Achilles Tendinopathy

Achilles Tendinopathy refers to both micro tears and inflammation in the Achilles tendon. It is a common overuse injury, especially with runners and other activities with repeated loading on the Achilles tendon.

What is the Achilles Tendon?

The Achilles tendon is located in the lower limb and connects the calf muscles to the heel bone. It is the thickest and strongest tendon in the human body. There are two areas of the tendon that can be affected by Achilles tendinopathy.

a) The mid portion of the tendon due to micro tears
b) The insertion of the tendon onto the heel due to mechanical irritation

What causes Achilles Tendinopathy?

An increase in load (training volume) is usually the main cause of Achilles Tendinopathy. The other underlying factors generally include:

• Abnormal foot biomechanics (eg excessive rolling in or out or high arch)
• Calf weakness
• Calf and hamstring tightness
• Poor footwear (inadequate heel or decreased forefoot flexibility)
• Change in training surface
• Decrease in recovery time between training sessions

Signs and Symptoms of Achilles Tendinopathy

• Burning pain in the Achilles at the beginning of activity which lessens during the activity and worsens afterwards
• Stiffness in the tendon first thing in the morning or at the beginning of exercise
• Tenderness, heat or swelling around the Achilles
• Thickening of the tendon

How is Achilles Tendinopathy treated?

Achilles Tendinopathy can be treated successfully by:

  • decreasing load on the tendon
  • correcting underlying foot biomechanics
  • eccentric exercises

Therapies such as soft tissue massage, electrotherapy and taping can help speed up the recovery process.

Learn more about Achilles Tendinopathy

For more information or advice regarding Achilles Tendinopathy call us on 9819 6151. We are here to help and keep you moving well.

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Do you suffer from lower back pain?

Lower back pain is extremely common, affecting 8 in 10 people at some stage in their life.

The majority of cases of lower back pain (90%) are not due to a serious disease or serious back problem. They fall into a category called ‘non-specific lower back pain’.

Non-specific lower back pain

The cause of non-specific lower back pain can be hard to identify but often happen after lifting a heavy load or twisting awkwardly. In some cases, you can wake up with lower back pain. The pain can be mild to severe.

Causes of lower back pain

While the cause may be hard to identify, it is usually a strain of a muscle or ligament. In some cases, it can be a minor problem with a disc that sits in between two vertebrae or the facet joint, a small joint in between two vertebrae.

These episodes can easily be treated with physiotherapy to reduce muscle tightness and pain and quickly improve your range of movement. Specific and targeted exercise management is an important part of the treatment process to help prevent a recurrence.


More serious back problems

A small group of back pain patients (less than 10%) may have a more serious back problem. These fall into 2 key categories.


Nerve root irritation

This is where a nerve root exiting the spine becomes irritated causing pain into the buttock and down the affected leg into the foot. You may also experience pins and needles and numbness.

This is often caused by a disc in between the vertebrae prolapsing or bulging and touching the nerve root.

Physiotherapy can help milder cases of nerve root irritation. If the nerve root irritation is severe or continues you will need to see your GP and be referred to a Specialist for treatment.

Cauda equina

Cauda equina is a serious nerve root problem where the nerves at the base of the spine are pressed on causing not only lower back pain but also bladder problems (unable to urinate), numbness around the saddle area and numbness down one or both legs.

You must see your GP if you experience these symptoms as it needs to be treated urgently. Fortunately, cases of Cauda equina are rare.


Rehabilitation (including targeted exercise management) following an episode of lower back pain or following back surgery is important to help speed up your recovery process and reduce the risk of recurrence.

For more information on how we can help you manage your back pain, please call 02 9819 6151.

Hamstring Stretch

The Supine Hamstring Stretch

About The Hamstring

The hamstrings are a group of 3 muscles located at the back of thigh.  They attach to the bottom of the pelvis and extend across the knee joint to join to bone in the lower leg.

The hamstrings work to extend your hip joint, flex your knee and rotate your lower leg. These are all important actions in everyday activities such as walking, running, going up and down stairs and jumping.

Hamstrings become tight due to lengthy periods of sitting, not stretching after sport or muscle imbalances.  Tight hamstrings can predispose you to hamstring injuries and/or lower back pain so routine stretching of these muscles is highly recommended.

The Supine Hamstring Stretch

My favourite type of hamstring stretch is the Supine Hamstring Stretch.  It supports your back and helps with stretching the hamstrings particularly behind the knee.

  • Lie on your back with a belt around the foot of the leg to be stretched.
  • Slowly raise your leg up to around 45 degrees.
  • Slowly flex your toes towards you.
  • Then using the belt slowly raise your leg up higher to a comfortable stretch.
  • Remember to keep your knee straight.
  • Hold for 30 seconds, then slowly lower your leg back down to the ground.
  • Put then belt around the foot of the other leg and repeat the exercise.
  • Repeat 3 times each side.

What can you do to improve flexibility?

improving-flexibility-strive-physioThe good news is you can improve muscle flexibility and joint range of motion through stretching, despite physiological and other factors.

But what type of stretching is best?

Stretching can be grouped into 3 key types and all of these are important in keeping your muscles and joints at an optimum.

Dynamic stretching are slow, controlled movements

Dynamic stretching helps the muscles to stretch through their optimal length and take the joint through a full range of motion prior to doing an activity.

It targets the most intensely used muscles in the activity, increasing their elasticity and as a result reducing injury risk due to muscle sprain/strain. An example would be hamstring swings for runners prior to running.

Static stretchingis where a muscle is held in a lengthened position for 20-30 seconds.

It is ideal for stretching connective tissue and helps lengthen a muscle. It is best to be used as a cool down after an activity. An example is a hamstring stretch after running.

3.  Proprioceptive neuromuscular facilitation (PNF)

Proprioceptive neuromuscular facilitation (PNF) is a type of stretching that promotes elongation of muscle tissue.

It aims to optimise the neuromuscular ‘stretch reflex’ response of the body. This involves stretching a muscle passively to its end of range, then either holding or contracting the muscle for 6 seconds, releasing and then stretching the muscle further to a new range, repeating 3-4 times. Yoga and pilates exercises are a form of PNF stretching.

Important to do 3 forms of stretching

To optimise the flexibility of your muscles and joint ROM, it is important to do all 3 types of stretching.

To improve flexibility I recommend …

1.dynamic stretching prior to exercise

2. static stretching after and

3. doing a session of yoga or pilates once a week

Or, make time for a good PNF stretch program once a week to keep you supple.

Tips to remember when stretching

• Always warm up before stretching. Stretching when your muscles are cold could lead to injuries.

• Stretch to the point where you feel some mild tension. You should not feel pain. If you do, stop and release the stretch. Try again in a shorter range, build up to the increased range.

Flexibility: why it is important

exercise-improves-flexibilityFlexibility is important in day-to-day activities and sports. It allows for greater comfort and ability  – and reduces your risk of injury.

To initiate movement, your muscles contract (shorten).  How well they contract will depend on the initial resting length of the muscle.

And, for any movement, there is an optimum resting length to gain the optimum contraction your muscles.

For example …

Turning your head

Turning your head while driving is something we do regularly. This requires optimum resting length in your neck muscles and a muscle contraction.   If the resting length of your neck muscles is less than optimum (shortened) , you won’t be able to turn your head to the desired range.

When you can’t turn your head it means some muscles are too tight and the optimum tension is not correct.

Bending over

Think about bending over to touch your toes. If you can’t bend over like you used to, your hamstrings may be too tight and need lengthening.

What is flexibility?

Flexibility refers to the mobility of your muscles and is defined as the Range Of Motion (ROM) of your joints or the ability of your joints to move through different planes.

There is a balance between the initial resting length of a muscle and the contraction of a muscle to build the right tension to move your joints.  This impacts on the joint range of motion.

  • If the resting length of a muscle is too long, or too short, it will affect the ability of the muscle to contract.

Why is flexibility important

Improves skill level

Good muscle and joint flexibility allow your joints to accommodate all the different angles required for everyday movements or sport-specific movements.

Decreases risk of injury

A balance between the length versus the tension of muscles reduces your risk of injury, particularly muscle tears or sprains.

There are several groups of muscles that show a tendency towards tightness.

These include the:

  • hamstrings
  • calf muscles
  • pectoral muscles and some
  • back muscles.

These muscles are often implicated in musculoskeletal pain, especially back pain and are prone to strains.

Increases efficiency

When muscle length and muscle contraction are optimised, you can obtain maximum muscle power and efficiency for your chosen sport or activity.

For example, when running …

If you have optimal length and tension in hamstrings, quads, hip flexors and gluteal muscles when you are running, this allows for:

  • an increase in speed
  • less fatigue over longer distances
  • overall enhancement of your running enjoyment due to less pain in your legs and lower back

Flexibility can be limited by …

High muscle tone

High muscle tone occurs when the muscle is overworked or tense. Nerves supplying the muscle continue to provide a low-level discharge. This means the muscle cannot fully relax so the resting length is altered. This limits the full range of movement of the joint to which the muscle is attached.

Stretch reflex

As a muscle is rapidly stretched there is an automatic neuromuscular response – the ‘stretch reflex’ which limits overstretching to prevent injury. Where the length and tension relationship of a muscle is reduced, this reflex can start earlier, limiting the joint’s range of motion.

Change in muscle and connective tissue

As we age, muscle fibres are gradually replaced with fibrous connective tissue which is less elastic. This increases the stiffness of the joint, limiting the range of motion of the joint, particularly in highly mobile joints such as the shoulder and hips.

Bony change

Bony changes in the joints due to ageing or injury can affect how the surfaces of the joints line up decreasing flexibility and decreasing joint range of motion.

Poor posture

Poor posture can reduce the optimum length and tension relationship of skeletal muscle leading to stiffness in the joints as they are prevented from moving through their full ROM.

Try this activity and see if you notice the difference in your arm’s range of motion.

  1. Sit in a slumped position and raise your arms up over your head.
  2. Now sit on your sit bones, stack your spine up long and now raise your arms up overhead.
  3. Do you notice the difference?

Previous injuries

Injuries to muscles and connective tissue can lead to a thickening (fibrosing) of the soft tissue. Fibrous tissue is less elastic and can lead to decreased resting length of the muscle and reduced range of movement (ROM) in the affected joint.




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