Achilles Tendonitis....
causes, treatments, nutritional thoughts (and a bone broth recipe!)
by Inez Kelleher, M.D.
The phrase “Achilles heel” has mythological origins and is defined as an area of weakness in spite of overall strength, a vulnerability. The mythological character, Achilles, met his demise when a poison arrow was shot into the tendon just above his heel. The Achilles is, then, a fitting name for this tendon, the largest tendon in the body.
The Achilles attaches the calf muscle to the heel bone and provides power during the push-off phase of running and walking. Achilles tendonitis is generally an overuse injury causing tendon tenderness, swelling, and pain with activity immediately or even the day after exercising. Pain and stiffness can also occur along the tendon in the morning.
Achilles tendonitis is common in runners. It is more common as you age and men are at higher risk for it than women. Injuries are related to increasing distance too quickly, training in worn-out shoes, and running on hilly terrain and very soft surfaces. Physical problems can increase your risk for Achilles tendonitis. These include leg length differences, hip weakness, tight hamstrings and calves, weakness in the foot muscles, foot instability, and flat feet.
Achilles tendonitis also occurs in people with certain medical conditions: those with arthritis, diabetes, psoriasis, high blood pressure and thyroid disease. Certain medications are associated with Achilles tendonitis. These include antibiotics (Levaquin, ciprofloxacin, and other fluoroquinolones) and a group of medications taken to prevent breast cancer, aromatase inhibitors.
Initial treatment of Achilles tendonitis starts immediately and lasts 1 to 3 days, the goal being to reduce the pain and swelling around the Achilles tendon. Runners should stop running. Ice the painful tendon, try compression stockings, and elevate the foot for 15 to 20 minutes twice a day or more. Shoes with a slightly higher heel or a heel insert raise the heel and support the tendon.
Once you can walk with minimal pain consider physical therapy, and specifically an eccentric exercise program. It is a heel drop exercise based on the Hakan Alfredson’s protocol. Gentle calf stretching exercises help stretch the muscles and aid recovery. A plantar fasciitis night splint worn in bed is excellent for preventing calf muscles tightening up overnight. Cross training with swimming, aqua running, and biking if not painful, is important to maintain your training. Depending on how bad the injury is, it can take six weeks to several months to heal.
Other treatments that have been studied include Nitroglycerin patches over the tendon, 88% effective compared to placebo, with possible pain and healing potential. Laser treatments, soft tissue friction, and ultrasound do not have clear-cut study results, but may be offered by treatment facilities. NSAID medications such as Ibuprofen, Advil or Naprosyn may be helpful for pain, but after the first few days the effectiveness decreases. Platelet rich plasma (PRP) injections, although with good results in other tendons, have not had as good results for Achilles tendonitis in recent studies. Cortisone injections are not used in tendons, but may help with pain around the tendon.
Although you may not prevent Achilles tendonitis, you can certainly decrease your risk for it. When starting a new training program, increase duration and intensity gradually. Warm up at a slower pace, stop and rest if you note Achilles pain. Choose supportive shoes and replace them when they are worn out. Take time to stretch your Achilles in the morning when you get up, before and after exercise to maintain flexibility. This also helps to avoid a recurrence of tendonitis. Add calf and foot muscle strengthening to help the tendon better handle the physical stresses with your activities. Add balance and stability exercises done without shoes to improve stability of both your feet and ankles. Cross train, alternating high impact activities (running, jumping) with low impact activities (swimming, biking).
Nutrition is important for healing and maintaining quality tendons and ligaments. Foods rich in Zinc, Vitamin C, Omega 3 fatty acids, collagen and protein give tendons the building blocks to heal and keep tendons nourished. Consider drinking an organic bone broth, rich in collagen and the supporting minerals and vitamins. There are many good recipes available. Drink a mug full of bone broth in the morning and at night to help the healing process.
Of course your doctor and physical therapist can help you with the proper exercises and treatments to get you through the healing process for Achilles tendonitis. It is up to you to protect the Achilles and turn a vulnerability into strength. See the bone broth recipe below the references.
- http://www.orthoinfo.aaos.org/topic.cfm?topic=A00147http://running.competitor.com/2016/02/injury-prevention/runners-sore-achilles_145752#Jv1Aw7TP3rTUUTrb.99
- DeLee JC, et al. Tendon injuries of the foot and ankle. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed July 9, 2015.
- Ham P, et al. Achilles tendinopathy and tendon rupture. http://www.uptodate.com/home. Accessed July 9, 2015.
Achilles tendinitis. American Orthopaedic Foot and Ankle Society. https://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Achilles-Tendinitis.as
Bone Broth Recipe
Calories: 379 per serving Prep Time: 10 minutes Cook Time: 25 minutes Total Time: 35 minutes
Ingredients
• 3-4 pounds beef marrow and knuckle bones
• 2 pounds meaty bones such as short ribs
• 1/2 cup raw apple cider vinegar
• 4 quarts filtered water
• 3 celery stalks, halved
• 3 carrots, halved
• 3 onions, quartered
• Handful of fresh parsley
• Sea salt
Serving Size: 3 Quarts
Procedure
• Place bones in a pot or a crockpot, add apple cider vinegar and water, and let the mixture sit for 1 hour so the vinegar can leach the mineral out of the bones.
• Add more water if needed to cover the bones.
• Add the vegetables bring to a boil and skim the scum from the top and discard.
• Reduce to a low simmer, cover, and cook for 24-72 hours (if you're not comfortable leaving the pot to simmer overnight, turn off the heat and let it sit overnight, then turn it back on and let simmer all day the next day)
• During the last 10 minutes of cooking, throw in a handful of fresh parsley for added flavor and minerals.
• Let the broth cool and strain it, making sure all marrow is knocked out of the marrow bones and into the broth.
• Add sea salt to taste and drink the broth as is or store in fridge up to 5 to 7 days or freezer up to 6 months for use in soups or stews.
causes, treatments, nutritional thoughts (and a bone broth recipe!)
by Inez Kelleher, M.D.
The phrase “Achilles heel” has mythological origins and is defined as an area of weakness in spite of overall strength, a vulnerability. The mythological character, Achilles, met his demise when a poison arrow was shot into the tendon just above his heel. The Achilles is, then, a fitting name for this tendon, the largest tendon in the body.
The Achilles attaches the calf muscle to the heel bone and provides power during the push-off phase of running and walking. Achilles tendonitis is generally an overuse injury causing tendon tenderness, swelling, and pain with activity immediately or even the day after exercising. Pain and stiffness can also occur along the tendon in the morning.
Achilles tendonitis is common in runners. It is more common as you age and men are at higher risk for it than women. Injuries are related to increasing distance too quickly, training in worn-out shoes, and running on hilly terrain and very soft surfaces. Physical problems can increase your risk for Achilles tendonitis. These include leg length differences, hip weakness, tight hamstrings and calves, weakness in the foot muscles, foot instability, and flat feet.
Achilles tendonitis also occurs in people with certain medical conditions: those with arthritis, diabetes, psoriasis, high blood pressure and thyroid disease. Certain medications are associated with Achilles tendonitis. These include antibiotics (Levaquin, ciprofloxacin, and other fluoroquinolones) and a group of medications taken to prevent breast cancer, aromatase inhibitors.
Initial treatment of Achilles tendonitis starts immediately and lasts 1 to 3 days, the goal being to reduce the pain and swelling around the Achilles tendon. Runners should stop running. Ice the painful tendon, try compression stockings, and elevate the foot for 15 to 20 minutes twice a day or more. Shoes with a slightly higher heel or a heel insert raise the heel and support the tendon.
Once you can walk with minimal pain consider physical therapy, and specifically an eccentric exercise program. It is a heel drop exercise based on the Hakan Alfredson’s protocol. Gentle calf stretching exercises help stretch the muscles and aid recovery. A plantar fasciitis night splint worn in bed is excellent for preventing calf muscles tightening up overnight. Cross training with swimming, aqua running, and biking if not painful, is important to maintain your training. Depending on how bad the injury is, it can take six weeks to several months to heal.
Other treatments that have been studied include Nitroglycerin patches over the tendon, 88% effective compared to placebo, with possible pain and healing potential. Laser treatments, soft tissue friction, and ultrasound do not have clear-cut study results, but may be offered by treatment facilities. NSAID medications such as Ibuprofen, Advil or Naprosyn may be helpful for pain, but after the first few days the effectiveness decreases. Platelet rich plasma (PRP) injections, although with good results in other tendons, have not had as good results for Achilles tendonitis in recent studies. Cortisone injections are not used in tendons, but may help with pain around the tendon.
Although you may not prevent Achilles tendonitis, you can certainly decrease your risk for it. When starting a new training program, increase duration and intensity gradually. Warm up at a slower pace, stop and rest if you note Achilles pain. Choose supportive shoes and replace them when they are worn out. Take time to stretch your Achilles in the morning when you get up, before and after exercise to maintain flexibility. This also helps to avoid a recurrence of tendonitis. Add calf and foot muscle strengthening to help the tendon better handle the physical stresses with your activities. Add balance and stability exercises done without shoes to improve stability of both your feet and ankles. Cross train, alternating high impact activities (running, jumping) with low impact activities (swimming, biking).
Nutrition is important for healing and maintaining quality tendons and ligaments. Foods rich in Zinc, Vitamin C, Omega 3 fatty acids, collagen and protein give tendons the building blocks to heal and keep tendons nourished. Consider drinking an organic bone broth, rich in collagen and the supporting minerals and vitamins. There are many good recipes available. Drink a mug full of bone broth in the morning and at night to help the healing process.
Of course your doctor and physical therapist can help you with the proper exercises and treatments to get you through the healing process for Achilles tendonitis. It is up to you to protect the Achilles and turn a vulnerability into strength. See the bone broth recipe below the references.
- http://www.orthoinfo.aaos.org/topic.cfm?topic=A00147http://running.competitor.com/2016/02/injury-prevention/runners-sore-achilles_145752#Jv1Aw7TP3rTUUTrb.99
- DeLee JC, et al. Tendon injuries of the foot and ankle. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed July 9, 2015.
- Ham P, et al. Achilles tendinopathy and tendon rupture. http://www.uptodate.com/home. Accessed July 9, 2015.
Achilles tendinitis. American Orthopaedic Foot and Ankle Society. https://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Achilles-Tendinitis.as
Bone Broth Recipe
Calories: 379 per serving Prep Time: 10 minutes Cook Time: 25 minutes Total Time: 35 minutes
Ingredients
• 3-4 pounds beef marrow and knuckle bones
• 2 pounds meaty bones such as short ribs
• 1/2 cup raw apple cider vinegar
• 4 quarts filtered water
• 3 celery stalks, halved
• 3 carrots, halved
• 3 onions, quartered
• Handful of fresh parsley
• Sea salt
Serving Size: 3 Quarts
Procedure
• Place bones in a pot or a crockpot, add apple cider vinegar and water, and let the mixture sit for 1 hour so the vinegar can leach the mineral out of the bones.
• Add more water if needed to cover the bones.
• Add the vegetables bring to a boil and skim the scum from the top and discard.
• Reduce to a low simmer, cover, and cook for 24-72 hours (if you're not comfortable leaving the pot to simmer overnight, turn off the heat and let it sit overnight, then turn it back on and let simmer all day the next day)
• During the last 10 minutes of cooking, throw in a handful of fresh parsley for added flavor and minerals.
• Let the broth cool and strain it, making sure all marrow is knocked out of the marrow bones and into the broth.
• Add sea salt to taste and drink the broth as is or store in fridge up to 5 to 7 days or freezer up to 6 months for use in soups or stews.