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Sports Medicine Updates. Grupo cerrado. Opinión entre pares
Paul Newcombe
The importance of considering 3 Dimensional Sports Rehabilitation with Achilles injuries
3D Sports Rehabilitation: The Achilles
Background of Achilles injuries in sports
Achilles injuries are one of the most common injuries to the lower leg. The Achilles injury is most commonly caused when an athlete is running, with the foot in contact with the ground. This often occurs during a dynamic change in direction, most commonly during the pushing off phase of the leg in contact with the ground upon the change of direction. This causes damage in the tissue ranging from a mild strain to a complete rupture. Although these injuries are often caught early enough and rehabilitated, often these are re-injured within a relatively short period, and often result in the once acute injury becoming a more chronic condition of Achilles tendinopathy. Athletes often re-injure the Achilles upon returning to running activities with change of direction work, and often when they return to full participation in their sport.
Alfredson et al (1998) state that in order to rehabilitate and Achilles tendinopathy injury, a protocol of eccentric loading of the Achilles tendon is to be followed. This consists of eccentric loading of the Achilles whilst lowering under control the return motion from a heel raise exercise, often from a step, working against gravity initially. This is repeated for 3 sets of 15 reps, twice a day, 7 days per week for 12 weeks, and studies have suggested that this has a positive outcome on Achilles injuries. There are however, occasions when this protocol has been followed, and there still follows further injuries to the Achilles, accompanied by a return of the original symptoms.
The ankle joint does not operate on one plane around a single axis. The ankle joint allows movement on all three planes around all three axis. As well as movements of plantar flexion and dorsi flexion on the sagital plane around the frontal axis, there is also lateral movement of the ankle joint along the frontal plane and sagital axis, and rotational movement on the horizontal a plane around the vertical axis. During the stance phase of gait, rather that the foot just moving into plantar and dorsi flexion on the sagital plane around the frontal axis, the foot also moves from supination into pronation, which in itself provides an element of rotation and lateral flexion. This places greater tension upon the Achilles that can be achieved when we follow just the Alfredson protocol of heel raise eccentric loading.
Importance of 3 dimensional approach to rehabilitation
In order to ensure that the Achilles is in a less vulnerable position when an athlete returns to running and change of direction work, there needs to be some element of rehabilitation that involves the other actions of the muscles that attach to the Achilles. This would ensure that we cover the other two planes of movement and ensure that these are sufficiently strengthened in order to reduce the chances of re-injury once we add in the functional movement of pronation and supination at the foot, which puts the Achilles at maximum stress. It seems unthinkable that we should follow Alfredsons procedures, without considering all 3 planes of movement that the Achilles is involved with around the foot/ankle joint. This can be easily achieved in the early stages of rehabilitation with the addition of some simple exercises in a two legged standing position, progressing to single legged, to ensure that the Achilles can assist in the control of the foot into pronation and supination, progressively moving into a dorsiflexed position which will progressively load the Achilles in a position that it will be in upon the commencement of running gait. This can all be achieved prior to commencing the more functional dynamic movements, reducing the risk of injury, and progression into a chronic state with the Achilles.
Background of Achilles injuries in sports
Achilles injuries are one of the most common injuries to the lower leg. The Achilles injury is most commonly caused when an athlete is running, with the foot in contact with the ground. This often occurs during a dynamic change in direction, most commonly during the pushing off phase of the leg in contact with the ground upon the change of direction. This causes damage in the tissue ranging from a mild strain to a complete rupture. Although these injuries are often caught early enough and rehabilitated, often these are re-injured within a relatively short period, and often result in the once acute injury becoming a more chronic condition of Achilles tendinopathy. Athletes often re-injure the Achilles upon returning to running activities with change of direction work, and often when they return to full participation in their sport.
Alfredson et al (1998) state that in order to rehabilitate and Achilles tendinopathy injury, a protocol of eccentric loading of the Achilles tendon is to be followed. This consists of eccentric loading of the Achilles whilst lowering under control the return motion from a heel raise exercise, often from a step, working against gravity initially. This is repeated for 3 sets of 15 reps, twice a day, 7 days per week for 12 weeks, and studies have suggested that this has a positive outcome on Achilles injuries. There are however, occasions when this protocol has been followed, and there still follows further injuries to the Achilles, accompanied by a return of the original symptoms.
The ankle joint does not operate on one plane around a single axis. The ankle joint allows movement on all three planes around all three axis. As well as movements of plantar flexion and dorsi flexion on the sagital plane around the frontal axis, there is also lateral movement of the ankle joint along the frontal plane and sagital axis, and rotational movement on the horizontal a plane around the vertical axis. During the stance phase of gait, rather that the foot just moving into plantar and dorsi flexion on the sagital plane around the frontal axis, the foot also moves from supination into pronation, which in itself provides an element of rotation and lateral flexion. This places greater tension upon the Achilles that can be achieved when we follow just the Alfredson protocol of heel raise eccentric loading.
Importance of 3 dimensional approach to rehabilitation
In order to ensure that the Achilles is in a less vulnerable position when an athlete returns to running and change of direction work, there needs to be some element of rehabilitation that involves the other actions of the muscles that attach to the Achilles. This would ensure that we cover the other two planes of movement and ensure that these are sufficiently strengthened in order to reduce the chances of re-injury once we add in the functional movement of pronation and supination at the foot, which puts the Achilles at maximum stress. It seems unthinkable that we should follow Alfredsons procedures, without considering all 3 planes of movement that the Achilles is involved with around the foot/ankle joint. This can be easily achieved in the early stages of rehabilitation with the addition of some simple exercises in a two legged standing position, progressing to single legged, to ensure that the Achilles can assist in the control of the foot into pronation and supination, progressively moving into a dorsiflexed position which will progressively load the Achilles in a position that it will be in upon the commencement of running gait. This can all be achieved prior to commencing the more functional dynamic movements, reducing the risk of injury, and progression into a chronic state with the Achilles.
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