Archive for the 'Achilles Tendon Injury' Category

Beware of your New Years Resolution!

Was your New Year resolution for 2012 to: lose 20lbs, run a marathon, start exercising regularly, begin walking to work instead of driving?  If you answered yes, please read my cautionary advice- Beware of your New Year Resolution!

In January and February each year my physio clinic sees a sharp increase in injuries amongst people who’ve made these types of New Year resolutions. These patients always share one thing in common, they push themselves too much, too soon!

It is inspiring to make lifestyle changes to increase fitness and improve health and well being.  Come the 1st of January people can be seen  jogging in the park, riding their bicycles, or hard at work at the gym.  Their enthusiasm can be infectious, if not sometimes irritating! 

But my words of caution are to start slowly and progress slowly.  Any increase in exercise must be done in a gradual way- this is to allow the body a period of adaptation. Adaptation is the physiological phenomenon of the body adapting to the stresses and strains of the training you subject it to- in this case making the muscles, tendons and bones stronger and the cardiovascular system fitter.

Here is a common example.  You have decided to enter a 10km fun run.  Having never run before you begin sensibly by doing combination walking / jogging intervals for a total of 20min, 3 a times a week- a very sensible start!  After 2 weeks you are finding it all a lot easier and can jog for 20min without stopping- brilliant! You then decide to increase to 30min jogging 3 times a week- surprisingly your breathing and endurance feel good- but after your third 30min jog you notice your Achilles tendon is hurting you.  And there you have a start of Achilles tendonitis- a condition that can take anywhere from 3 weeks to 3 months to settle down!

What went wrong, you ask yourself, I was doing so well.  Quite simply your cardiovascular fitness improved quickly, but your musculo-skeletal system did not have enough time to adapt to the new stresses of jogging.  By increasing the loading on the tendon by 50% extra from one week to the next- the Achilles tendon had not had enough time to adapt and was not strong enough to withstand the increased loading.  The tissue broke down and became inflamed.  This is a typical example of a training related injury that we see in the clinic.

The advice is quite simple- give your body, particularly your joints, muscles and tendons time to adapt to your increases in training.  Don’t be overeager and push yourself too much too soon when you feel things getting easier.  As a simple guide, increase training volume by no more than 10% each week to begin with.  Allow your body time to adapt and adjust.

My own experiences were quite similar- I took up jogging following my 30th birthday one February, having entered the Watford 10km fun run in April that year.  My first problem was shin splints (medial tibial stress syndrome), this eventually settled somewhat by the June after the fun run, my cardio fitness had improved much more quickly than my musculo-skeletal adaptation. I then entered my first half-marathon, Stevenage half marathon, that September.  Up to that point I could run 10miles with no trouble other than the shin splints.  But during the half marathon from mile 10 to 13 I began feeling pain on the outside of my foot.  I completed the half marathon in 1hr50min which I was very pleased with- but my foot hurt for 6weeks!  The upside was that I was thrilled with my half-marathon time and the shin splints never came back.  But no way could my body have adapted enough during that year to run a marathon.  It was 18months later in April 2006 that my body had adapted enough to enable me to train for and run the London marathon successfully.

Good luck and congratulations on a commendable resolution for 2012, give it time, be patient and most of all

The BOOST Blogger- Steven Berkman, Head Physiotherapist at BOOST PHYSIO, Hendon NW4

persevere.

Regards- from Steven Berkman- the BOOST BLOGGER

David Beckham’s Achilles injury- 6months at least

Everyone is asking me “how long will David Beckham be out for”- a long time I keep telling them!  It sounds like he has a ruptured achilles tendon, this is very easy to diagnose with 1 very simple test (the need for MRI’s and advanced scans etc is a nice bonus, but mainly useful if you suspect a partial tear only).

The achilles tendon is the very strong and tough sinew that attaches that big calf muscle (gastrocnemius and soleus) to the calcaneus (heel bone).  Ruptures (where the tendon snaps completely) of the achilles tendon are a common injury in over 35 year olds, making David Beckham a prime candidate for a rupture.  It is a common injury it football, but also in tennis, squash and basketball due to the explosive push-off (and also in fathers and sons races at school sports day as a good friend of mine will testify).

So what is the treatment- well it aint gonna grow back by itself- so surgery it is.  I’ve personally diagnosed and sent for surgery 4 cases of ruptured achilles tendon that have been missed by GPs.  The surgery stitches the tendon together and then usually involves immobilising the leg from the below the knee down to the toes for 6 weeks.  Then is the slow process of physiotherapy to recover the movement and strength.  Like I said 6 months out of sport at least. 

One of my patients had surgery in Israel for a ruptured achilles tendon which was very successful- this involved a per-cutaneus stitching of the tendon.  Per-cutaneus is where there is only a very small hole made in the skin, rather than a big incission to perform the traditional operation.  This led to much quicker rehab and recovery time- reduced by approximately 1/3.  I suspect that in David Beckham’s case a traditional procedure will be performed (probably today) because it is critical that the tendon is repaired very strongly and this may not be the case with the per-cutaneus procedure.

So in short David Beckham will not be able to attend the world cup in my opinion.

Steven Berkman- the Boost Blogger

The BOOST Blogger- Steven Berkman