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You can beat chronic pain

“-itis” is used to describe an acute condition not more than 10 to 21 days old. It’s commonly associated with acute pain, swelling, a limp, and a tenosynovitis (swelling of the tendon within its sheath) or soft tissue crepitus. Heath Matthews tells more.

health and fitness Updated: Sep 26, 2009 16:29 IST

I’m 49 and have been a regular jogger all my life, running the Mumbai Half Marathon (21 km) several times. Recently, I developed Achilles tendonitis and get a severe pain in my ankle when I run. I can’t walk for long distances either. Despite consulting several doctors, taking medicines, trying physiotherapy and rest for six months, the pain keeps coming back.

I’m 183 cm tall and weighed 84 kg before my injury. Due to the lack of exercise, I’ve gained 10 kg. I eagerly await your advice.

- Siva Kumar Dyta

What you describe sounds more like Achilles Tendonosis than Tendonitis. “-itis” is used to describe an acute condition not more than 10 to 21 days old. It’s commonly associated with acute pain, swelling, a limp, and a tenosynovitis (swelling of the tendon within its sheath) or soft tissue crepitus (a creaking, mushy condition when you palpate in the tendon and move the associated joint). This is almost always an over-use injury where the same movement has been done over and over until the tendon has become inflamed.

A problem with the Achilles Tendon can also arise when the back tongue of the shoe rubs against the mid portion of the Achilles. This can be easily confirmed by a painful spot in the middle of the Achilles that corresponds to the lip/tongue of the shoe when you put it on. ‘Tendonitis’ is treated like any other acute injury. The easiest way to remember this is RICE, which starts for: R – rest, I – ice, C – compression, E – elevation. Follow this for 3 to 4 days, as frequently as 3 times a day for 15mins, and you will dramatically reduce swelling and pain.

After that you can begin eccentric calf raises. This exercise is performed with your forefeet on a step and your heels hanging in the air. From there you drop your heels down as low as your ankles will allow and then raise them up into a standard calf/heel raise exercise for your calf muscles. Hold onto the wall or hand rail for support and do the movement downwards as slowly as possible (in at least 6 seconds).

This slow movement against resistance (your body weight) is called an eccentric movement and is classified by a muscle doing work while lengthening as opposed to shortening. Do 3 sets of 15 and build it up to 30 every day for 6 weeks and your Achilles will no longer be prey to pain’s evil arrows!

I believe what you have is not tendonitis, but tendonosis. Tendonosis is a chronic condition. It is the result of the “itis” never settling properly. The body’s attempt to heal itself means that a lot of scar tissue is laid down in the tendon, leading to a chronic weakness within the tendon, which becomes a vicious cycle. Since the tendon is weaker, the force required to tear fibres is lesser. Each successive tearing, however tiny, leads to more swelling and damage. Still, there’s no need to despair; there is a solution. The massage should start at the heel bone and finish at the top of the calf muscle. This, combined with hot fermentation to encourage increased blood flow, will take more nutrients to the area, assisting in tissue regeneration.

Most importantly, you must do the eccentric heel raises I described earlier as they will strengthen the tendon fibres, Soleus, and calf muscles, and increase tensile strength in the tendon. This is ultimately what will help you return to running.

I trust that this answer has been helpful to you and hope you’ll remember these two key issues: get the correct shoes and do your eccentric exercises.

Matthews is physiotherapist with the Mittal Champions Trust.