Insertional achilles tendinopathy / tendonitis | Achilles Rehabilitation / Treatment
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- čas přidán 16. 07. 2018
- A quick video looking at some theories, behind Achilles Rehabilitation.
Including some do's and don'ts, as the treatment for insertional Achilles tendinopathy is different from mid portion tendinopathy
We also cover this in the Nk Active Lunch Club...
nkactive.co.uk/nk-active-lunc...
Thanks for watching and always #MoveForward
Nick and the NK Active team…
PS thanks for watching - Insertional achilles tendinopathy / tendonitis | Achilles Rehabilitation
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I had a partial tear of my ATFL and developed a throbbing pain where my Achilles meets the heel. Glad I was able to find this and figure out what the pain actually was. I assume it was because I had my ankle wrapped while I'm healing my injury these past 10 weeks.
Glad it was helpful
Thank you for this video and explanation. I had to cut back on my trail running due to this issue, but rest alone hasn't done the trick. Now that I know the proper exercises, I have hope. My ultra days are over, but would still like to make some miles.
Yes, unfortunately rest can be helpful in the short term, however does not do you any favours long-term, if you can get the right treatment strategy in place and there is always a chance of returning back to ultrarunning
I hope you're advice will help with my current Achilles problem on both legs. Thanks for the video!
No worries and good luck
Hi, great video ! You mentioned posting a link to seated calf raise video ? Do you have the link please I can’t see it.
Thanks. Yes of course the old link doesn't seem to work any more.
czcams.com/video/FiT6tbCwRwE/video.html
It is you don't have a seat calf raise machine you can use a barbell.
czcams.com/video/jv-HynNCmjw/video.html
I developed this from arthritis in 2021, it's 2023 and it is still enlarged and sore. Much better, but not 'normal'
Thanks Elle, yes it will likely be enlarged going forward, however keep up with the exercises and load management and this can help reduce the risk of it been problematic in the future
I developed this condition after doing a lot of treadmill running during the winter. Looking back I realize I was losing strength in my calf as treadmill running does not require a push-off from the ground to move forward. Even with the incline cranked up to 7% it kept getting worse. Still have pain in my left heel, but it is definitely better than it used to be. Heel raises and actual "running to cover distance" got my calf muscles back and I do not mess around with treadmills anymore.
Glad you are back to running, keep up the strength work, that is key !
Treadmill is the same thing as running on ground. Does require push off
@@latortugapicante719 It does require pushing upward, but you push backward at the same speed as the tread is spinning so there is no force parallel to the tread and you stay stationary. If you push back faster than the spinning tread you would run into the front of the machine.
Running on the ground is different because the force applied backward is against a stationary surface, which causes forward motion relative to the surface. And you have to keep applying that force to stay in motion.
@@jamietodd2560R u completely Ok now
???
If yes
Please give me some tips
And how much time it took to recover?????
@@Priyan0000 stretching and massage of the Achilles tendon helped ease the pain but it never seemed to get rid of the problem. I started doing exercises to strengthen my ankles. The CZcams channel kneesovertoesguy has a bunch of exercises that’ll help, especially walking backwards to help strengthen ankles and knees.
Hi, many thanks for the video. I had luck to catch this very early and avoided running through it at all. I'm used to low-drop shoes, and could only notice the pain twice in a pair of 0mm shoes. I've therefore been running in 5mm-drop shoes and everything is fine - no pain at all. Nonetheless, if I press the insertion area when at rest I can still feel discomfort or very light pain. I want to progress to my 3mm and 0mm shoes but not sure how to do it safely. I've been doing isometric (standing) calf raises progressing from 10x30s, 5x1min, and now 3x2min three or four times a week. Probly will incorporate the seated calf raises as you advise. Many thanks again!
Manuel Torres Sahli yes seated calf raises are key and make any changes to footwear gradually
Any luck?
Hi Nick , thanks for your excellent video , does might splint help with IAT? also is massaging the gastroc with massage gun helpful ?
HI Hamed, A night splint, massage or massage gun do not tend to offer any long term benefits, some people may find it helpful in short term (and not in the acute stage as that will just hurt) however long term it is strength work and load management with education is key. Nick
Can you make video on subcutaneous bursitis and treating confusion on insertional tendon and bursitis on insertion point. thanks..
Yes we can do
Would you apply the tendinopathy continuum to insertional Achilles tendinopathy? If so would you exclude any exercises you recommended in the reactive phase?
Have you taken antibiotics? I have and have IAT
Nick, would you recommend doing the seated calf raise exercise with single leg or both legs? Or a mix/combination? I'm asking because my left leg (affected with IAT) soleus is noticeably weaker than my right (unaffected) leg. Thanks. Great video!
Hi Jeff, I work on single leg if possible, bring the strength of the weaker side up to the other side. Doing heavy slow loading if possible. Then do mix of double and single and play around with the speed as well. Good luck
R u ok now
Well Nick I sincerely apologize for the comments of my fellow countryman regarding your accent. He would be advised to do what I have done. I watched your fantastic video several times and now I have it. Thank you, I will follow your astute advice. My current problem is that now my wife cannot understand me because I speak with your accent. Do you have a video that will address my problem? All humor aside I really appreciated your video thank you.
Glad it is helpful, sorry CZcams not done a translate service for accents 😀 glad you found it helpful
Hey Nick, very informative video. I am at the stage where I can run moderately for 5minutes on a treadmill before taking a break. I still don’t have the strength to jump without pain, although there is none to minimal pain when I am putting dorsiflexing my foot (no weights). Do I need to start doing heel drops and seated calf raises that go below floor level? at what point is it appropriate to start loading and compressing the tendon in dorsiflexion, or is the road to full recovery to do plyometrics without dorsiflexion?
Hi Glen great question, there is no hard and fast rule when it is best to start dorsiflexion work, is it needed? in my opinion yes as running includes dorsiflexion so the rehab needs to include that. However personally I like my patients to have but up a good amount of calf strength first so weight calf raises with limited doors flexion (seated and standing) then once strength improved and symptoms settling, however the person helping you with this journey should be able to guide you with this. but end aim is plyometrics that include dorsiflexion and graded return to activity
Im a runner and Ive had this for nearly 2 years, as soon as i start training hard for a race is flares up again. Ive finally found something that makes it go away. I go to the gym and do Deadlifts, squats etc and the discomfort disappears.
Once strength is built up look at building calf and single leg strength then adding in plyometrics which is the posh word for jumping around, this helps to improve the elasticity back within the tendon, so it can’t get ready for repetitive continuous loading activities like running, if you just build basic strength, and then look at incorporating exercises into the rehab process that the tendon is going to do during your sporting activities things tend flareup
Thank you Nick for ur golden words . I have a mild insertional injury . It's been more than 5 weeks . Everything is normal . But a slight pain is there when I press the end of achellis tendon . Should I start rehab exercise or wait for few more weeks . Plz advice
Firstly my advice is to have a consultation with a health care professional. Though I wouldn’t worry about pain on pushing too much. Pain when doing activity is more of an indication. Also always working on improving strength in general is not a bad thing at all
Hi Nick, thanks for the explanation in the vid. I ran the whole of cross country season with a heel/achilles issue but managed the pain to the close of the season. Went to the physio in Feb and was diagnosed with insertional Achilles tendinopathy. So far I've taken the load off completely (6 weeks no running at present), currently doing all my training on the bike and complete 3x15 heel raises daily (just the eccentric phase at the moment). I've only seen a slight improvement in the pain when pressing on the area in the last week or so. Is there anything else that could speed up recovery, I was originally icing everyday but can't say it made much difference and I'm wondering whether heat therapy my help with the healing process. Is it a case of just being patient, I've seen you've previously commented that it takes 3 months? Any further info would be appreciated, thanks
Jack Hope hi Jack, shockwave therapy can be helpful. I would focus on seated calf raise to strengthen soleus. Don’t worry about pain on palpation, pain on running and stiffness in the morning is more important. Makes sure you are regularly increasing the weight on the heel raises and seated calf raise. Good luck
Hey man -
About 2 weeks ago I had a tingling sensation shoot up my calf during a trail run. I didn't think much of it and kept running/exercising through the week. The following week, I noticed a similar tingling/burning sensation whenever I pulled my foot up to stretch my calf so I decided to hold off on running for a couple of days. Yesterday, I decided to try doing some lower body work outs as to not fall too behind in my training regiment and after doing some Romanian split squats, I feel like the sensations may have traveled up into the mid portion of my achilles tendon and mid calf area. Is this something you've seen before? And what do you recommend I do to treat it?
It should be noted that the injury isn't debilitating in any respect and I only feel it when pulling my foot up to stretch my calf.
Thanks for the message. Sounds more like a possible nerve irritation with the tingling pain. Need to work out is tibial nerve and coming from the foot area or is is coming from the back. Recommendation is to get someone to look at it, so they can get a diagnosis, if it is nerve irritation some times it is just time and settle on it’s own. Sometimes stretching or an injection.
What do you recommend if which i do you got it in both the insertional and mid portion bit on same foot? stupidly used the mid portion eccentric exercise to try sort a insert tendonosis i've had for 10 odd years off and on, and now i've ended up with abit of irritation in the mid bit too. Did alot wrong with the mid p exercise and was doing too much too often. Was thinking maybe i rest it for like 4-6weeks do the insertional eccentrics for like 3-6 months then move onto the mid portion eccentrics depending but not stressing it as much as i was doing, what do you reckon? cheers.
Hi James, I would look to start on managing the insertional first, however if you are suffering with both , I would speak professional help to manage and progress the programme to try and prevent and irritation at the insertion
Thanks Nick for this video. I am suffering from Insertional Achilles Tendinitis in my right leg. To summarise you recommend heel raise excercises and not heel drops. Please confirm. Thanks.
Somessh Bahuguna correct yes
Somessh Bahuguna I think you can heel drop but dont drop below the underside of feet. By doing it on the floor is the way to go.
R u ok now🥺🥺
Or still suffering🥺🥺??????
@@Priyan0000 completely recovered but I am always careful with that foot. Warm up, cool down and stretching is the key।
Do you recommend accupunture or shock wave therapy for this condition? Mine started mid tendon and went down, though I've had mid tendon on/off for years. This insertional is much worse, my ankle mobility is poor and I'm hobbling. So upset cos I love my running. Now walking and jogging a bit, alternate days. Not sure if this delays the recovery?
Thanks for the message, I would recommend shockwave, however only along side a loading and education programe, shockwave can help settle the pain, however the education and loading exercises are the key part. Key is pain less than 4/10, if pain is above that then that is sign you are overloading it
R u ok now????? Please reply🥺
Thanks a lot, could you plz tell the difference between insertional achilles tendonitis and retrocalcaneal bursitis..I have this pain on back of my both heels which are tender to touch on plantarflexed position at a point and its been chronic..also the 1st morning pain under the heel bothers too..what can be the diagnosis..thanks .
Retro calc bursitis tends to be slightly higher up just above the calcaneal bone. You also don’t tend to get the morning stiffness with retrocalc bursitis. Plantar flexion of the foot would aggravate the retrocalc bursitis. It is possible to have both pathologies existing at once.
@@NKActiveClinics Thanks
@@sandeepshukla745R u ok now????
Please reply🥺
Literally been suffering from this for 30 years
I always explain that once we have an tendinopathy we can settle the sympotms however need to keep nice and strong going forward to help reduce the risk of it coming back, so you think of it as it is a constent managment, hope your symptoms not causing you too many issues
hi. so what volume do you suggest for the heel rasies, how many sets? once pre day or multiple times? what about rest days? should the movoment be done slow or explosive? thanks.
Hi SumanutiLudjak, thanks for the questions, It depends on a number of factors, which method of landing you are using and stage of rehabilitation. If you using the heavy slow method, this is normally around 8 reps, 3-4 sets however only 3 times a week, this requires heavy load, so access to weights. If you are looking at more traditional ways, then you may look at 10-15 reps x 3 sets x 4-5 times a day, with a slow tempo still and that would be done daily, it is important to remember that all the exercises need to be a around 7/10 on the effect scale (0 no effect 10 max effort) at the end of rehab and return to play you want fast paced exercises, high reps and no weight (this is your plyometrics) However all programmes need to be monitored by a health care professional so they can make sure you are doing the right exercises and volume for you as we are all different.
Thanks a lot for the answer Nick.
I think it was an overuse injury a few years back that wasn't healing. When I finaly checked it out they diagnosed insertional achilles tendinopaty with haglund's deformity and had me doing some generic physical therapy for a while that contained a lot of streching and high rep strenghtening, again with a streching component. It did not help.
A year or so passed since then. Tendons are still stiff in the mornings and can get inflamed if I stand a lot during the day or do sports for too long. Btw I'm 35 years old, 2 meters tall, 100 kgs.
I have acces to weights so I figure i could try the slow and heavy method to see If I can get some improvement.
Can you tell me how long does that protocol take on average and how often do I add more weights? Do you have a link to any resources I could read?
No Worries, I would have a look at the work by Seth O'neil, Insertional Tendon issues can be pain to manage, try and avoid stretching, do the strengthening and get an medical professional to have a look at it again, if you are based in the UK I can offer a recommendation, thanks
Thanks, I'll check it out. I'm not in the UK and I don't think I can get adequate medical help here. I'll try to fix it myself.
Where are you based, try the exercises and add a heel raise in the trainers
I have been on crutches for almost a week and just stared doing some rehab. Still can't walk on it without significant pain. Is it usual to not walk on the hurting foot at all for that amount of time?
Yes this is, rehab journey will be at least 3-5 months
Brilliant synopsis of rehab and the goals there Nick, i understand it so much better now,thank you for doing that :) #pottypurplepod xx
Lane Ends Podiatry glad it was helpful, if you need anymore let me know
will do, what I like about your videos is that they explain things in language people can understand and relate to. They are also great for sharing with patients, so thank you for doing that. Have you done any on peroneal tendinopathy rehabilitation yet?
I was out on a run and felt a dull cramp in my lower calf and my achilles felt tight but not painful so i walked home. In the mornings now i feel tightness close to the heel bone and i feel a 2/10 pain in my lower achilles if i try a short run. When i press the area where the tendon attaches to the heel bone i can feel it is sore as well as a kind of liquid bubbles under the skin. I can do 100 star jumps pain free, 100 burpees pain free, i can hop on the spot pain free etc. I am doing the floor calf raises and will start doing the seated calf raises - i hope this will cure my issue for my running.
The question is how are you the afternoon / morning after burpees etc. try the seated calf raises. Also don’t worry about the pain that is 2/10, you can keep on running and that can settle on it’s own. If things don’t settle, maybe worth seeing if there is a retrocalcaneal bursa present
there's no increase in pain or stiffness after these exercises so I figure it's ok, it's really just the running that doesnt feel right and i can feel the mild pain during. Thanks, i will give the strengthening a go and see a specialist if it doesnt resolve.@@NKActiveClinics
Your video is good. I am dealing with insertional achilles tendonitis since 2017. How long it will take to recover. Can i play football again or i should quit. Take rest about 6 months. But it reoccurre within 3 days
If suffering with since 2017 that would
Suggest the treatment hasn’t been the right one for you so far Or not pushed hard enough during the rehab process. Unfortunately rest doesn’t do you any favours long time. Insertional Achilles tendinopathy takes around 4-6 months to settle ( providing there is no other medical reasons why it may not settle )
Hi Nick..just found your page..I've been desperately searching for help..I'm a football player and I've been diagnosed with insertional achilles tendonitis...for 3 years now...if i train once in the day I'm limping for 2 days I'm frustrated and on the occasion i get kicks on the spot in matches i guess it makes it worse pls help me with a guideline on what to do. The rehab specialist i visit doesn't seem to be so experienced
meli henry thanks for the message. It is important to speak to your person doing the rehab about load management and how much you are training and playing as this may need to be adjusted, in my experience most of time people are not using heavy enough weight during rehab. However I have not assessed your foot so advise is always speak to the person doing the rehab. Also I tend to put a heel raise in the football boots. Hope that helps
@@NKActiveClinics thanks a lot..if i do these exercises how long would it take before i see results and do i expect the pain to stop completely or would it permit me to train everyday with an acceptable degreee of comfort
meli henry everyone is different, and difficult to say with out assessing you. But at least 3 months normally
@@NKActiveClinicsR u ok now??
Or still suffering🥺
I have this injury... I cannot run nor jump, play basketball anymore.. The pain is just unbearable doing such activities
Sorry to hear this, most will recover from this, just need to make sure the treatment is right and progressive and keep in contact with the person helping treat it
R u ok now
Please reply???
Hi Nick i justo Gor injured Aquiles insertion one week ago , why should i do after start rehab and when it would ve a good time to start rehab??
Hi Andrew, my advice would be to start the rehab straight away. My advice also is make sure you are seeing a health care profession virtually or face to face to help progress it forward and to find out your starting point as it is different for everyone. General rule of thumb quicker you start the rehab the quicker you get back to activity.
@@NKActiveClinics thanks for quicl response ,You mention You Will ve worrried about stiffness in the morning what Will that means ??? Do You offer virtual consultant ? I couldnt find any relayable profesional where i live how can i contact You?
@@andrewbrown2976 No worries, morning Stiffness means you are overloading it ie doing too much on it.
Yes I do offer online appointments
nk-sports-podiatry.cliniko.com/bookings?practitioner_id=53034&appointment_type_id=449327
Or one of my team members
nk-sports-podiatry.cliniko.com/bookings?practitioner_id=105489&appointment_type_id=449350
Thanks,
Nick
@@NKActiveClinics can i do My normal activities like walk been stand up for short periods like i'm the work Even ir if hurts sometimes
@@andrewbrown2976 we tend to work on the guidelines of pain 4/10 or less is ok, we try not to go above those pain levels
so calf raises without going into dorsi flexion are the only treatment?
Hi Inoc, not the only treatment, however it is the key and most important exercise. They key is to load the tendon and avoid compression of the tendon, this is why you don't go into doors flexion. on return to sport / exercise if required you can do full heel raise and drop if needed, however you need to make sure that the tendon and foot can cope with this
@@NKActiveClinics Thanks for clarifying that. How about straight leg vs bent knee calf raises, or isometric holds? Is it worth doing both or only straight leg? I realize they work different muscles.. Are any stretches recommended? I also realize you don't want to stretch the tendon by going into dorsi flexion on the first stages of rehab.
@@inoculati0n they work different muscles. Bent knee works on soleus and straight more gastrocnemius. I think soleus is forgotten about and very important. Isometrics some people find helpful, others don’t. If you can tolerate doing concentric exercises then do them, if you can’t start with isometrics. Stretching as you say avoid this, once symptoms have settled you can start again if you like / need to.
As always my advice is if you are struggling and symptoms are not settling always get an appointment with a health care professional.
I'm 5 months into this insertional Achilles tendinitis issue and I still feel it flare up after some physical therapy (single leg heel raises, balance workouts, etc.) But I have gotten better forsure. When is it OK for me to start doing fast twitch workouts like running jumping etc? Should do it anyway to test myself out? Or would that be risking further injury to the Achilles because it does still flare up on me here and there but nothing too drastic
This should be discussed with your physical therapist. However for us in clinic once someone has built up their Strength, we then start testing with some single leg hops and see how it reacts then progress forward. We are happy for pain to be 4/10 during or after. You have to test and progress at some point.
@@NKActiveClinics thank you!
@@abualzuareeR u completely Ok now
???
If yes
Please give me some tips
And how much time it took to recover?????
@decent_learner I'm about 90% now. Never fully recovered but alot better than last year. I'd say after month 12, I was pain free but it does bother me once in a while if I train my calves and get sore for a few days.
@@Priyan0000 I recommend swimming. That's what helped me recover.
I have a little bit of scar tissue in my heel. But mostly in the mid portion achilles. Do I start by heel dips on the floor and progress to a step? Or would I alternate exercises? Any suggestions would be awesome! Thanks in advance.
if it is a midpprtion injury then heel drops are. good place to start, if there has been previous insertional injuries just be careful
Hi Jeff, m suffering from insernational achilles tendon from last 5 months.. the pain is coming back again n again.. and m not able to walk on flat sleepers, m using 1 inch heels. Plzz suggest me some treatment
Hi Jyoti, sorry without a full history we can't recommend specific treatment for you, however, the general advice is to work on calf strength, try some calf raises and keep using the shoes with a heel. The biggest bit of advice is to get a plan that you can follow and overcomes barriers that you have.
@@NKActiveClinics Thanks alot, I will do the same
@@jyotivishwakarma5101Heyy Jyoti
R u ok now or Still suffering🥺🥺
Actually I m suffering from this right now
Please reply
R u Fully healed ??????
@@Priyan0000 m not fully healed still suffering
How much percent U get relieve by this ??????
🥺🥺
hello can i still run in this injury
Yes, we try and work on if pain 4/10 or lower then ok to keep running, if above 5/10 then maybe back off, work on treatment and then get back to running
Which shoes is better for inserional tendinopathy.... High heel or flat footed shoes
Higher heel
Hi
Hi
and the seated calf raise exercise
facebook.com/NKSportsPodiatry/videos/1087771101373646/
Mine looks like I have 2 heels on my right Achilles
I walk an average of 50 to 51 hours per week.
@@stoniegadg3t-music345 Do you mean a 2nd bump on the back?
How in the hell can anyone understand these brits, have to leave
and my accent isn't even that strong, you want to hear the Scottish or people from Birmingham speak
Yo Momma yes sorry just trying a new Bluetooth mic and it wasn’t great. Have a rode mic and zoom voice recorder now
That is such a rude thing to say! Also i am American and was able to understand everything that was said completely
Vince Andrews - You Knob! (Spoken with a strong British accent)