Achilles Tendinopathy

Achilles Tendinopathy

What is Achilles Tendinopathy?

(Aliases: Achilles tendonitis, Achilles tendinitis, Achilles tendon pain, Achilles tendinosis, Achilles tendinopathy)

Most health experts now use the term Achilles tendinopathy to include both inflammation (tendonitis) and other Achilles tendon pathologies.

But many people may still use the term tendonitis out of habit.

Achilles Tendinopathy is usually an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that require the same repetitive work.

What Causes Tendon Pain?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually, it is the result of many tiny tears to the tendon that have occurred over time. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendonitis (or Tendinitis): This means “inflammation of the tendon,” but inflammation is rarely the cause of your tendon pain.

Tendinosis: This refers to tiny tears in the tissue in and around the tendon caused by overuse.

What Causes Achilles Tendinopathy?

Achilles tendinopathy is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that require the same repetitive work.

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has weakened over time.

Common Causes of Achilles Tendonitis include:

  • Over-training or unaccustomed use – “too much too soon.”
  • Excessive intensity or Distance increase
  • Change in training surface – e.g. grass to bitumen
  • Lack of training variation
  • Poorly supportive footwear.
  • Hill running.

Achilles Tendinopathy Risk Factors

  • Gender: Men > Women
  • Age: >30 most common
  • Weight: Higher body weight increases risk
  • Diabetes
  • Calf Muscle: weakness, poor endurance &/or tightness
  • Poor Lower Limb Muscle Control: e.g. Poor hip and knee muscle control
  • Stiff Ankle/Foot Joints

What are the Symptoms of Achilles Tendinopathy?

Achilles tendinopathy may commence as a burning pain at the beginning of an activity, which gets less during the event and then worsens following the event. The tendon may feel stiffness first thing in the morning or at the beginning of some exercise.

  • Achilles tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use your Achilles tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • Your Achilles may be tender, red, warm, or a swollen lump on the Achilles tendon.
  • Variable pain. Achilles pain can vary significantly depending upon your exercise load.

How is Achilles Tendinopathy Diagnosed?

Achilles tendinopathy is one of many causes of lower calf or heel pain. The correct diagnosis is vital to your treatment plan and recovery! Please seek the professional opinion of your trusted physiotherapist or sports doctor. They will base their determination on your history, symptom behaviour and clinical tests. You will rarely require diagnostic imaging in most cases of Achilles tendinopathy. In some cases, an MRI or diagnostic ultrasound may be recommended by your health practitioner in refractory cases. Achilles tendons will often have a painful and prominent lump within the tendon.

Tendinopathy Phases

Tendinopathy is a continuum of pathological processes, and your treatment plan progresses by correct identification of the current phase of injury and the application of appropriate exercise in the rehabilitation of your injury. Inappropriate loading may delay your recovery and your return to sport.

Identification of the phase helps to identify an entry point for your rehabilitation and how much you can perform in your recovery and balancing your activity levels in your rehabilitation plan.

It is crucial to have your tendinopathy professionally assessed to identify your injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment since specific modalities or exercises should only be applied or undertaken in distinct tendon healing phases.

Please seek the advice of your trusted physiotherapist with a particular interest in Achilles tendinopathy.

Achilles Tendinopathy Treatment

Achilles tendinopathy treatment varies significantly from how we treated the condition just a few years ago. Researchers are continually updating their treatment recommendations. Based upon that, our Achilles tendinopathy treatment protocols we regularly upgrade to the latest research-supported versions.

Achilles tendinopathy treatment can become complicated due to the high level of recurrence and patient variables. Achilles treatment also varies depending upon where you are within the tendon injury phase continuum as outlined above. The secret to a quick path to success is correctly assessing which phase you are currently and prescribe the appropriate exercises and advise suitable for that phase. That’s exactly where the support of an up-to-date Achilles physiotherapist can fast-track your rehabilitation success.

How is Your Rehabilitation Progress Monitored?

Your physiotherapist is highly skilled in the management of Achilles tendinopathy. They aim to guide you towards a return to sport safely. Among other tests, your physiotherapist will use your pain provocation tests, strength measures, and functional activities as a useful tool to monitor your pain, function and when to progress exercises or return to sport.

They’ll also be happy to discuss your injury rehabilitation with your coach.

How Do You Treat Achilles Tendinopathy?

Achilles tendinopathy treatment has progressed significantly in recent years. It is essential to ensure that an up-to-date Achilles tendinopathy physiotherapist treats you.

Exercise!

There is increasing importance in exercise in the management of tendinopathy. Isometric exercise, or exercise that the joint angle and muscle length do not change during use have proven effects at pain relief for athletes suffering from tendinopathy.

How Does Your Physiotherapist Progress Your Treatment?

Tendinopathy treatment is progressed based on your tendon’s ability to withstand your exercises load. For most athletes, we can the traffic light system is utilised to define how much training is too much clearly.

Red will indicate that you need to reduce your exercise load. Amber suggests that you can exercise at current loads. Green indicates that you can safely increase your exercise loads.

Your physiotherapist will explain how to interpret your symptoms and plan your exercise loads based upon their assessment and your symptoms.

Managing Your Activity Load is a Priority!

Exercise load monitoring is crucial to the success of your Achilles tendinopathy. Mild load increases will stimulate new tendon growth. In contrast, overload leads to tendinopathy deterioration.

Reduce the load to a level that allows the tendon to recover. In severe cases, this may mean total rest from your sport or modifying training depending on the severity of tendinopathy. Discuss your activity load with your physiotherapist, who will plan and adjust your program accordingly, based upon your pain provocation tests, traffic light response to activity and other symptoms.

When managing load, you should be guided by how the tendon responds not just immediately but also 24 hours later. Tendons are known to have a latent response to loading. This latency means they can take 24 hours or more to react. It is essential to modify your activity to remain pain-free during and for following 24 to 48 hours.

For more specific information, please discuss your Achilles tendinopathy with your physiotherapist.

How Long Does it take for Achilles Tendinopathy to Heal?

If you identify your Achilles tendon injury in the early stages, then load management and reduction will allow the tendon time to adapt and quickly recover. The reactive stage can be relatively short. Pain may settle in 5 to 10 days, but the tendon will still be sensitive to high loads, and training needs gradual progression to prevent relapse. It mustn’t progress into late-stage two or stage 3 tendinopathy. These tendinopathies require additional time and rehabilitation.

A likely return to sport is in the order of 12 weeks. However, everyone is very different!

There is no specific time frame for when to progress from each stage to the next. Many factors will determine your Achilles tendonitis rehabilitation status during your physiotherapist’s clinical assessment and reviews. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression requires carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. The severity of your tendon injury, your compliance with treatment, and the workload that you need to return to will ultimately determine how long your injury takes to rehabilitate successfully.

When Will Your Achilles Tendinopathy Heal?

Some practitioners suggest that the prognosis with guided treatment can be summed up by the tendinopathy phase:

  • Phase I: days
  • Phase II: weeks
  • Phase III: months
  • Phase IV: years

Exercises to Avoid with Achilles Tendinopathy

Avoid exercises that provoke your pain such as running up hills or stairs, sprinting, jumping, hopping and deep squats until advised otherwise by your physiotherapist.

Massage, Foam Rollers & Stretches

Massage or foam rollers can release your calves, shins, quadriceps, ITB, and hamstrings, may assist in cases of Achilles tendinopathy. You can perform these in positions that avoid ankle hyperdorsiflexion. Ask your physiotherapist for specific advice.

Eccentric Strengthening

Eccentric exercises were for many years the “go-to” exercises for tendinopathy rehabilitation. While important, premature or overloaded eccentric exercises can delay your recovery. Your physiotherapist will guide you when appropriate. They aim to commence strengthening that does not aggravate your Achilles tendinopathy. They may start you with isometrics that avoid tendon compression and progress from there towards a basic and then advance eccentric exercise program.

Adjacent Joints & Lower Limb Biomechanics

Researchers have identified several lower limb biomechanical issues may predispose you to Achilles tendinopathy. Your physiotherapist will individually assess you. Tests may include your ankle dorsiflexion, single-leg squat alignment and control, gluteal control, hip/knee bend ratio and running and landing technique. They’ll advise you if you require some treatment to address any deficiencies.

Other Treatments

Novel therapies such as the injection of sclerosing agents, platelet-derived growth factor (PDGF), and autologous blood into diseased tendons, have shown potentially promising results. However, more clinical trials are needed, so it is still considered experimental at this time. Your physiotherapist is happy to discuss these options with you when they find them an appropriate treatment option.

Remember, all tendinopathies are different. Please seek the advice of your Achilles tendinopathy physiotherapist. They will assist you in determining the best rehabilitation appropriate to your tendinopathy.

Can Your Achilles Tendon Rupture?

The worst-case scenario is a total rupture of your Achilles tendon, which occurs when tendon cell death occurs, and the tendon strength is insufficient. Treatment, in this case, may require surgery, plaster or a wedged walking boot for at least six weeks. Most of these injuries take six months or more to rehabilitate adequately, so avoiding Achilles tendon rupture remains the best option.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

More info about Achilles tendon rupture.

FAQs about Achilles Tendinopathy

Sports Injury Management

You probably already know that a sports injury can not only affect your performance, but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary greatly to how we treat you this year. The good news is that you can benefit significantly from our knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving or other problems will develop.

Ice or Heat?

We normally recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, heat packs  can be used. We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to specifically discuss your situation.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the bandage will also help to support the injury as the new scar tissue is laid down. This should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is very helpful, especially for ankle or hand injuries.  Think where your injury is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain drugs can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

In most cases, "the early bird gets the worm".  Researchers have found that intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you do return to sport - we'll detect and help you to correct any biomechanical faults that may be affecting your technique or predisposing you to injury

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally there are four main reasons why you develop arthritis:

  • Previous injury that was inappropriately treated (eg old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, simply ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, they'll also refer you elsewhere if that's what's best for you. Think about it. you could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker . and for a lot longer.

If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

Planning on running a marathon, half marathon, participating in a charity run or just running for fun? Dreading the post-exercise soreness and fatigue? When you push your body to perform intense exercise or exercise it may be unaccustomed to, it is beneficial to know what to do to assist recovery after the event.Here are six tips to assist you in recovering after a running event.

1. Post-Run Nutrition

After exercise it is paramount you replenish the energy stores (glycogen/carbohydrates, electrolytes and protein) and fluid stores you lost during activity. This will assist the body in recovery from intense exercise and assist your immune system damaged by the exercise.

Carbohydrates

Within the first-hour post-exercise, when glycogen synthesis is highest, it is advised to consume a carbohydrate rich snack/meal which provides 1-1.2g of carbohydrate per 1kg of body weight.

Protein

Intense exercise causes a breakdown in muscle tissue. Protein is used to restore tissue and assist muscle adaptation. Essential amino acids from high-quality protein rich foods in the hour post exercise is recommended to promote protein rebuilding. 10-20g of protein in the first-hour post exercise is recommended.

Rehydration

It is essential to replace the fluid lost during exercise. To ensure proper rehydration electrolytes, particularly sodium, lost through sweat are required. Sodium assists to reduce urine loss and therefore increased fluid balance post exercise. It is recommended to weigh yourself before and after your race. A guideline to fluid replacement is 1L for every 1kg lost during the event.More info: Sports Dietitian

2. Cool Down Exercise

Low-intensity exercise can assist in removing lactic acid build up and promote blood flow to relieve tight and sore muscles. This can be performed as a light jog or walk after your event or the day following. This can be followed by a brief 5 to 15-min period of stretching to assist with tight muscles.More info:
  • 4 Reasons to do a Cool Down

3. Soft Tissue Recovery

Ways to assist soft tissue recovery at home include foam rolling and wearing compression garments. Foam rolling can be used on the back, ITB, hamstrings, quads and calves. It is recommended to spend 2x 1minute intervals on each area. Compression garments are recommended to be worn for 24hrs post exercise. Both techniques can assist in reducing post-exercise muscle soreness and may enhance recovery of muscle performance.More info: Foam Rollers

4. Recovery Massage

A post-run recovery massage can reduce excessive post-exercise muscle tone, increase muscle range of motion, increasing circulation and nutrition to damaged tissue, and deactivate symptomatic trigger point, reduced post-exercise soreness and delayed onset muscle soreness (DOMS). Soft tissue therapy has also been said to aid in psychological recovery alongside music, warm baths and showers to enhance muscle relaxation and allow recovery.More info: Recovery Massage

5. Ice

There is often debate whether ice baths (cold water immersion) is beneficial after exercise. In regards to running, ice helps to decrease inflammation resulting from an intense activity. This can help to decrease post activity muscle soreness.The day after intense activity, heat can be used to help relax tight muscles. Heat also promotes blood flow to an area, which can promote the recovery of lactic acid build up.More info: Ice therapy

6. Sleep

A good night’s sleep consisting of around 8 hours is important for muscle recovery among other biological functions. As mentioned above compression garments can be worn to bed to further assist with recovery. A good night’s sleep can be achieved by ensuring the room is cool, dark and quiet, and free of electronic distractions. Ideally one should have a well-developed sleep routine that consists of the aforementioned strategies and avoids caffeine and excessive fluid intake before bed.
Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies being referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies so the medical community now refers to them as tendinopathies.Typically, tendon injuries occur in three areas:
  • tendon insertion (where the tendon attaches to the bone)
  • mid-tendon (non-insertional tendinopathy)
  • musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear:Tendinitis (or Tendonitis): This means "inflammation of the tendon".Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor!
  • Tendon cells are dying!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

What is Your Tendinopathy Phase?

It is very important to have your tendinopathy professionally assessed to identify it’s current injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. Diabetics, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to carefully watch their training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, your symptoms and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively.As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. You physiotherapist can assist not only your diagnosis but also guide your treatment to fast-track your recovery.Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:
  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage, and set you back weeks!

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:
  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan.  Researchers have found that tendon injuries do respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.

What is Barefoot Running?

Barefoot running is a term that means either running either without shoes or with minimalist shoes. Barefoot running has gained popularity over the last few years as a way to return to pure running and has been proclaimed to help reduce the rate of running injuries. But is this accurate?To gain a more scientific basis on whether barefoot running is advantageous or not for you, let’s look at what researchers have discovered.

Who is Suited to Barefoot Running?

When you run without shoes, you tend to land on the front part of our foot. This is called a forefoot strike. Landing through the centre of your foot is called a midfoot strike.If you were to land barefoot on your heel, it's called a rearfoot strike, the ground-shock would be excessive, and you would develop heel pain or injury, plus some other injuries further up your leg. That's why most barefoot runners tend to have a forefoot or midfoot strike. When you put on a traditional jogger with rearfoot cushioning, this cushioning allows you to land on your heel without damage. This is why lot of shoe runners become rearfoot strikers.

Ground Reaction Forces

The graphs below chart what is called ground reaction forces. The chart to the left is a rearfoot strike technique, and the right chart demonstrates a forefoot strike.

What does this Mean?

Generally, the higher the force, the greater the risk of injury. When you look closer, however, you can see that the ground reaction forces are actually higher in the forefoot strike chart. Surely this would mean that you would get more injuries running with a forefoot strike technique. Not exactly. As well as considering the ground reaction force, you also need to look at the vertical loading rate.

Vertical Loading Rate

Vertical loading rate (see the chart below) is a measure of how quickly the ground reaction forces increase.The steeper the curve, the greater the risk of injury. Running with a rearfoot strike produces a steeper curve, and makes some leg injuries more likely, but once again not all.

Running Shoes vs Barefoot Running

Does this mean you should toss away all of your running shoes? Maybe hold on them just a little longer. The evidence is not clear yet as to whether a forefoot/midfoot strike does actually reduce your injury rate. What appears to occur is the barefoot running reduces loads in one area only to increase loads in another. And, since you are probably running on firm or rough surfaces such as footpaths, roads or gravel, you'll need some form of cushioning and protection for your feet. Don't you hate landing on those little stones!

What Should You Do?

If you are running without injuries at present you would probably be silly to change. Changing footwear and technique may simply add another increase in loading and create new injuries elsewhere. Certainly, at PhysioWorks, we are seeing more forefoot injuries in barefoot runners, which does make sense given the load charts. Plus, most of these injuries occur within a few weeks of changing your running style.However, if you have been suffering injuries from running, barefoot may be a consideration for you. Changes to your running technique such as reducing your stride length or your shoe style could help you. You may also have some muscle control issues in another part of your body that could be altering the way you adapt your running style. So, before you toss your running shoes, it may be in your interest to consult with a running physiotherapist, a sports podiatrist or a running coach who can analyse your running style, assess your body for weakness or tightness, check your leg and foot biomechanics or simply help you to retrain your running technique or some slightly weak muscles.Most problems that cause running injuries are simpler to fix than you may think.

What is Therapeutic Ultrasound?

Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied.ultrasound Therapeutic ultrasound may increase:
  • healing rates
  • tissue heating
  • local blood flow
  • tissue relaxation
  • scar tissue breakdown.

How Could Ultrasound Help?

Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.

Specific Ultrasound Uses

Mastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours.The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies.Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.

What is an Ultrasound Dose?

A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all.Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.

How Does an Ultrasound Work?

A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.

When Should Ultrasound be Avoided?

Contraindications of ultrasound include:
  • local malignancy,
  • over metal implants,
  • local acute infection,
  • vascular abnormalities,
  • active epiphyseal regions (growth plates) in children,
  • over the spinal cord in the area of a laminectomy,
  • over the eyes, skull, or testes
  • and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Like all medical equipment, when used by highly trained professionals, such as your physiotherapist, therapeutic ultrasound is very unlikely to cause any adverse effects. Please consult your physiotherapist for their opinion on whether therapeutic ultrasound could assist your injury.Therapeutic Ultrasound differs from Real-Time Ultrasound Treatment.

7 Ways to Prevent a Future Leg Injury?

You may reduce the chance of leg injury by following these seven simple tips:
  • Warm-up before you exercise.
  • Warm down when you finish. Warm down usually includes some simple stretching exercises and plyometric drills.
  • Wear well-fitting shoes, boots or braces that provide excellent joint support.
  • Tape or brace your ankles/knees in high-risk sports such as football, basketball, volleyball and netball.
  • Avoid activities on slippery, wet or uneven surfaces, or in areas with poor lighting.
  • Strengthen your leg muscles and regularly use a wobble disc or balance board
  • Maintain general functional fitness.

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose.Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person.You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage.It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs.The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not!Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional.So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.

Private Health Insurance Rebates

PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.

However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.

HICAPS - Instant Health Fund Claims


Most health funds are members of the HICAPS instant claims system.  Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.

Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.

Third-Party Insurers

PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:

  • Workcover
  • InjuryNet
  • Australia Post; Coles Myer; Woolworths
  • Medicare
  • Department of Veterans' Affairs
  • CTP & Sports Insurers
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