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Achillespees Bursitis

As you can read in the general blog over achillespees klachten te lezen is, zijn er verschillende soorten achillespees klachten. Dit artikel gaat alleen over de Bursitis achillespees klachten. Het is belangrijk om onderscheid te maken met andere types achillespeesklachten omdat de behandeling anders is!

Wat is Bursitis?

Bursitis is een irritatie/ontsteking van een slijmbeurs. In dit blog gaat het over de 2 verschillende slijmbeursen namelijk de Retrocalcaneal- en de superficial slijmbeurs.(zie afbeelding 1)

Figure 1
  1. De Retrocalcaneal slijmbeurs ligt tussen het hielbot en de achillespees.
  2. De superficial slijmbeurs ligt tussen de achillespees en de huid.

Symptoms

  • Pijn rond de hiel net boven het hielbot.
  • Roodheid, zwelling warmte rond de hiel.
  • Drukpijn rond de hiel.
  • Pijn bij beginnen van sport of meteen na het opstaan in de ochtend.

Test jezelf 

Door de huid op het hielbot bij elkaar te knijpen met je duim en wijsvinger kan je testen of de superficial slijmbeurs de klachten geeft.

Door de net achter de achillespees te knijpen bij de aanhechting test je de Retrocalcaneal slijmbeurs.

Deze testen zijn niet perfect en het is altijd aan te raden om langs een specialist te gaan om dit te controleren.

Voorkom compressie

In het geval van slijmbeursklachten is het belangrijk om compressie te voorkomen. Om de compressie te verminderen is het belangrijk om de enkel niet verder dan 90graden te buigen (tenen naar je toe). Vermijd bijvoorbeeld heuvelop lopen of de heeldrop oefeningen.

Do not use shoes where the heel is very tight and therefore exerts pressure on the attachment of your Achilles tendon. Shoes with a higher heel may help to reduce the pressure, you can also use a heel enhancement.

And perhaps most importantly, do not stretch the calf muscles! Stretching the calf muscles causes compression and can make the symptoms worse!

Wat kan je wel doen?

Stap 1 Isometrische oefeningen

To reduce the pain and control the tensile forces, it is important to perform the following two exercises.

Exercise 1: Isometric M. Soleus holds

Execution: Stand on the toes, bend the knees to about 90 degrees and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds

Execution: Stand on the toes, keep the knees extended and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Stap 2 Kracht verbeteren

When the pain is gone and the symptoms are gone, you can start training the strength of the calf muscles. Calfraises are the right exercises for this. You must do this exercise with both straight and bent knees. Below the explanation of the exercise:

Exercise 1: Heelraise stretched knee

Execution: Stand on one leg. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Heelraise bent knee

Execution: Stand on one leg with bent knee. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

During this exercise the complaints should not increase, if this is the case the exercise is still too heavy for that moment. What is important in exercise 2 heeled knee is that you do not get an increase in the symptoms. If this is the case, you should bend the knee less. For example, start with 10 to 15 degrees of knee flexion and build it to 25 degrees.

Stap 3 Hardlopen!

Figure 2

Now you start running again! It is important that you start up quietly, ask for help from your therapist. Make sure that everything you do is virtually pain-free. It may be that you get some sensitivity during the build-up, as long as it is a maximum of 4 on a scale of 0 to 10 you do not have to worry about it. If the complaints then go away again. See figure 2 as an example.

Besides starting to walk, it is important to do the following exercises.

Exercise 1: Triple extention

Execution: Stand on one leg with bent knee, bend your torso slightly forward. Now stand checked on the toes while simultaneously stretching your knee and hip. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Calfraise stretched knee with resistance

Execution: Stand on one leg. Put a large resistance band around your feet and your shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 3: Heelraise bent knee with resistance

Execution: Stand on one leg with bent knee. Put a large resistance band around the feet and shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Bij vragen neem gerust contact us!!

Achilles tendon complaints on heel bone (insertion complaints)

Figure 1

As you can read in the general blog about achilles tendon complaints, there are different types of Achilles tendon complaints. This article is only about the insertion Achilles tendon tendinopathy. It is important to differentiate with other types of achilles tendon complaints because the treatment is different!

Insertion Achilles tendon complaints are located at the spot where the Achilles tendon inserts on to the heel bone (calcaneus). This can be seen in Figure 1.

What is the difference with other types of Achilles tendon complaints?

In the case of the insertion complaints, the compression of the tendon plays a major role. Compression of the tendon against the heel bone occurs mainly in the final phase of dorsiflexion (pulling the toes towards you).

The type of exercises that are associated with this type of Achilles tendon complaints is different from the exercises with a mid-achilles tendon complaint.

The complaints arise just as with the other types of Achilles tendon complaints due to overload of the tendon, read more about this in the general blog about the Achilles tendon..

Type of insertion Achilles tendon tendinopathy

Reactive tendinopathy: This is usually with an increase in training load. For example by walking more kilometers per week or more hills in the training. The tendon can be swollen and painful.

Degenerative tendinopathy: The degenerative tendinopathy is when there are complaints for a long time. At this stage the structure of the tendon has already changed a lot. With these complaints, the Achilles tendon can be swollen or bumps may form on the tendon. If you continue to exercise with this, there is a chance that the tendon will partially or completely tear. However, you must then continue to sport for a very long time. 

Phases of recovery

The recovery of the insertion Achilles tendon complaints goes through a number of phases, it differs per person how long the phases last. This depends on many factors such as the degree of tendon damage, duration of complaints, tendon health, age etc.

Phase 1. Pain reduction

In the first instance, reducing pain is important, for which 2 steps are important.

Step 1. Managing the load

The insertion complaints are aggravated by compression, by high tensile forces of the calf muscles and by the shorter and lengthening of the tendon (such as during running, jumping, etc.). To tackle these three factors, a number of measures must be taken. To reduce compression, it is important not to get into dorsiflexion. For example, avoid running uphill or the heel drop exercises.

Do not use shoes where the heel is very tight and therefore exerts pressure on the attachment of your Achilles tendon. Shoes with a higher heel may help to reduce the pressure, you can also use a heel enhancement.

And perhaps most importantly, do not stretch the calf muscles! Stretching the calf muscles causes compression and can make the symptoms worse!

Step 2. Isometric exercises

To reduce the pain and control the tensile forces, it is important to perform the following two exercises.

Exercise 1: Isometric M. Soleus holds
Execution: Stand on the toes, bend the knees to about 90 degrees and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds
Execution: Stand on the toes, keep the knees extended and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Phase 2. Improve strength

When the pain is gone and the symptoms are gone, you can start training the strength of the calf muscles. Calfraises are the right exercises for this. You must do this exercise with both straight and bent knees. Below the explanation of the exercise:

Exercise 1: Heelraise stretched knee
Execution: Stand on one leg. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Heelraise bent knee
Execution: Stand on one leg with bent knee. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

During this exercise the complaints should not increase, if this is the case the exercise is still too heavy for that moment. What is important in exercise 2 heeled knee is that you do not get an increase in the symptoms. If this is the case, you should bend the knee less. For example, start with 10 to 15 degrees of knee flexion and build it to 25 degrees.

Phase 3: Running!

Figure 2

Now you start running again! It is important that you start up quietly, ask for help from your therapist. Make sure that everything you do is virtually pain-free. It may be that you get some sensitivity during the build-up, as long as it is a maximum of 4 on a scale of 0 to 10 you do not have to worry about it. If the complaints then go away again. See figure 2 as an example.

Besides starting to walk, it is important to do the following exercises.

Exercise 1: Triple extention
Execution: Stand on one leg with bent knee, bend your torso slightly forward. Now stand checked on the toes while simultaneously stretching your knee and hip. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Calfraise stretched knee with resistance

Execution: Stand on one leg. Put a large resistance band around your feet and your shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 3: Heelraise bent knee with resistance
Execution: Stand on one leg with bent knee. Put a large resistance band around the feet and shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Human Tecar

Thanks to our work with the world elites in marathon runners, we have the Human Tecar at our disposal, which we can now use at Running Solutions for all recreational or subtop runners. The Human Tecar is an innovation within the world of injury recovery. We use the Human Tecar for muscle complaints, acute pain complaints, tendon problems and fatigue/stress.

What does the Human Tecar do?

The Human Tecar is a device that uses an electromagnetic field, which stimulates both the blood vessels and the lymphatic system. With this stimulation you promote recovery of the different tissues from within the body: the body gives heat from within during such treatment. This ensures relaxation and a faster recovery.

At the time of an injury, the Human Tecar ensures that the natural processes of recovery are promoted. This way the recovery time of an injury can be accelerated.

What do we use the Human Tecar for?

  • Muscle problems;
  • Pain relief;
  • Moisture discharge (decrease of swelling);
  • Restoring the joint mobility;
  • Relaxation / recovery treatment after a great effort (for example the marathon);
  • Specific complaints such as:
    • Acute and chronic tendon complaints;
    • Runnersknee
    • Shinsplints
    • Ankle sprain;
    • Heelspur

The treatments with Human Tecar have already proven themselves in elite sports. Many top athletes use this technology, such as Usain Bolt, Wilson Kipsang, Eluid Kipchoge and many others.

Recovery after great effort

We are happy to use the Human Tecar to support people who have made great efforts in a race. The marathon is a wonderful example for this. After running a marathon, the body must absorb a huge blow and has to recover from it. By using a relaxation treatment of the Human Tecar, your body gets a little push in the right direction.

Contact us for an appointment!

Midportion achilles tendon pain

Figure 1

As you can read in the general blog about Achilles tendon, there are several types of Achilles tendon complaints. This article is only about the midportate achilles tendon tendinopathy. Mid-achilles tendon complaints are located in the narrow part of the Achilles tendon between 2 and 7cm above the heel bone. As shown in figure 1.

What is tendinopathy?

Tendinopathy is degeneration of tendon tissue. This can happen not only in the Achilles tendon but also in the patella tendon or in other tendons in the body. Tendons, like many other structures in the body, are constantly building and breaking tissue. This happens in bones, ligaments, muscles and tendons. It is a balance between the fabrication and degradation.

A good balance between structure and degradation is largely due to the way in which the tissue is loaded. If you load a tendon too much, this can lead to more breakdown than fabrication. The tendon tissue then begins to change its structure and becomes less strong.

No, your Achilles tendon is not inflamed

For a long time it was believed that Achilles tendons could become inflamed. However, this is not the case, if there is swelling, stiffness and redness on the tendon this is not due to inflammation but a reaction to protect the tendon. This ensures that you will be less used. As described earlier, degeneration of the tendon causes a weak tendon.

Different stages of Achilles tendon tendinopathy.  

Reactive tendinopathy: This is usually with an increase in training load. For example by walking more kilometers per week or more hills in the training. The tendon can be swollen and painful.

Degenerative tendinopathy: The degenerative tendinopathy is when there are complaints for a long time. At this stage the structure of the tendon has already changed a lot. With these complaints, the Achilles tendon can be swollen or bumps may form on the tendon. If you continue to exercise with this, there is a chance that the tendon will partially or completely tear. However, you have to go through it for a very long time.

Symptoms

Most runners describe the first symptoms as a slowly rising pain during and/or after walking. The symptoms gradually increase until there is pain at the start of running or even during daily activities.

Usually the pain is 2 to 7 cm above the heel bone. Often it is painful when the tendon is pinched. Activities in which the achilles are loaded are painful, such as climbing stairs, standing on the toes and of course running.

Sometimes there is swelling in the beginning of the complaints and later a thickened tendon. There may also be stiffness in the calf.

Treatment of reactive tendinopathy

You can assume that if you have acute complaints after a change or increase in training, you have reactive symptoms. What you have to do is to reduce the load to get the complaints under control. It is possible that you can train slowly if this does not hurt. Make sure you keep a close eye on whether the complaints have not increased the next day. Achilles tendons can in fact give a reaction 24 hours after loading. Can’t run pain free? Then take a few days rest and try the next 2 isometric exercises for the calf.

Exercise 1: Isometric M. Soleus holds
Execution: Stand on the toes, bend the knees to about 90 degrees and keep this position full for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3×10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds
Execution: Stand on the toes, keep the knees stretched and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3×10 repetitions per side.

Besides these exercises you can also use tools like:

1. A heel raise in all of your shoes, not just your running shoes. This allows you to reduce the tensile forces on the Achilles tendon. You can buy this at Run2Day.

2. Use kynesiotape that supports the calf / Achilles tendon. Have this applied by a professional. Use this especially in the beginning of the complaints and during the build-up of running.

3. Use a foamroller to reduce the tension in the calves, but do not do this on the tendon itself.

4. Use the treatment with Human Tecar. The Human Tecar promotes the recovery of the tendon from the inside! At Running Solutions we use the Human Tecar, the Tecar is also used by all top marathon runners like Eluid Kipchoge and Wilson Kipsang.

Are your complaints going down? Then build up the running again slowly. Follow the advice of your therapist. The tendon can in the first period after the Achilles tendon complaints react quickly again if you build up too quickly.

Treatment of degenerative tendinopathy

These are the Achilles tendon complaints that have existed for some time. With these complaints, the tissue of the tendon has clearly degenerated and the recovery takes much more time than with the reactive variant.

With most of the degenerative tendinopathys, the damage can not be completely repaired. However, that does not mean that you can never run again. It is likely that you should always have a plan to keep the Achilles tendon symptoms under control.

Reducing and managing the load on the tendon is very important. If you continue to overload the tendon, chances are that the condition of the tendon deteriorates and eventually ends with a ruptured tendon.

In addition to controlling the load, you can use eccentric exercises for the calf. The idea of ​​these exercises is to give the tissue that is damaged in the tendon the right stimulus for recovery. This allows you to load more! The following two exercises are good as eccentric exercise:

Heeldrop extended knee:

Heeldrop bend knee:

It is then important to set up a program together with a specialized paramedic to train the calf muscles. This is much more than just the eccentric exercises.

Read more about the causes of Achilles tendon complaints in the general blog..

If you have complaints and need help? Please contact us!!

Achilles tendon pain

Achilles tendon pain is a common complaints with runners. The complaints are often long-term and very difficult to treat. You often see that runners do not know what to do. In this article you will get an explanation about how the complaints arise, what different forms there are and what you do and what you should not do.

What is the Achilles tendon?

Figure 1
Figure 2

The Achilles tendon is the tendon that connects the deep and superficial calf muscles to the heel bone. The tendon is the strongest tendon in the body and has to endure enormous powers while running. Too much repetition of excessive forces on the tendon can cause an overload. On picture 1 you see the M. Soleus muscle, this is the deep calf muscle and on picture 2 you see the M. Gastrocnemius the superficial calf muscle. The M. Gastrocnemius consists of two muscle heads (inner and outer) that overlap in the Achilles tendon. Together they form about 50% of the Achilles tendon. The Soleus is responsible for the other 50% of the Achilles tendon.

How do you recognize an achilles tendon injury?

In general, injuries of the Achilles tendon gradually arise. The pain is initially only at the beginning of activity and goes away after the warming up. Later the pain persists longer and is also present at rest. Often there are stiffness complaints in the morning in the Achilles tendon.

The complaints can occur in several places: about 2 to 7cm above the attachment on the heelbot and on or around the heelbot itself. Sometimes there is swelling in the tendon or the attachment to the heel.

Causes of Achilles tendon complaints

Achilles tendon injuries are generally caused by overload. This is often due to several factors that work together.

  • A sudden increase in training size or intensity for example through more hills in the training;
  • An instability in the leg while running;
  • Weak muscles in the hips, upper legs, calves or feet;
  • Limited mobility in one or both ankles;
  • Foot position deviations that cause the tendon to be asymmetrically loaded;
  • Poor running technique;
  • Bad or old running shoes.

How can you prevent Achilles tendon complaints?

  • Make sure you gradually build up the running;
  • If you are training, a good warm-up is indispensable, especially in the winter months it is important to pay extra attention to this dynamic warm-up;;
  • Have a specialist check your shoes, for example at at Run2Day.;
  • Ensure sufficient mobility in the ankles;
  • Train for sufficient strength in the calf muscles;
  • Ensure sufficient stability in the hip;;
  • A good running technique, Like in this article.

Learn more about the different types of Achilles tendon complaints:

1. Insertion 

2. Midportion 

3. Bursitis