Category Archives for "achilles"

Tendon Pain with Jumpers

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, and we're talking bodies. How you doing Iyad? 

Iyad: Doing well. Let's talk some bodies. 

Mark: So tendon pain with jumping sports. How do you deal with that?

Iyad: It's pretty common that we see people who play a lot of jumping sports in clinic and often they have aches and strains all over the place. And I mean, most athletes that we deal with are usually managing an injury or two through the season because by the time they come and see us, it's kind of been persistent and they're just kind of patching it up as they go.

So one of the things that we've been seeing more recently, especially as we get closer to kind of the nationals and the provincials where we see kinda an increase in people's schedule and their training and their volume of jumping, we start to see a little more tendon pain and tendon dysfunctions with these people.

So this isn't just necessarily one type of tendon cuz it could affect their achilles tendon or also their patellar tendon, which is the tendon at the front of the knee, under the kneecap. And we rely on those two structures very heavily when it comes to jumping. So, you know, part of the things that we would have to kind of do, and this is the challenge here, is managing mid-season versus, let's say in the off-season, where we can completely take them out of that aggressive, provocative program, build them up, and then send them back in.

Which we would never do that way anyways because we don't wanna cut off jumping entirely if they could still tolerate it. But ultimately, what we have to do in, in season is really be mindful of the total volume of things they do and their training program and kind of tinker with that. Maybe substitute some exercise and some different programming aspects, and then maybe also try to shore up some areas where they might be a bit underserved. So that we can kind of help support that sore spot. 

So a common one we'll see is in adolescent boys. We'll see this a lot. Just the the patella tendon, which is the front of the knee. We'll see a lot of people in volleyball. If you ever go to a high school volleyball game and you'll see people like knees with a little kinda strap that's just across the kneecap. They do that for relief, but those tend to be kind of like a primary demographic. Basketball, volleyball, and sometimes soccer. Anything where you're involving like repeated jumps or just like high intensity sprinting, you'll see some of that stuff happen.

Mark: So, I guess the symptoms or pain, what's causing it? Just overwork? 

Iyad: So a few things can cause this, but tendons are really funny. They're very finicky structures. They kind of like a nice consistent program. And then whenever you kind of go through a period where you disrupt that by like rapidly spiking the volume. It can happen. The funny thing about it is it doesn't just happen the next day. Basically what happens is I could ramp up all of a sudden and it could show up a few weeks later because I just don't have adequate recovery time in between that, to go back to where my baseline was. And then eventually tendon just reaches a threshold where it just becomes too sore.

And one of the things that people will complain about is, actually funny story, is we worked with a volleyball player last week, and his main complaint wasn't the pain, because he could play through pain, it was the fact that he can't jump high anymore. And he's lost some of that kind of explosiveness that is associated, like, you know, especially when he's blocking off a volleyball, where he has to jump up and create a full reach.

You know, he said, oh, I can't jump up anymore. I have to kind of really think about it and have to really, really kind of like dial in. And we were able to kind of assess him and based on what we saw, it was basically part of the process was that his pain was so significant on some days that he just can't even kind of recruit that muscle adequately in his cap.

So we had to kind of really tinker with this program and, you know, we kind of set some priorities, for example, for him to, to play in the big tournament coming up. So we kind of monitored restraining and kind of modified some of that to kind allow him to go and play in that tournament. And he ended up responding really well to the program, to the exercise program. And we just did it in a way where we just didn't only jump. And I think that's really, really important that we kinda like do the rehab along with some of the movement that we wanna do. 

Mark: So one of the things that I learned, and I don't know if this is true, it was that the muscles will increase in strength and ability to respond to hard work, far faster than tendons will. 

Iyad: That's probably accurate I would say. What I can tell you is the specifics of like, what's the dosage that you need and how much time. We just know the tendons tend to be slower in adaptation. They're quite strong structures. So what I'm trying to say here is not to freak people out and say, oh, don't ever jump, because your tendon's gonna, they're quite strong.

And they're quite resilient structures and often the fix is just more training, but just more specific training to kind of help improve, let's say, the capacity of that tissue to be able to handle all of that volume of jumping. And what we see a lot of times, especially in the adolescent population or maybe like kind of like the late teen population is, some of them absolutely love to do their jumping training and their training on the courts, but they absolutely neglect the strength side.

And that's kind of where we come in and try to like really help them on the strength and conditioning side to help, not just with the Achilles itself, but you know, when you jump it's a whole body movement. So people we've worked a lot on, kinda how their trunk, how their body stacks up over their hip, hip over the feet kinda thing.

And then also like you wanna build the areas that are potentially gonna help you put all that force into the ground so you could pop up. So yes, they are slower adapting, but the good news is they are very adaptable structures. 

Mark: So when you're diagnosing this and it could be whichever of the places that are causing an issue, how are you determining which beyond pain?

Iyad: So it's really simple actually. With tendons, there's a few rules. One of the things we see in the Achilles, for example, or in the patella tendon, is it's very localized. It tends to be about a finger width in area. Nothing more than that. So when somebody comes in and says this whole thing hurts, it might not just be the tendon.

It tends to be quite localized and pinpoint, and it also tends to be repeated because we aggravate it with repeated activity. Now most tendons will be worse upon starting the activity and kind of warm up a bit and then creep back up in the end. So that's kind of the pattern you'll see, with the runners will say, yeah, I start my run. It's kinda rough. And then it gets easier and then it gets worse later on. And then the other thing that happens with tendons is they kind of have that delayed response. So 24 hours later or so, people wake up and they're like, well, I actually feel really sore. I couldn't put too much weight, I couldn't jump as much. I couldn't kind of exert the area as much as I did before. And they often wonder if they slept upon it or anything like that. But it's really more of a product of doing too much, you know, the day or two before that. 

And then finally when we test it, it's really funny. Most people assume that the diagnosis happens by imaging and the diagnosis is a clinical one. So we do a clinical kind of cluster of exams, and what we would usually see with tendons is, if I make you do let's say a loaded activity to the tendon that's exerting it by, let's say this much and then I give you something that exerts it by this much, the more we go up and load, the more pain you're gonna have or the more discomfort you're gonna have.

So that's typically how that system works. So we kind of try to kind of do that sequencing cause we know what movements, for example, could be really, really high stress and what movements are really low stress. And based on all of those things together, we can kind of figure out, plus the pattern tell us like, oh, it hurts at 20 minutes of my run, or 30 minutes of my run. Or after intermission I usually feel it like, you know, when I'm coming back on the court. Those are kind of things that, you know, we use to put together to figure out what's that irritability level, so how much can this person handle? And that's also what's gonna dictate how aggressive we could be in their training.

Mark: In the course of treatment, was it just, I imagine it's not just laying off. If someone's in the middle of a workout or a competition season, how do you treat this? 

Iyad: So the cases where we would lay off are pretty rare, I would say. Most often we would kind of modify the program first before we lay off completely. Obviously in cases where like there are times where we lay off for a day or two. That's kind of like, what it tends to be is we would just modify that program afterwards. We would wanna look at all the things that provoke it. So sometimes it could be habitual friction or rubbing. 

So for example we had a hockey player once who developed it and you know, he just got new skates, not broken in, heels digging right into his Achilles tendon. So that got really, really sore. So we just got him to skate in his old skates while he was rehabbing. And then we actually made him do a breaking in program for the news skates where he would just wear them kind of for warmups and that's it. Just to kind of loosen them up a bit.

And then with that, we were able to train him up to the level that Achilles tendon could handle, like the pushing off. Even though hockey's not considered a high achiles tendon activity necessarily, it was still quite aggravating for him whenever he would stride out and kick his leg to the side. So that was kinda one of the things that we kinda would have to do.

And we would also really wanna exercise, like that's primarily the fix here. It's not just exercise the local area, exercise surrounding musculature, make sure they have adequate mobility in some of those areas. 

So for example, if you need to be able to squat really low or your ankle is really stiff, well that's gonna be a little more difficult to do. We tend to kind of look at the ankle underneath the hip in that case to be able to kind of carry that movement forward. But then also, I think what most people will do, is focus on that rest of the chain and forget the actual tendon itself. We really need to address the tendon. So it's a case for local intervention and also let's call it the distal and the proximal area too.

Not just the, oh yeah, just hit the knee and you'll be fine. Or not just hit the area around it and the knee will be fine. So you kinda have to like look at both. And then it's really a matter of building up tolerance from there. So we would start with managing minutes and we would never stop hundred percent, tends to be a last resort for us.

Mark: If you're having tendon pain from your jumping sport or running, sprinting, whatever, the guys to see are Insync Physio. You can book online at, or you can call the office to book. (604) 298-4878 in North Burnaby. They also have a Vancouver office at (604) 566-9716 both are available to book on the website. Thanks so much for watching and listening. Thanks Iyad. 

Iyad: Thank you.

Achilles Tendon Pain with Iyad Salloum

Mark: Hi there internet people, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, near Vancouver, and the outskirts of Vancouver, the soul of Vancouver in North Burnaby. And we're going to talk about Achilles tendon pain. How are you doing Iyad?

Iyad: Good. How are you doing Mark? 

Mark: Good. So what's Achilles tendon pain. I have a sore ankle. How do I know it's the Achilles tendon? 

Iyad: That's a good question. Usually one of the first things we'd want to do is talk about how it started and the history and all that kind of stuff. And that usually helps us kind of figure out if we're going to look at the Achilles tendon or not.

And with most tendon issues, it tends to happen slowly over time. It's not like a sudden trauma. Obviously there is some of this kind of where I took a step and I felt something go and those tend to be a little different. So if we think about the classic Achilles tendon pain, it's either somebody who had taken lots of time off, I'm gone away on vacation. You know, just a bit of walking and then I come back. I'm like, okay, maybe I'm going to hit the gym at the same level I used to hit before. And that big spike from a big rest. So it's a period of disuse. And then you come back to where you used to be that sense tends to look like a spike on load on our body. And then we can kind of start to develop some of these issues. 

And where the issue happens, honestly, our best bet now is to do with maybe the resilience of that area or the training history. So for example, if this person's very well-trained they might have a bit more buffer, and they can withstand that jump in activity more, or not. 

The other really important one is the pain location. So tendon pain, you know, we expect it to hurt especially in the lower limb. So like the Achilles tendon, if somebody comes in and says, well, my foot hurts. I'm not going to be looking at the Achilles. Or if they feel painted like high up in their calf, we're going to look at something else.

So we'd like it to be in and around the tendon for us to have a pretty good confidence, that it is that. And then the other one, which is really, really important is how localized the pain is. So tendon pain is very localized. It doesn't really present where it jumps up and down and moves around a lot.

So if they have that, it doesn't mean necessarily that they don't have tendon pain, but maybe it's not the only thing that's on their plate that they're dealing with. So that's where we would want to dive in and assess all the things that could contribute to sensations there. 

Example, I had somebody who said, oh, I feel it when I run. And it turns out that they have some issue with their low back and we treated the low back and their leg pain right away. So it could look like a tendon, but if it doesn't behave like it, that's where we'd want to look a little more in depth. 

Mark: So let's just dig in a little bit deeper. Is there any relationship with pain the plantar fasciitis that pain down in the middle of your foot and tendon. Is this particular Achilles tendon pain.

Iyad: Could be. They're kind of connected, the two structures and you know, the name plantar fascia makes it sound like it's not a tendon, but it kind of behaves like a tendon. It's like a flat tendon. So they could be related or it could not be related. And sometimes you don't have to have one to have the other.

So some people only have heel pain, plantar heel pain, which is pain just at the inside of their heel, and that could be related to the plantar fascia getting a bit effected. So we would treat that with a multitude of ways, including figuring out why they're just so easily triggered with certain activities and try to modify that. We could do different shoe modifications for these people just to kind of help them continue to stay active, just because, you know, you're unable to maybe exercise the way you normally do doesn't mean you should stop exercising altogether.

And that's usually what happens, is people stop for a long period of time because they try to rest it. Then they lose function in other areas, and then all of a sudden, you know, they'll tell you I gained a bit of weight and I've lost my strength and all of this stuff that happens with just prolonged rest. 

So really our job as physios is to see okay, great. So you have this injury, how can we keep you as active as possible, while also trying to treat this injury at the same time. Instead of just completely cutting them off of any activity? So yeah, they can happen together or they can happen separately. But just because they're connected structurally, they don't necessarily have to go one and two, you can just have Achilles tendon pain sometimes.

And it's because the Achilles tendon is really important. We use it through our lifetime as a spring to help us recycle the energy that we use. So for example, when we walk or when we run, we're able to kind of recapture a lot of that energy that our body puts into the system and into the floor through this nice little spring function that it has.

Mark: So how related is an ankle sprain, say like a high ankle sprain or something like that, to this Achilles tendon pain? 

Iyad: They're pretty different. They're remarkably different I would say. High ankle sprains will happen from impact. They'll happen from some kind of trauma, some fall. You know, some people say, oh, I rolled my ankle, but then it happens usually from some kind of mechanism and direct episode.

I've rarely seen it happen just from a slow buildup, an insidious onset like that. The Achilles tendon also functions very differently. It's an active structure. It's a contractile structure. Meanwhile, in the high ankle sprain, the job of that structure in the front of our ankle just the top, is to hold the two bones together. So it's literally just acting as a binding so that we don't get excessive wiggling between the two bones. Meanwhile, our Achilles tendon is constantly contracting and releasing in conjunction with our calf. 

Mark: They're opposite of each other then, really? 

Iyad: Yeah. So you could think of them as one of them is kind of like connecting bone to bone, the other one's connecting muscle to bone. So functionally very different. Structurally very different. Location very different. One's going to hurt primarily in front, the other one's going to be at the back. And one of them is primarily like, again, the key thing with Achilles tendon pain is there has to be some kind of load change that we see and it doesn't have to happen last week. It could happen weeks and weeks ago. 

But then the idea is you do is huge kind of spike in activity. And then you kind of maybe go back to normal, but your body might not have enough time to repair and adjust and it slowly builds up where you start to become symptomatic. And then in that case, what we would do is just try to see what are we actually dealing with?

Is this actually the Achilles or is this something else? We can have, for example, pain in the structure, just around the tendon tissue itself, like the sheath, which could look very different. And this is where you can get something like a cyclist saying my Achilles hurts, even though what we consider biking is not really that heavy on the Achilles tendon. Not quite like running or jumping. It's not considered a high elastic activity. It's not a high springing activity. 

Meanwhile, if you have a jumping athlete, you're kind of going to look at that a bit more or a soccer player, or even a runner where they have to constantly be using that tendon. So yeah, we would look at that first and then we would kind of figure out where their symptomology is. And then we can modify lots of things. 

Same with the plantar fascia. We can modify the load. We can put them on a different exercise routine to keep them healthy, but also do some small modifications that we can again, modify footwear. That's a temporary solution obviously, that's not going to fix the tendon, but it helps them continue staying active and training. Especially if somebody, for example is training for a marathon and their time is a little limited. So they don't have this big window of opportunity to drop six weeks off their training program.

Mark: So if we kind of narrow down to the core here, the history is really important. That's how you're going to get to the exact diagnosis and where the pain is, of course. And then you got to keep moving is basically the other message. 

Iyad: Absolutely. So the way we diagnose tendons is it's mostly functionally diagnosed. So we have a bunch of tests and the idea is you'd expect it to hurt more, as I progress the load on you, I'd expect you to be more symptomatic if it's actually a tendon that's hurting.

So progressing load is just as general term, but it means if it's heavier, if it involves maybe more pressure on the tendon, if it's faster, those are all considered higher loads, but those are the parameters that we tinker with when we're designing, for example, somebodies running program within the Achilles tendon.

We would definitely want to keep you as active as possible, but also we want to put you on a loading program for the tendon. That's how we think the tendon restores its function best. It's not an inflammation only problem. You don't just want to rub an ice cube over it and let it rest. If it's actually a tendinopathy we're dealing with, so we want to kind of put you on the best regiment and it's not necessarily just doing heel drops, because you can think about just if you're a runner, how just doing heel drops off a stair might not be enough to get you back to full function.

So we need to start restoring some of that activity. Obviously we can definitely do lots of calf strengthening and we can work on muscles of the knee and the hip to kind of help support the chain a little more because that just helps any runner. And it can definitely help people with Achilles tendon problems.

And then we could do things like gait retraining, if it's that, that we suspect caused it. Somebody's a new runner, they haven't run before. We can kind of do some modifications to how they run and that could help them continue training, but ultimately they need to load the tendon. And that's where we come in and we design a program that's appropriate for that.

Most people are quite surprised by how much they could do load wise with a tendinopathy. And that's where, you know, sometimes getting the confidence from somebody who's telling you this is safe and here's how we do it. That could be very, very useful to kind of get things started. 

Mark: There you go. If you need some help with your Achilles tendon pain, you've got pain down your heel, around your heel. Get it diagnosed, know exactly what's going on and get expert help on what to do to get it better. You got to keep moving, but you need to know what the heck's going on and how to do it properly. And the experts, they've all been trained in this extensively at Insync Physio are the people to see. You can book online at their website or you can call the Burnaby office at (604) 298-4878. They're also in Vancouver at (604) 566-9716. Get in there and get some help. Get back fully active. Thanks Iyad. 

Iyad: Thanks Mark.

Tendon Pain with Iyad Salloum

Mark: Hi there, internet people. It's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby. And we're going to talk about tendon pain. What's going on with pain in your tendons. Can even feel pain in your tendons? 

Iyad: Hi Mark. Good question. So we have tendons all over our body. In the upper limb and the lower limb. And it's kind of I guess the function of a tendon is to transmit the force of your muscles to your bone. And just saying my tendons hurt is probably doing the condition a disservice, because it's oversimplifying it. Because if you think about how we use our shoulders, it's nothing like how we use our legs and our Achilles tendon.

It's very different. You know, just all you need to do is see what a baseball pitcher does versus a hurdler, for example. And then you'll see how markedly different the structure is and the function is. And if you think about also the uses that tells you that the problems that you get in one is very different than the problems you would get in another. And this is kind of where I was hoping to explore with that today. 

Mark: Okay, well, let's compare and contrast then. What's the difference with Achilles pain versus knee pain? 

Iyad: So we have two different tendons there, like the knee gives a lot of structures there, but if we want to compare the tendons specifically, so we have patellar tendon, which is where our quads would be acting primarily. We see this primarily in adolescent males with a patellar tendon. And that's usually in adolescent males doing lots of jumping sports because that's where you need a lot of that explosive power to come in. It does affect females as well. But where we see in the data is that they show a market kind of selection towards that group.

And it tends to be just like repetitive jumping, and it tends to be tons of stuff involving like group of activities that involve the stretch shortening cycle of the muscle, where the muscle has to kind of start at a stretch contract and then explode out, think of like how you would compress the spring and let it recoil.

That's kind of what we use our lower limb tendons primarily as. And then the Achilles tendon will affect everybody from the adolescent, all the way up to our seniors and geriatric population. So it tends to affect everybody. But because we use them differently through the lifespan. You need your Achilles tendon to walk. That's a good way to kind of think about it. So imagine when you walk around a 5, 10 K walk, you're doing a few thousand steps. The way we're able to do that is a lot of that energy that we put into our system gets recycled by our tendons. So we don't have to put external energy all the time to carry over that function.

But then at the same time, I can't ask somebody to do 10,000 calf raises in a row because that won't work that same way. So this is where you differentiate the function of let's say the calf muscle versus the Achilles tendon. So yeah, it'll affect things differently. The function is different, which is really, really important because we always want to think about the function when we're thinking about how does this issue develop, but also what can we do to help them after a tendinopathy develops.

Mark: Right. So is tendon pain, always tendinopathy, which is basically the inflammation of the tendon? 

Iyad: So good question. And it's not inflammation. We used to think it's inflammation. So we used to treat these with rest and anti inflammatories and ice. The traditional kind of approaches and lo and behold, it didn't really work out so well.

And we know this, we have a ton of data now showing that the tendon itself starts to lose its ability to do that job that I was talking about, that springy job, where you get to compress it and spring out of it. And we think the way it happens is it goes through, like the healing is just, it's not a normal repair, it's a disrepair.

So it doesn't fix itself in a proper way. When it doesn't fix itself in a proper way, you lose that organization of the structure, which makes it not be able to do its job so well. And we know also the other thing about the, that it's not entirely inflammatory from this fact that exercise actually, and doing lots of exercise could be very helpful to fix the tendon and to help people with tendon pain versus making it worse. Because when you think of something that's really, really inflamed, you know, we'd want to usually just give it a bit of a rest, back off a bit. That seems to work in the short term only. And the only thing that rest from what we see in the data seems to do is just gets people better at rest. 

And I can talk about from the group of people that we work with at Insync, a lot of them are seeing us because they can't do their sports anymore. So it's not because they have pain when they're sitting and watching TV. It's usually you know, I can't walk as much anymore. I can't hit that hill. I can't run. I've lost the ability to jump. It depends on that. 

So I think making an important distinction that it's not inflammatory is really important from that point of view. And then, yeah, tendinopathy is the more accurate term to describe this because it describes all tendon pathology.

So first of all, when people would see us, we've got to figure out, is this actually the tendon or does this hurt somewhere near the tendon? So for example, if you have a patellar tendon issue, it would hurt just under your kneecap, but there's a lot of things that hurt in front of the knee. So that's where we want to test them, when we test their function. We test a few different things to make sure that we're actually dealing with the tendon problem. Because you wouldn't treat a tendon, a patellar tendon, the same way you treat a meniscus tear. Even though both of them can hurt them in front of the knee. 

So it's really important to differentiate the two. But yeah, tendinopathy is the term we would describe this general condition. And tendinopthy again, it just means tendon pathology and it could be for the upper limb or the lower limb.

Mark: Yeah. Or your digits, even your toes, I guess there's tendons everywhere throughout her body. 

Iyad: Absolutely. And then the other thing that we can have a tendon pain is sometimes an inflammation of the outer cover of it, which is a little different. And in that case you would treat it completely differently because like we said, inflammation needs its own kind of management strategy. So that's where you know, we've all done extra training on treating tendon pain and that's where we were able to just differentiate what we're actually dealing with. Is this just a an irritation of something that's near the tendon? That's looking like a tendon, but not behaving like a tendon.

So that's where you need a little more sometimes help. Because the stock approach of just ice and rest doesn't seem to help. And if you do sometimes general exercise, some people will tell you, yeah, I tried this thing that I found online and it worked. And then you get the same for one-to-one where the other person says it didn't work. It actually made it a bit worse. So this is where knowing what you're dealing with is really important. 

Mark: Absolutely. So one of the things I know from weight training, and being coached in that, is that the tendon now, is this true or not? I guess it's the first question. The tendon takes longer to get strong than the muscle does. And so that's why you need to be careful with your training regime and increasing the load. 

Iyad: That's a great question and it's true. So tendons and bones and muscles and all of our structures actually adapt to load. That's what we know about now. So for example, when you have a power lifter lifting really, really heavy weights they are keeping in mind, not just that their muscles need to grow and adapt, but also like that their bones need to be able to handle maybe a thousand pounds on a squat.

So that's where we don't want, for example, people to develop fractures and stuff like that, just from lifting weights, which again will happen with the powerlifter group maybe. And yeah, the tendons are a completely different structure. So you would imagine that they don't respond the same way as muscles. Muscles seem to be the quickest adapting of all of them, but then that's also generally speaking, there's always an individual that just struggles with this. And it could be a bunch of other factors, but yeah, a tendon is different and it takes longer to adapt. And this is really important when we're trying to program somebody who's exercise routine, that we don't just spike their volume willy-nilly, because that's a great recipe for an injury.

Mark: And what about the treatment options? You mentioned, it seems like there's a lot of exercise that can be done. And that's important depending on what the tendinopathy is. What kind of exercise would that be typically. 

Iyad: So we start with a different, it depends on the person, first of all. So some people where it's primarily a pain dominant presentation where they just can't do anything because it hurts so much. We would start them really light and the exercise tends to have a pretty decent analgesic painkiller effect. So we could pick something appropriate to that person. 

We have lots of different exercise options that have been studied. And the good news is a lot of it works, but it works differently. So for example, it's not a one size fits all. And if you come and see me and you're like, Hey, I hurt at kilometre 10 of my run when I'm trying to train for my marathon, I'm not going to treat you the same as the person who can't just walk down the street. And that makes a lot of sense. So this is where we want to avoid protocolized doing this thing and just making it a cookie cutter recipe. 

The exercises, there's all a whole bunch of stuff where we just train sometimes the muscle at the beginning to make sure that the muscle that helps scaffold the tendon almost, is able to do its job properly and help the tendon.

And then there are tendons specific things where we would try to train that ability of the tendon to absorb energy and release it. And usually we will do that depending on the person's tolerance and function and where they are in their training history as well. 

Mark: Is that more of an eccentric exercise?

Iyad: So eccentrics are useful for the muscle primarily. They do work a bit on the tendon, but they're not enough to get the tendon to restore its elasticity. And the first training program that came out was by Dr. Alfredson who tried to use eccentrics to tear his own Achilles tendon. So you can get a surgery on it and in doing so he ended up helping his issue.

So that's how we kind of first delved into this. Because nobody wanted to operate on him. He had achilles tendon pain and it was hurting him a lot, but then nobody's going to operate on it and then it's not sore. And so he tried to do this really aggressive eccentric program. And then eccentric is when a muscle starts really short, then it has the contract as it's stretching out as it's stretching out.

So that's what he tried to do with lots and lots of reps and ended up helping his condition instead of tearing his tendon. So, which takes me to my other point is that this is the other issue where people get scared. You know, especially when you see videos of, for example like in the NBA where somebody is doing a crossover and their Achilles just snaps and it makes them very fearful of movement and fearful of putting actual stress through the tendon. But we know it's pretty safe. We know it's the way forward. As of yet, as of where are our evidence is.

Mark: Tendon pain. It's complicated. Basically you need an expert to make sure you're being treated in the appropriate way. Because is it tendinopathy? Is it something else? What's actually going on? And the experts at Insync Physio in North Burnaby can drill into exactly what's going on and prescribe a course of treatment that will get you better quickly. As quickly as possible. So you can book online at You can book at both locations. They have one in Vancouver as well. And the Cambie office is at (604) 566-9716. The North Burnaby office is (604) 298-4878. Thanks a lot Iyad. 

Iyad: Thanks Mark.

Heel Pain – Achilles Tendinopathy Isometric Holds

Start with one foot halfway off a step. Maintain your foot in a neutral position and hold this position for 10 seconds.

Relax your foot. Perform this exercise for 3 sets of 10 repetitions.

This is a great exercise in the acute or early stages of Achilles tendinopathy, a condition involving the overuse of the Achilles tendon. 

Heel Pain – Achilles Tendinopathy Eccentric Heel Drops

Start standing with both feet halfway off a step. Push through both of your big toes to lift your heels up as high as possible.

Remove the unaffected leg, and then slowly lower down the affected foot into full range below the level of the step. Bring back the unaffected leg and push through both feet once again, repeating the exercise.

Perform this exercise for 3 sets of 10 repetitions.

This is a great exercise in the later stages of Achilles tendinopathy which is a condition involving the overuse of the Achilles tendon. 

How to Recover from Achilles Tendinopathy

The Achilles tendon is the thickest tendon in the human body. It attaches the gastrocnemius and soleus muscles (together known as the triceps surae) as well as the plantaris muscle to the calcaneus bone (heel) of the ankle. These muscles combined allow for plantar flexion at the ankle and flexion of the knee.

Tendinopathy of the Achilles tendon refers to a condition that causes pain, swelling, or stiffness at the tendon connecting the muscles to the bone. Commonly found in athletes such as runners, overuse of the tendon, may result in microtrauma or repeated injuries to the Achilles tendon. Wearing improper footwear, having poor training or exercising techniques, making a sudden change to your training program, or exercising on hard surfaces may also cause minor injuries to this tendon. Pain and stiffness may develop gradually and are typically worse in the morning. Pain is generally worse after exercise, but may potentially arise during training. Overtime, symptoms may be so severe that individuals may be unable to carry out their usual daily activities.


Rehabilitation occurs quickly or over several months depending on the severity of the injury. Although pain may be present, expert clinicians and researchers recommend continuing daily activities within one’s pain tolerance. As complete rest should be avoided as much as possible.

In the early stages of Achilles tendinopathy, a treatment called iontophoresis may be used to reduce soreness and improve function. This treatment involves delivering a medicine (dexamethasone) to the painful area. Ice packs are also effective in reducing swelling. Apply ice pack wrapped in a towel or dry cloth to the affected area for 10 to 30 minutes at a time.

However, researchers have found that Achilles tendinopathy is often successfully treated with strength training guided by a physical therapist. Strength training relies on using one’s body weight with or without additional weight for resistance to load the tendon and associated muscles to strengthen the calf. Do exercises slowly to decrease pain, improve mobility, and return to normal functioning.

Try these exercises below:

1) Heel-raise: Stand with your feet a few inches apart. Raise up on to your tiptoes and lift the heels by using both legs. Then lower yourself down using the affected leg. Perform 3 sets of 15 repetitions twice per day. This exercise can also be performed seated in a chair.

2) Calf stretch: Stand a few steps away from a wall and place your hands at about eye level. Place the leg you want to stretch about a step behind the other leg and bend the knee of the front leg until you feel a stretch in the back leg. Remember to keep your heels planted. Hold this position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat twice per day.

3) Towel stretch: Sit with both knees straight on the ground and loop a towel around the affected foot. Gently pull on the towel until a comfortable stretch is felt in the calf. Hold position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat two to three times per day.

Check out these videos:

Strengthen the Calf Muscles with 1-Legged Squats:
Roll Out Stiff Calves:

Reference: J Orthop Sports Phys Ther 2018;48(5):427. doi:10.2519/jospt.2018.0506

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, & IMS.

10 Effective Home Remedies to Treat Achilles Tendon Pain

Have you hurt your Achilles tendon? Is that giving you terrible pain in your calf and restricting your movement? Achilles tendon pain might be a common issue, but can get complicated if ignored.

So, how can you treat this ailment? There are a number of excellent home remedies that can treat the pain very effectively! Here are 10 of them to try:

1. Castor Oil:

This plant-based oil is used for treating a number of ailments and problems, from stomach pains to dandruff and even wrinkles. Castor oil is also the oil of choice for treating Achilles tendon pain. How does the oil do so much? We know that castor oil is a triglyceride, which comprises of almost 90 percent ricinoleic acid, a potent anti-inflammatory agent. It is this acid in castor oil that relieves pain and inflammation of the Achilles tendon when applied to the affected areas.

2. Vitamin E Oil:

Vitamin E oil is a potent antioxidant. Vitamin E helps in relieving inflammation and pain by cleaning up free radicals from the body that cause pain. The oil also supports circulatory function, which helps to relieve soreness and inflammation.

3. Turmeric:

Turmeric, as we know, is a wonder spice. It is an excellent remedy for Achilles tendon pain because of the presence of curcumin. Scientific community is united in proclaiming that curcumin is one of the best natural painkillers available.

Last year, the European Journal of Pharmacologypublished a paper that explained how curcumin works as a painkiller. According to it, curcumin reduces pain by activating the opioid system that is linked to our body’s pain-relieving response. Curcumin also serves as an anti-inflammatory.

You can reap the pain-relieving benefits of turmeric by using it as a tincture or as turmeric tea or even garnishing your dishes using this super spice. Other ways of using turmeric are making a turmeric poultice and applying it to your painful Achilles tendon to encourage circulation and reduce swelling.

4. Resting The Affected Leg:

Achilles tendon injuries are mostly caused due to overuse. So, proper rest is an effective self-care technique for reducing Achilles tendon pain. Give your Achilles tendon some rest and avoid activities like climbing stairs, running and even walking about too much that strain the tendon. We would suggest that you switch to swimming for exercise. Have patience though, as Achilles tendon pain takes anything between days to weeks and even months to heal.

5. Icing To Bring Down Pain:

Application of ice packs for a duration of 20 minutes brings down Achilles pain substantially. This works by reducing the blood flow thereby bringing down the pain almost instantaneously.

6. Gentle Massage:

Massage the affected area as it increases blood circulation and decreases the pain. We also suggest that you do gentle stretches and strengthening exercises to heal. Calf stretches work the best.

7. Avoid Tobacco:

Smoking slows down healing by decreasing the blood supply to the affected tissues and delays tissue repair. This means that you will have to bear the tendon pain longer. So stop smoking tobacco products.

8. Wear Protective Footwear:

We suggest that you go for athletic shoes that support the arch of your affected foot and cushion the heel. This shoe gives a chance for the Achilles tendon to heal. Silicone heel pads are also a good option as these reduce the pressure on the Achilles tendon. These are not home remedies as such but some of the ways in which you can stem Achilles pain.

9. Use A Bandage To Keep Your Affected Foot Flexed:

This will restrict the movement of the Achilles tendon, thus reducing pain. You can also use the bandage when you are sleeping as it will stop involuntary movements of your foot which can increase Achilles tendon pain.

10. Use A Night Brace While Sleeping:

This will prevent your tendon from shortening and stiffening while you sleep. The Achilles tendon will get optimum rest this way while you are sleeping, making sure that you experience less pain and stiffness in your calf and heel during daytime.

These are the effective home remedies for Achilles tendon pain. We also suggest that you lose weight if you are overweight, to stop repeated Achilles tendon injuries. Do let us know if our suggestions have helped you in reducing Achilles tendon pain. Feel free to post comments in the section below!

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, & IMS.