The Achilles’ tendon connects the calf muscle to the heel. It deals with an enormous amount of strain when we run, jump and walk. And so it is often injured in runners, and in high intensity sports.
This week, in our Kensington physiotherapy clinic, we saw a 35 year old man who suddenly started to sprint for the bus – hardly high level athletic activity, but still a huge load on the achilles.
“As I took off to catch the bus, I felt a sudden twinge in the back of my heel. It was a sharp pain, and felt like something had pulled from my heel. I was able to hobble to the bus and get myself to work. But the next morning I have woken up, and can hardly walk.”
What would you do?
Three questions the client asks
1. Do I stretch this to get rid of tightness.
2. Strengthen this by exercise to protect it? or
3. Do I rest this?
We as the physios need to answer this question to ensure proper management. The big question for us is what has happened. Has he ruptured his Achilles (needs rest/protection/maybe surgery. Has he developed a tendonitis? This would need a graded strengthening program to repair the weakened tendon. Or has he torn fibres of the achilles? This would require protection as the fibres repair.
The clue to what he has done is in the story he has told. He was fine before (probably not a chronic tendonitis, which tends to develop over weeks/months), he could hobble to the bus and get through a day at work (not a rupture as he would be on the ground unable to walk). But it does sound like a partial tear of some of the fibres- as it happened suddenly, and worsened over the day, meaning inflammation and bleeding was building up after the event.
So our management is then driven by the diagnosis of acute partial tear.
It needs REST – to avoid further damage. ICE to prevent excessive bleeding and inflammation.
He SHOULD gentle move it and use it using pain as his guide.
HE SHOULD NOT stretch it or load it with painful exercise, as the fibres are trying to knit back together.
If you need help knowing how to treat your injury, a physiotherapy assessment will give you the diagnosis and a clear course of action.
Call us if you need our advice. He are happy to talk you through your injury first if you are not sure what you need. T. 0203 538 3424
Or come and see us in our Notting HIll Gate physio clinic!
