Achilles Tendonitis - Michael Irvine (Paladin Biokineticists)

The Achilles tendon is the largest and strongest tendon in the human body. It is a tough band of fibrous tissue which inserts onto the calcaneus of the foot. The Achilles tendon is the common tendon to the gastrocnemius and soleus calf muscles. When these muscles are contracted, the Achilles tendon pulls on the calcaneus causing plantar flexion of the ankle. This is a common movement which makes walking, running, jumping and standing on toes possible. The Achilles tendon is said to withstand forces up to seven times one’s body weight, showing how much force the Achilles tendon is made to withstand during sporting activities.

Achilles Tendinitis is a condition which involves the inflammation of the tendon surrounding the ankle joint. Tendinitis within the heel complex is either due to a single cause, or may involve a variety of mechanisms. Although the Achilles tendon is an extremely strong structure and able to withstand large forces placed on it, it is still vulnerable to injury. This is due to a large amount of tension placed on it, as well as tendons having a limited amount of blood supply.

Achilles tendinitis is an inflammatory condition which involves the degeneration of the Achilles tendon. This is a result of micro tears which have developed within the structure which directly causes instability and a decrease in the tendons tensile strength.

There are two types of Achilles tendinitis:

• Acute Achilles Tendinitis

This is usually the result of abrupt or sudden onset, with the individual experiencing moderate pain 2 – 3 cm proximal to the tendons insertion on the heel. The pain is pinpoint tenderness and pain will increase when palpated.

• Chronic Achilles Tendinitis

This is generally an injury which occurs from overuse. Chronic Achilles Tendinitis exhibits a similar pain to Acute Achilles Tendinitis except the pain is usually at the insertion of the Achilles tendon. This injury generally occurs from repetitive micro trauma to the tendon and if left untreated, it could progress to an Achilles Tendon Rupture.

Aetiology:

It has been highly speculated that runners are more susceptible to Achilles tendinitis due to the repetitive micro trauma. This micro trauma is produced by:

1.       Eccentric Loading of fatigued muscles

2.       Excess pronation which produces a whipping action of the Achilles tendon

Therefore, all Achilles tendon injuries tend to be a result of either structural or dynamic disturbances of the lower leg. The main cause of Achilles tendon complex is due to overuse/overtraining.

Causes:

•     Overuse/changes in training
•     Ageing
•     Biomechanical faults (Pronation)
•     Tight calf muscles
•      Lack of ankle instability
•     Inappropriate show wear (resulting in biomechanical faults)

Signs and Symptoms:

Unless acute Achilles tendonitis, symptoms tend to develop gradually and become worse over time.

•         Local and tender pain in Achilles which tends to increase with specific activities
•     Crepitus (Grating or crackling sensation within the tendon upon movement)
•      Redness/swelling around the area
•      Affected tendon may appear thicker
•      Stiffness in tendon in morning which gets better with movement
•      Pain experienced with active or passive stretching
•      Reduced flexibility
•      Weakness and pain when standing on toes

Exercise as treatment:

Due to the Achilles tendinitis being an overuse injury, it is important to reduce activities that place strain on the Achilles tendon. Research has found that there are passive as well as active methods which can be prescribed to treat Achilles tendinitis. Aggressive stretching of the Achilles tendon complex should be implemented and incorporated into the training program to loosen the calf muscles and relieve the tendon of some of the tension placed on it. Exercises can be done to improve one’s biomechanical faults such as pronation which can help reduce the strain on the Achilles tendon.

Scoliosis... we've got your back! - Melissa Biffi (Paladin Biokineticists)

What is Scoliosis?

Scoliosis is an abnormal, curvature of the spine.  Viewed from the back, a typical spine is straight. When scoliosis occurs the spine can curve in two different ways, the spine can curve to one side, either the left or right side (shaped like a C) or the spine has two curves (shaped like the letter S) normally occurring at the cervical and lumbar spine region.

There are two types of scoliosis. Structural scoliosis which is characterised by permanent structural changes in the bone and usually caused by congenital abnormalities. Non-structural or functional scoliosis is generally caused by a problem elsewhere in the body, such as a leg length discrepancy or muscle spasm. 70-90% of all cases are idiopathic (unknown). Idiopathic scoliosis can be seen at any age, but is most commonly diagnosed between the ages of 10 and 13 years, and is more common in females. Degenerative scoliosis is more likely to develop in adults, where degeneration in the spine and surrounding musculature can result in abnormal curvature. 

How do you know you might have scoliosis?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by friends or family. The change in the curve of the spine typically occurs very slowly and over a long period of time and so it is easy to miss until it becomes more severe. Pain is a symptom of scoliosis .When back pain is present with scoliosis; it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by the curve itself. 

Scoliosis may cause the head to appear slightly tilted to one side or one hip or shoulder to be higher than the other side and can also cause one leg to appear shorter than the other. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly as severe scoliosis can cause a rotation of the rib cage, which will cause shortness of breath.

How can Biokinetics help scoliosis?

Mild cases of scoliosis generally have minimal deformity. Such cases can therefore be treated with appropriate stretching and strenghening exercises. A biokineticist will assess what functional aspects may be contributing to the scoliosis, so that appropriate stretching and strengthening exercises can then be prescribed to manage the  scoliosis and prevent further deterioration.

Biokineticists can prevent the progression of curvatures in adolescents with scoliosis and in some cases even improve their curvature. Biokinetics will focus on prescribing a specific individualised exercise regimen according to the need of each person. The program will consist of isometric and other muscle strengthening and stretching exercises in order to strengthen the spine causing it to straighten out. Treatment will also focus on posture correction and stabilising the corrected muscles so that posture will be improved in activities of daily living. It is very important that the correct exercises be prescribed and done obediently, as incorrect exercises; a lack of effective management of the scoliosis and to poor compliance of the individual can lead to progression of the curvature. 

Melissa Biffi obtained her BCom Sports Management Degree at the University of Johannesburg and completed her Honours in Biokinetics at the University of Witwatersrand.

She has a special interest in dancing and other sports such as soccer and hockey, which lead to her interest in orthopaedic rehabilitation, particularly knee rehabilitation.

Melissa is also very passionate about working with children in specific areas such as rehabilitation and development of individuals from very young ages all the way through to adolescents.

Melissa can be contacted on 082 822 9677 or melissabiffi@kinetics.co.za