Heel Pain - Part 2 - Grumbling Achilles Tendon

Heel Pain – Part 2 – Grumbling Achilles Tendon

Last week I discussed Plantar Fasciitis one of the major causes of heel pain, this week I am going to discuss a grumbling achilles tendon, or to be technically correct, non-insertional Achilles tendinopathy, he other major cause of heel pain. Although a rupture of the Achilles is well known, it is actually more common to have what is known as a grumbling Achilles. The pain is felt at the back of the heel above where the Achilles tendon joins the bone. It feels stiff and swollen, particularly in the morning and can prevent the sufferer from taking part in sport. Sometimes the pain is lower down where the tendon joins the bone.
How can I tell if my heel pain is a grumbling achilles tendon?

You may have swelling over or either side of your achilles tendon which runs from your heel to your calf muscles. The skin over the achilles tendon may be red and/or hot. If you sit down with your feet on the floor and raise your foot, as you use your achilles tendon you may hear a crackling sensation.

What causes a grumbling achilles tendon?

The tab on your shoe rubbing against your achilles tendon.
Failing to warm up properly before playing sports.
Over use of the tendon from intensive training, e.g. running
Scar tissue from a previous injury.
High impact on hard surfaces e.g. any sport where you jump or tennis.

What can I do to help myself?

If you are in pain then rest and ice your tendon, to ice it wrap ice cubes in a tea-towel and hold against your tendon for 5 – 20 minutes, every 2 hours for 2 -3 days and then 3 times a day.

The key to preventing further bouts is to ensure your are wearing appropriate footwear for the sport you are doing, ensure you warm up and cool down properly and always stretch your calf muscles.

In addition a deep tissue massage release any tension in the tendon, remove scar tissue and ensure that your calf muscles are flexible.

So massage is safe for pregnant women, but is it effective?
Last week we established that massage is safe for pregnant women. A scientific review of studies of pregnancy in massage fond that pregnant women who received massage had

decreased depression

decreased anxiety

decreased leg and back pain

In addition pregnant women who received massage had reduced

reduced cortisol levels

reduced excessive fetal activity

lower rate of prematurity (a baby being born before its 37 weeks old)

For pregnant women who received massage during labour they

experienced less pain

required less medication

had shorter labours (on average 3 hours shorter)

The study concluded massage is effective for pregnant women. Reference Field T. Pregnancy and labor massage. Expert review of obstetrics & gynecology. 2010;5(2):177-181. doi:10.1586/eog.10.12.
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Good Posture Exercise
Having spoken previously about why poor posture is bad for you, I wanted to move on to give you a simple exercise that helps promote good posture. Brugger's exercise routine is devised to activate postural muscles weakened and simultaneously stretched by a prolonged sitting posture. Slumped Position Check the tension in your upper back and shoulders in the slumped posture and then in the Brugger's position, to see if you notice any difference as the muscle tension is dramatically reduced. Brugger Exercise Posture Step By Step Guide

Sit perched towards the edge of your seat; this will naturally place your lower back into a curve (lumbar lordosis) with your butt sticking out a little. As you do this your breastbone (sternum) will naturally lift up.

Separate your legs to 45 degrees each side with your feet turned out slightly and in line with your knees.

Your shoulders are relaxed and down with your chin tucked in, making the back of your neck longer – imagine a piece of string is attached to the top of your head and someone is lifting you up.

Fully straighten (extend) both elbows and arms.

Make sure you keep your shoulders down and imagine your shoulder blades [scapula] are pushing down and together to form a V.

Turn your thumbs out (externally rotate), palms up.

Separate your fingers.

You should now be in the position show above in the Brugger's exercise posture picture.

Hold for 30 seconds.

Ideally you should perform the Brugger's exercise once for every thirty minutes of sitting, so why not try this once a day. PS The Science This exercise was developed by a Swiss Neurologist called Alois Brugger MD, the exercise is neither a traditional stretch or strengthening technique but works neurologically by being complementary to the way your body is wired to work. Our bodies are neurologically much stronger in all of our flexor muscles. This is displayed perfectly if we look at a person with a neurological disorder, e.g. cerebral palsy; their body naturally has increased tension (hypertension) in the flexor muscles, also known as the spastic posture. This demonstrates our natural prosperity to an Upper Cross Posture which often develops when we sit for prolonged periods of time in a slumped position. Muscles work in groups. When one group is working then the opposing group are unable to work (inhibited). An easy example to visualise of this is when you place food in your mouth. To do this you flex your fingers, wrist muscles, bicep muscles and pecs., all flexors. However, to be able to do this you have to inhibit your finger extensors, wrist extensors, triceps, rhomboids etc. This is called reciprocal inhibition. If you were unable to do this you would be unable to feed yourself. The Brugger exercise works on the principal of reciprocal inhibition. When doing this exercise you are activating all your extensor muscles and therefore inhibiting all of your (usually hyper activated) flexor muscles.
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My self help guide for looking after your psoas
Given all my clients sit for prolonged periods of time as part of their job which can cause contraction of your psoas muscle. It goes without saying that [...]
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