View Single Post
Old 12-13-2012, 07:51 AM   #48
charliefedererer's Avatar
Join Date: Feb 2009
Posts: 5,639

Originally Posted by Say Chi Sin Lo View Post
Just found this gem of a thread regarding calves/achilles injuries. And I have a question.

So I believe I'm developing early signs of insertional achilles tendinitis. It doesn't affect my performance on the court but when I shut it down, there's significant pain behind my heel. After dealing with post-play discomfort for a few months, I decided to shut it down completely and just let it heal. And here is my question:

I plan on doing as much RICE therapy for the next 2-3 weeks, just to get the inflammation to subside. Then your usual stretching and strengthening once the inflammation is gone. During my recovery, will cardio workout such as the elliptical and stationary bike hinder the healing of the achilles? And I'm going to assume running isn't going to help my cause.

In case you were wondering how I injured it, I wish I can recall a precise event, but I can't. I'm sure I took a hard and wrong step somewhere on the tennis court (probably on an stomp volley). What I can tell you is, it's my left achilles, and I'm a righty, so it's my landing foot when I serve.

Sorry to hear you are having problems.

As you undoubtedly know, inflammation is the first stage of healing. Indeed without inflammation, no healing will occur.

Inflammation represents that the greatest number of chemicals (cytokines) is present at the site to attract and activate the fibroblasts which will produce the protein strands that will heal the microscopic tendon tears that are likely present.

Pain is a side effect of those chemicals (cytokines) being present and irritating sensitive nerve endings.
(It is unclear if this is just coincidence or whether this evolved as a warning signal to our forebears that an injury was in the process of healing, and that decreased activity was needed to let the injury heal.)

RICE clearly improves the symptoms of pain and swelling.
Nerves don't conduct pain optimally at cold temperatures.
Compression clearly reduces swelling.
And it is clear that on occasion our immune system can run amuck and produce more inflammation at a site than will optimally lead to healing.
It is just hard to know in your situation if other than Rest, RICE really will alter the underlying inflammatory process in a productive way.

It takes many, many weeks for the protein fibers in connective tissue to interconnect and become really strong.

There is no foolproof way to know when exercise can begin, or how fast to advance our exercise level.
We tend to use pain as a guide - return of pain indicates inflammation is beginning again because of reinjury.
So sometimes it is two steps forward and one step backward.
The danger in a "go-getter" like you or Nadal is not to make it one step forward and two steps backward by doing too much exercise too soon.

At least you are doing the best thing now by resting, so that the process of healing can occur as straight forward as possible, instead undergoing multiple episodes of partial healing and tearing, partial healing and tearing that leads to fibrosis and tendon degeneration.
charliefedererer is offline   Reply With Quote