Originally Posted by Torres
The right achilles flared again today after about 2 hours of a 3 hour session. Again, felt painful to push off after it flared.
Have seen the physio in the meantime. Had some ultrasound and massage. She said exactly what you said - eccentric, massage/loosen calf, ice achilles.
The eccentric exercises (to anyone else interested), are desgined to strengthen the tendon over its entire (not just part) of its lengnth. Same principle as with tennis elbow eccentric exercises. Basically, I stand off the edge of a step, sink down as far as it will go to stretch the achilles and then rise up on my toes. x10, x 2-3 times a day. Very easy exercise to do as well in terms of discipline, routine etc. Not sure whether it should be 2 footed or 1 footed, but I've been doing it with 1 foot.
Will see how things go over the next couple of weeks.
I'd advise anybody who is currently feeling pain to do eccentric heel drops with two legs, and maybe even in a swimming pool to make it easier if that's where you need to start. Use your leg without the injury (and maybe your arms as well) to perform the "rise" part of the motion, then drop both heels very slowly, about 10-15 seconds. You want to emphasize the down/eccentric heel drop, and think of the UP motion just as a way to start the down/eccentric/heel drop over again. Yes there is a stretching component to the exercise, but that's not what it's really about. If you are doing this correctly, you will feel muscle burn.
Think of it this way. PT is just a fancy word for controlled destruction, you are tearing down muscle so that you can build it back up again with more strength. What the eccentric heel drop therapy does is re-groom all those little micro tears that havent healed properly. By that I mean, the body knows how to rebuild muscle withing the next 24 to 48 hours when it senses that it isnt up to the tasks it is being asked to perform. But chronic problems can arise when instead of taking a day off, you go out and play tennis the next day and the day after that. The muscle is trying to re-build itself, and you are asking it to do this work on the tennis court, so the muscle does not build itself up properly. There actually is still a debate over why eccentric stuff works, but the primary notion is you are re-grooming, re-building muscle in a very specific way that heals, as well as prepares the muscle to handle more stress loads.
The worst thing you can possibly do is push too hard, too fast, and too early in your PT. So when you are 100% certain that the two legged heel drops are working for you (or at least not causing additional pain) do them a little longer. Then move on to the one leg version. The Tortoise beats the Hare every time with Achilles PT. With the one leg heel drop, you want to use both legs on the rise, it's just a way to start the drop again.When you are certain the one leg versions are helping, just stick with it! you are then very close to the finish line. I will find some videos that show how to eccentric heel drops correctly and post them in my thread eventually. When I first posted about this in 2005, the idea was at the at the fringes. Now it's more mainstream, and with that, I'm finding to my horror legions of youtube videos that are poorly demonstrating the proper technique.
PS you need to stop playing for a while. and if you can't manage that, don't play two days in a row.
I'll keep in touch