercise through).

We discuss this in the below video:

The other important consideration we pointed out in the video above is the anatomy of the calcaneus. The shape of the heel creates a compression force on the Achilles tendon when stretched. Which is important to consider if the pain or location of the injury is at the base of the tendon or if the tendon is highly sensitive. For these reasons, it is often NOT a good idea to stretch your achilles tendon (especially when you are experiencing pain).

Once you understand the pain and irritating factors it is important to understand how to re-establish capacity back into the tendon without aggravating the tissue. 

We do this through strengthening in a NON stretched position FIRST. Then start gradually working our way back into STRENGTHENING THROUGH a stretched position. Not hanging out for 30 seconds in a sustained stretched position. 

In Part 2: the video below we discuss our two favorite exercises to start accomplishing this:

Step #1 and #2 are the easy parts of the rehab gameplan. However, this will probably only solve about 70% of cases. The other 30% of cases you need to consider other factors which may be influencing pain, as well as return to play scenarios for those involved with higher levels of activity!

To understand this further we need to consider the two main achetypes of feet you will see...

A pronated (flat) foot, and a supinated (high arch) foot.

Depending on what media and other healthcare providers have led you to believe, you probably feel that both flat feet and arched feet are undesirable. However, that couldn't be further from the truth!

Both types of feet are necessary for everyday tasks. It's no different than the ability to rotate your head right and left. Flat feet and arched feet are two extremes that the body should be capable of experiencing both. If the foot is not adaptable at creating both, and experiencing both at the correct moment, then you limit the foots capabilities.

During gait or walking our foot SHOULD experience supination, to pronation, to re-supination. That is normal and necessary mechanics of walking, gait, running, etc.

Pronation is needed to absorb force (store potential energy) or absorb/attenuate forces. Supination is necessary to produce force by creating a rigid foot.

The body's ability to re-supinate the foot is accomplished through the windlass mechanism. Which is only created by getting great toe extension. The only way to get great toe extension during gait is by allowing the foot to pronate and weight bear over the great toe as your center of mass moves forward (horizontally) during gait, walking, running, etc.

If you cannot pronate effectively, you will not create an effective windlass mechanism and thus not experience re-supination. So all those towel scrunches or tripod foot exercises you are doing with the knee straight have little carry over to life as during walking, running, etc we are moving forward! The tibia is moving forward, the knee is moving forward, the hips and body is moving forward...

So we must pronate effectively to allow our body, knee, and tibia to move forward. Load the foot and the kinetic chain. Experience pronation effectively and let the body get over the great toe to effectively utilize the windlass mechanism to re-supinate the foot and prepare for propulsion. The video below will hopefully give you a better understanding:

This above step #3 is often the most overlooked problem to achilles injuries as well as many foot/ankle/knee problems. Understand it, and you can make a world of difference for people who seem to be constantly stuck in a state of injury or rehab purgatory.

Finally the last step in the process is exposing the tendon back to a situation similar to sport.

Sure eccentric loading is great for the tendon histology development, and the athlete will certainly experience eccentric loading of the tendon in sport. However, a concept often over looked is the ability to create co-conntraction of the kinetic chain to distribute or absorb force more effectively. When running or jumping, the body needs relative stiffness in the ankle (as well as all the other joints) to not crumble when applying a force into the ground. Then store the potential energy to propel themselves forward. Look at any sprinter at top end speed or dunker taking off from a one foot jump approach.

Those who do it effectively create a lot of stiffness around their joints at ground contact. Meaning you will not see a large counter movement occur during a one foot jump approach (or really even someone who is more of an elastic two foot jumper). A sprinter you will notice a very stiff an rigid foot and even knee at ground contact. This is because the body is co-contracting the calf, hamstring, quad, and glute to quickly apply force and absorb force through the kinetic chain.

In video 4 we discuss some of my favorite dynamic exercises that take into account teaching co-contraction at ground contact.

If you are in Ann Arbor, MI we invite you to a FREE Discovery Session to see how we can best help you!

If you don’t live near Ann Arbor, MI no worries! We work with distant clients all the time online :) 

The #1 Reason Why Injury Happens

Injuries can be frustrating, but they happen to everyone.

It’s very common to think when you have an injury, that you are alone. But that couldn’t be further from the truth as many people suffer from injuries and lingering pain.

So your understanding of how injuries occur is the best defense you can have against getting injured in the first place. Furthermore, this knowledge will also be very helpful to get out of pain!

I made the video below, because this is often a question I get asked by patients. Furthermore, I happen to run a continuing education company for rehab professionals and strength coaches (Sports Rehab Expert) and this concept is something that I spend a lot of time trying to drive into people’s minds so that it becomes common knowledge.

As you will see, the concept is not that unique or novel. It’s actually pretty common sense when you look at it this way. But unfortunately the medical community likes to over complicate problems and make the process seem more complicated then it really is…..

Aside from how an injury happens, the second most common question I get asked is “how I can help?”

When you look at the equation of Stress vs. Capacity, here is what we can help you do!

Building Capacity = Help you rebuild the tissues compromised in the fastest most efficient way through very specific/direct exercises. This depends on your current capacity and as that improves, the activity should become more challenging along the way. So we help guide you to make better decisions on WHEN, HOW MUCH, and WHAT to do. It’s also important to take into consideration the activities you would like to return back to doing. The more specific we can get these exercises to mimic what you would like to do, the better shot you have to return back to them!

Tissue Stress = First this involves modifying or sometimes removing provocative factors. Secondary to this is show you through exercise how to more efficiently distribute stress across your entire body instead of in one particular area. This is where range of motion and coordination come into play.

Recovery = We also perform hands on treatments such as massage, mobilization, cupping, dry needling to help the recovery process and start removing tissue stress quicker so that the capacity bucket doesn’t start to overflow and help you to continue and be more active (which ultimately starts help building the capacity up when combined with previous mentioned interventions).

I hope you have found this to help provide clarity on what the problem might be and what you can start doing about it. Also, feel free to share this if you feel it could help a friend!

If you would like more information on how we can help, I would encourage you to set up a FREE Discovery session to meet :)

Why TYPICAL Physical Therapy Didn't Help Your Pain

If you’ve ever trusted a physical therapist, chiropractor, or any healthcare provider but are still in pain….we are sorry!

We understand making a decision takes a lot of courage.

You open up about your pain and give your hopes for a brighter future to an individual who is there to support you. It can be a vulnerable process.

But unfortunately, there is always a chance for disappointment.

You may still be in pain, you may regret wasting your time doing exercises that didn’t help, you may resent that you spend so much energy into something that failed.

But I urge you, please do not give up. And I give this example to give you clarity.

If you needed a roof fixed on your house and you talked to one company, how do you know there is not a more qualified service out there?

The same goes for pain.

Just like any industry, there are specialists who are just poor at what they do….

Many are mediocre.

Only a few are exceptional at what they do!

Set high standards, and make sure you never tolerate anything but the best for your recovery. Your health and future are way too important!

For this reason, we have designed a FREE Discovery visit to On Track Physio to meet us before ever making a commitment. It’s our way of showing you the difference and expertise we have in this field!

Injuries vs. "Wobby Jobber"

This is a quote which really resonates with me as it relates to injuries:

“You have to listen when it whispers as opposed to waiting for it to yell!”

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The idea is simple: if you ignore minor aches and pains, they rarely just magically disappear.

Instead, they start to amplify by volume or intensity. Causing you to reach a painful threshold where a TRUE injury happens and more extensive intervention is required. The research actually supports this concept - but only if you know how to dig a bit deeper.

One study in particular is this Scandinavian study of patellar tendinopathy in junior basketball players. This study had 134 teenagers (268 total knees examined) and found that only 19 tendons presented clinically with symptoms.

However, under ultrasound diagnostic examination, 22% of the remainder of the group who had no pain, could be diagnosed with tendinopathy. In other words, "ultrasound tendon abnormality is 3 times as common as clinical symptoms or being in pain."

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This study just looked at teenagers, who are markedly less likely to have tendinopathy than older individuals.

What if they did this study on middle-aged men playing hoops at the local YMCA. The point is that whether you have symptoms or not, you likely have some changes in your tissues.

Now to be honest, this study isn't particularly shocking to anyone who's looked at MRIs of asymptomatic (not in pain) individuals.

I’ve seen loads of x-rays, MRIs, and Diagnostic Ultrasounds in non painful people but according to their diagnostic image they have a rotator cuff tears or spondylolysis (stress fractures) or torn labrums or herniated discs. This list goes on and on…

The point I am making is that if we just treat a person’s image we are missing the boat.

It’s also a reminder that we often have several issues that might just be waiting to reach a painful threshold if we aren't cognizant of our training volume and intensity - and our movement quality.

The country background in me refers to these slight movement problems as a bit "wobby jobbered". In other words, something is a bit “off” and not necessarily a problem currently but could be a contributing factor to something down the road.

Maybe it's that cranky knee first thing in the morning, but feels good after you warm it up. Or, it's that stiff neck you get after a few hours of working at the computer, but feels better after your spouse massages your neck (ha yea right!). Or maybe its a shoulder that bugs you only when you bench press, but feels pretty good when you do rows instead.

Maybe it's seeking out some extra manual therapy in a specific area that we provide at On Track Physio. Maybe it’s a more individualized home program or warm-up to address movement issues. It might even be that you strategically drop particular exercises from your program at various points during the year.

If nothing more, understand that good training and movement teaches your body how to spread stress over multiple joints. Instead of that cranky knee taking on 90% of the load, we work on hip and ankle mobility and strength so that it might only have to be 30%. Spreading out the stress ensures that one area is less likely to feel “wobby jobbered”.

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Distribute stress requires you understand what quality movement actually looks like, and that's unfortunately where a lot of healthcare professionals fall short. Which is why we offer a Free Discovery Session to all new clients in order to experience the difference at On Track Physio!




4 Biggest Mistakes To Avoid When Recovering From Injury

Ann Arbor, Mi

To many people fall to these 4 common mistakes when getting out of pain. Ultimately leading to longer recovery times, frustrations, and unnecessary dollars spent at the doctors office.

When you get these 4 things right, often times you get back to the things you enjoy most in life much sooner!

#1) Don’t treat the symptoms….Treat the cause

This may sound counter intuitive, but stick with me here. Treating the symptoms may momentarily help your pain. But more than likely it does not solve the root problem which put you in this situation. Solving the root problem is the key to never having to deal with the issue again. While we do things at On Track Physio to help ease your pain. We also always talk about solving the root problem, and we are always testing movements out to make sure this is actually what we are accomplishing.

#2) Jumping the gun

Reach for some medication, go to your primary care physician who prescribed the medication. You go to a surgeon who recommends surgery. Is surgery and reliance on medication what you really want? Broaden your horizon to other options that are out there which can solve your problems. People spend more time searching for hotels on vacation then they do a healthcare provider. Do your due diligence, don’t assume, and trust the person giving you medical advice.

#3) Settling

“Everybody deals with it”….. “Your getting older”…. “That’s just the way it is.”

Media, our family and friends, facebook, etc they all give us preconceived notions which aren’t always true. A lot of times healthcare providers and people in general will be searching for just one problem. When in reality, our bodies are much more complex than that. Focusing in on one things is doing your body an injustice. Focus on treating the human body as a whole and you will get a much better outcome.

#4) Focus on the wrong things

Focus on the cost??

How long will it take??

Will my insurance cover it??

But let me ask you this…..What is you pain costing you right now?

What are you currently missing out on right now because of your pain? What relationships is it affecting? What activity with friends and family can you not do because of the limitation? What is that costing your right now???

What is the cost of not taking action?

The cost of not taking action will be exponentially worse than the little things you are focused on right now.

Again, go back to #3. Do your due diligence and find someone you trust to give you the outcome you desire.

Then take action!

If you’d like to see how On Track Physio can help you, we make it as easy as possible to remove barriers. Our goal is for you to start taking action. We provide a FREE Discovery visit to give you clarity on what the problem is, so that you can take action (whether that’s with us or someone else). Our goal is simple, give you clarity on the steps necessary to improve and start taking action.

Back and Shoulder Pain Recovery Story (“More Improvement in 6 Treatments than 30 Session Experienced Elsewhere”)

Matt - Back/Shoulder Pain, Ann Arbor

Injury: Limiting his exercise routine, impacting life at work and home.

Matt initially came to On Track Physio for a lingering shoulder issue which did not resolve with other rehabilitation methods. He had actually accumulated ~30 visits with another provider before finding us!

Looking for an alternative option, Matt found us online and we started with a Free Discovery Session.

We sat down and discussed how his shoulder was limiting him and what life would look like once the shoulder pain resolved. Then we mapped out our plan of attack to get him where he felt fully confident in his shoulder again.

Over the course of 6 treatments Matt noticed significant progress and was kind enough to write us this google review:

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Unfortunately, about 3 months later he experienced an unrelated injury. A flare up of a previous low back disc herniation.

Being familiar with our process and having success in the past, Matt set up another appointment with us to address his current low back issue.

After 5 visits his back was feeling much better and no longer dealing with frequent discomfort at work or bending forward. The ability to see us so soon after the injury was very helpful to get him recovered FASTER!

Matt’s story is very similar to many of the clients we treat here at On Track Physio. Starting with Free Discovery Session, then feeling positive and noticeable improvements within 6 session….Even if failing other treatment options (Remember, Matt received 30 visits of treatment prior to starting with On Track Physio).