October 13th, 2012
It’s not too often skiers are diagnosed with Achilles tendinitis, but it can happen, especially during running intensity the athlete isn’t accustomed to, tight calf muscles (gastrocnemius and soleus), improper form, or ill fitting ski boots and shoes. Ideally any exercises performed should be pain free, so adjust accordingly.
Before taking on a rehabilitation program, first try to control the pain in your Achilles tendon. Depending on the stage of your injury, a multitude of options are available. Lots of heel stretching (See previous post, Part 1 of “Am I Imbalanced?”), icing after workouts, NSAIDs (ibuprofen), and massaging are good options to start with to control pain. Compression socks are also very popular to wear if activity isn’t too aggravating.
Through my experiences, I have found that eccentric exercises usually produce success in getting athletes back to full strength. Eccentric means an athlete is working on strengthening the muscle in an elongated position. Think of it this way, you are bench pressing and push the bar up quickly in a 2 second count, but you lower it to your chest slowly in a 4-6 second count. These types of exercises are often referred to as “negatives”. Another common example is when female athletes are unable to perform large numbers of pull ups, they can start with a negative pullup (getting a boost to hold themselves at the top of the bar, then lowering their bodies down in a 10 second count). Below are some great eccentric Achilles exercises to perform.
Exercise 1, “Heel Drops”: Find a box, or anything high enough and sturdy enough to stand on. This exercise is pretty basic, and is essentially taking calf raises and reversing them. Start by placing your heels off the back of the box, make sure to have a wall or something to hold onto so you don’t lose your balance. Drop your heels into the starting position, do a calf raise up in a 2 second count, and then lower yourself down slowly in a 6 second count back to the starting position. Repeat this at least 15 times, if possible perform 20.
Video here: http://www.youtube.com/watch?v=epgJdM2muzI
Exercise 2, “Single Leg Board Squats”: Find a slanted board if possible, and set against a wall so it doesn’t slide around as you move. Plus, holding to the wall for support will help with balance and safety. Stand about midway on the board on just your toes, pick which leg you want to start with. In an upright position, lower your body in a 6 second count to the bottom of your range of motion, then push up on your toes in a 2 second count. If you can perform this in front of a mirror, that will be helpful to make sure your knee is staying in a straight line, and not moving all over. The key to this is to not let your heel touch the board. Do 10 repetitions on each leg, add another set if you feel able.
Video here: http://www.youtube.com/watch?v=P2Cbr_SvdJo
Exercise 3, “3 Dimensional Lunges”: This exercise is not as focused on the eccentric aspect, but proper form and hitting all ranges of motion. Focusing on the three dimensions the body operates in is sometimes overlooked in rehab, and can be a secret to success. To start, go forward into a lunge position. On the return push back, really focus on using that calf in the behind leg to bring yourself back. Perform these squats slowly, it’s not meant to be explosive in anyway. After going forward with the lunge, step into the next lunge but aiming to the left. At a 45 degree angle. Return to the center, and the lunge to the right at a 45 degree angle. Going the three ways counts as one set, repeat 10 sets on each leg.
See video below for how to perform, just do it without the rotation.
Variation on Exercise 3: While performing the three different motions, a rotational aspect at the hips can occur as well. We do this because it turns the hip into internal rotation, which translates the tibia (shin bone) creating a different pull on the muscle. Hitting all these dimensions of the Achilles will properly ensure even strengthening throughout.
Video of the variation can be seen here: http://www.youtube.com/watch?v=W7R7VmBSy-c
These exercises can be done as preventative as well as rehabilitation. Part 2 of “Am I Imbalanced” will be out soon! Thanks to the athletes who helped me.