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First Aid

Achilles Tendonitis

In this section you will find some information on how to practice first aid to relieve the pain of certain pathologies. These indications do not replace a professional treatment that only the doctor is able to perform.

Basically it is a tendon cord stretched between the heel and the triceps muscle of the leg which serves to control the plantar flexion of the foot. This tendinitis is quite frequent and is generally due to a chronic overload of forces that subject the fibrils that make up the tendon to many small stresses. The symptomatology consists of a pain that can also be accompanied by a swelling localized towards the terminal part of the tendon, above the insertion on the heel. Usually the disorder exacerbates with the continuation of physical effort. It is important to understand the biomechanics of movement in order to successfully deal with the recovery of its functions. During the run, in fact, the triceps sural muscle is active mainly during the first half of the contact phase of the heel with the ground when the muscles absorb the effects of the impact of the heel on the ground. In this moment of the march the muscles work in an eccentric way controlling the correct support of the foot on the ground and the gradual beginning of the support phase. Therapeutic exercises that can help an athlete heal must seek to increase flexibility and eccentric strength (that which is exercised during controlled stretching of a muscle, e.g. movement of the quadriceps when going down stairs) to allow tendon to respond better to the stresses to which it is subjected. It is important to remember that exercises can only be started once it is ascertained that there are no serious structural injuries to the tendon.

Before starting the rehabilitation exercise that we will see later, the athlete will have to observe fifteen days of rest in which he will make a gentle movement of flexion extension in discharge to allow the tendon fibrils that are reconstructing to settle in the scar structure with a straight orientation and parallel to healthy and non-random fibrils as would happen during complete immobilization. This healing process can also be aided with some Deep Cross Massage sessions.

Before starting the exercises it is advisable to perform a 10-minute warm-up session (for example, an exercise bike), after this warm-up it will be necessary to stretch the soleus and triceps for a few minutes.

Exercise 1:

Eccentric stretching

It is performed on an axis of about 5 cm thick or on a step of the same height. The heel of the healthy leg must be raised by standing next to what supports the body and must follow its movement. At this point, applying strength with the healthy leg, the heels are slowly released until they touch the floor, allowing the effort to be carried out only by the healthy leg while the diseased one follows it passively. The descent must last 5 seconds. You have to repeat 3 sets of 10 exercises interspersing it with 30 seconds of rest. You must progress by progressively accelerating the speed of descent of the heels to the floor, first with a series in which the descent lasts 3 seconds and finally with a series in which the descent lasts 1 second. If you can perform these exercises without feeling pain on your legs for both the ascent and descent phases.

Exercise 2:

Intense eccentric stretching

Three sets of the same 10 exercises above must be performed with 30 ”rest between them. The difficulty is increased by increasing the speed and flexing the knees by 20 ° -30 °.

Exercise 3:

Eccentric reinforcement

The lifting phase must be performed only with the healthy leg and the descent phase must be performed only by the diseased leg. In this way, eccentric work is concentrated only on the diseased leg. Three sets of 10 exercises must be performed with 30 ”rest between them. It is improved by increasing speed and flexing the knees by 20 ° -30 °.

Exercise 4:

Intense eccentric reinforcement

The lifting phase is performed with both legs and you go down using only the diseased leg. Here, too, three sets of 10 exercises must be performed with 30 ”rest between them. It is improved by increasing speed and flexing the knees by 20 ° -30 °.

Exercise 5:

More intense eccentric reinforcement

Both the lifting phase and the descent phase are carried out only with the diseased leg and continue with the same progression described previously. Exercise 4 and 5 only need to be done when tendonitis has become completely asymptomatic.

Prevention also plays an important role in this disease: it is necessary to avoid using the upper metatarsals. There is also a good self-treatment method that allows you to relax the soleus muscle. The metatarsal must be taken with one hand and the foot extended until the tension in the Achilles tendon begins to be felt. At this point the muscles of the leg must exert a slight plantar flexion lasting 30 ”while the hand is resisting this force; the exercise is better if you coordinate it, push your foot against your hand with an inhalation and if you exhale during the relaxation phase. The exercise is repeated five times.

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Dr. Giuseppe Ridulfo

Comun. Order of the Physicians of VR

Prot. 1729 of 07.10.2002

VAT no.01386850232

CF RDLGPP50H22F257E