What’s the Biggest Mistake ‘Weekend Warriors’ Make?

The bay area is filled with many recreational athletes or “weekend warriors”. The myriad of sporting activities they engage in ranges from soccer, basketball, baseball, and running, to hiking, cricket, and Frisbee golf.

I’m sorry to generalize, but the issue at hand is that most of these “warriors” rarely do any stretching or focused strengthening with their bodies prior to participation in their sport of choice. The exercises they attempt to do are mostly what they remember from high school PE.

I, as a physical therapist, then see them, in pain, feeling older than their years and extremely disgruntled with their body. What have they done to themselves? They’ve pulled, strained, and/or sprained muscles, tendons, and ligaments.

One of the most common tendon injuries by far is the Achilles heel tendon injury. The heel cord, as it is also known, is prone to all sorts of pulling, tugging, and tearing forces. We use it practically every waking second of our life.

How Does the Achilles Tendon get Injured?

The injury may happen in one of two ways –

1. A direct hit to the tendon causing it to tear
2. A slow build-up of repeated small injuries to the tendon over a period of time due to improper training, stretching, or strengthening.

The first type typically may need surgery depending on the extent of the tear. If surgery is not needed, then the patient is cast or fitted with a walking boot that prevents movement of the ankle joint for a period of time until satisfactory healing occurs. Once the boot is removed the process of physical therapy rehabilitation begins.

Here at Root Cause Physical Therapy, we work extensively with manual work and exercises to regain the flexibility and strength of the tendon, as well as the related muscle. The treatment is relatively straightforward and patient compliance is high because they are fully aware of what occurred to create the injury.

The second type of injury is more resistant to treatment, unfortunately. Due to the fact that this injury occurs slowly over a period of time, the patient is often unaware of what is truly happening to his foot.

Achilles Injuries are Often Misdiagnosed

The pain may be generalized around the foot and ankle region, rather than pinpoint over the Achilles tendon. The patient may limp for a few days and then be able to walk or run normally. Most cases are erroneously diagnosed as plantar fascitis or mild ankle sprains.

Patients often try home remedies or doctors may recommend insoles, different footwear, etc. As the days and months pass, the pain becomes more pronounced and it begins to affect walking as well as prolonged standing. In some patients, a small hard nodule or bulge starts appearing where the Achilles tendon joins to the ankle.

In the majority, patients are referred to me, a physical therapist, quite late into the condition. During the evaluation, in addition to noting what causes pain and where it’s located, I commonly note that the calf of the affected leg is markedly reduced in size. The tightness in the heel cord too is often quite severe.

If Not Treated Correctly the Damage Can be Permanent

The tenets of Physical therapy in such conditions are slightly different from the norm.

Typically we begin with pain management as our highest priority. And while there is no denying that pain management is important, as a clinician I am more concerned about the integrity of the tendon where it attaches to the heel bone.

Research has shown that cumulative trauma to the Achilles heel tendon causes the tendon cells attaching to the bone to wither away and degenerate.

Once that happens, even surgical fixation will not have a 100% success rate. Therefore our priority, along with reducing pain levels, is tendon integrity. The question is: how do we achieve this goal? Pain reduction is achieved with a combination of manual therapy and ultrasound therapy. I have achieved my best results by using a combination of both.

What’s the Best Treatment?

The treatment program should go something like this:

1. Receive a thorough evaluation by a doctor of physical therapy

2. Severity of the damage incurred is established

3. Very specific exercises are begun that restore length and rejuvenation to the damaged tendon. These are called eccentric exercises and they literally work wonders.

4. As the patient progresses, more exercises with increasing levels of difficulty are added to the regimen.

5. Here at Root Cause Medical Clinic, we have a special treadmill set up that allows us to put patients in a harness so that they can walk on the treadmill in all directions – forward, backward, and side to side leading with their left and right food respectively. These are called 360s and we are one of the very few clinics that offer this. The 360 procedure strengthens the ankle and foot, ensuring tendon healing and pain reduction.

6. Finally, the patient is educated on good stretching and strengthening habits in order to prevent future injury.

We’re Here to Help

The moral of this story is that while exercise is very encouraged, with it comes the responsibility to stretch adequately and train properly in order to minimize injuries.

In the field of physical therapy, we work with our patients to ensure that they are knowledgeable about the incredible machine they possess and learn how to treat it well so they can enjoy it for many, many decades to come. Please contact me should you have any questions. I would be delighted to offer you a free health analysis.