Here at Bend & Mend we see our fair share of very impressive hard working bankers who shoehorn as much marathon running/cycling/triathlons into their free time as possible. Unfortunately it doesn’t always work out. Typically endurance athletes, (that’s you) alternate periods of intensive physical training with periods of rest and recovery. An imbalance caused by overly intensive training and inadequate recovery leads to a breakdown of cell repair mechanisms and eventual tissue breakdown, usually about a week out from race day!!
Physicians have historically referred to overuse injuries of tendons as “tendinitis,” suggesting that the underlying process is inflammatory but histopathologic (looking at tendon tissue under a microscope) studies show that most overuse tendon injuries are degenerative, not inflammatory.
These tendon injuries are characterized by collagen fibre degeneration and disorganisation and an apparent “stalled” healing response. It is more accurate to use the term “tendinopathy” for these overuse injuries
The recognition that overuse tendinopathies are degenerative rather than inflammatory has important clinical implications. Any of you unfortunate enough to experience a tendinopathy will know they are SLOW to recover, they often require significant activity modification and rest, and may or may not respond favourably to non-steroidal anti-inflammatory drugs (NSAIDs) such as Voltaren, Ibruprofen or injected corticosteroids. Relative rest is a fundamental component of management.
The usual history of an Achilles tendinopathy is a gradual and insidious onset of pain in the Achilles tendon. In mild cases, symptoms may be present only during exercise, whereas in more severe cases, the pain will interfere with normal daily activities.
This can sometimes be attributed to your saddle position or foot position on the pedal, pedal stroke or running technique so it is a good idea to get your bike or your running style checked out if these problems persist.
Thankfully there is a well-documented and extensively researched treatment program and we at Bend + Mend know all about it, eccentric strengthening. Discovered by a frustrated physiotherapist/ runner who was determined to rupture his chronic Achilles tendinopathy he discovered with intensive eccentric strengthening exercises his pain levels actually decreased. Later in histological studies it was shown that eccentric strengthening actually helps to stimulate tissue repair.
The protocol he developed for treating Achilles tendinopathy consisted of high repetitions of heel drops off a step with your knee bent and repeated with your knee straight. See video on YouTube here.
As I mentioned tendinopathy problems can be slow and usually need a specific management plan so if you notice yours don’t delay, give us a call at Bend + Mend today.