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Ballet Talk for Dancers

Care of the achilles tendon


Pirou

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Ms. Leigh,

 

First of all, the more of this forum I read, the more appreciative I am of everyone's hard work and contributions here. This is a most fascinating place (both information-wise and, well, almost anthropologically...) So thank you so much everyone who posts and especially all moderators and administrators. This is a most unique and valuable community. Anyway...

 

Early in these pages (2001) you mentioned to a returning adult student that ordinary soreness was to be expected but that one should watch out for soreness in the achilles tendon. I've been experiencing a little tenderness in my left achilles and wanted to ask if you would elaborate on care for the achilles. E.g., should I take care that it not get sore at all; should I be most wary of stretching, pointing, relevé-ing, or all three; are there tell-tale signs of overuse that I can look out for; how do I know if I have overdone it, and if I have, what are some steps I should take in the aftermath, etc.?

 

Thank you.

 

(p.s., I just ask generally, not for "medical advice." If the slight tenderness progresses to something scary, I will certainly go see my ortho.)

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Victoria Leigh

Pirou, thank you for your nice words about our board! :)

 

The Achilles tendon is vulnerable, even though it is generally a very strong tendon. It receives a lot of stress, not just in ballet, but in many sports activities too. Tendonitis is a repetitive stress injury, so it's always important to try and figure out which stress is causing the problem. It can be over working, over stretching, too many relevés on one foot, too much jumping, landing incorrectly, etc., etc. Very hard to know, usually.

 

When there is pain in that tendon, the only way to heal it is to remove the stress, which means removing all stress, as you probably won't know exactly what is causing it. Anti-inflammatories may help, along with rest and ice, but compression is not a good idea. If you do not rest it in the early stages, it is highly likely to become worse and then take longer to heal. Elevate when icing, and try to elevate as often as possible.

 

Another thing would be to take care even when walking, especially in terms of what kind of shoes you wear. High heels are not good, but totally flat not so good either. Walking a lot in shoes without good support is never a good idea. Running not good either if there is any pain or even tenderness in that tendon.

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Pain in any tendon needs to be taken seriously. Tendonitis, which is an inflammation of the tendon causing the tendon fibers to swell, is caused by tight muscles working extra hard. The distinguishing characteristic of tendonitis is that the pain is more intense in the morning and diminishes with time, which gives one a false sense that there really isn’t anything wrong.

 

The treatment for tendonitis is the same no matter which tendon we are talking about. First, you have to stop doing what caused the tendonitis and then once the pain decreases you have to stretch the muscles attached to the tendon. I’m not in favor of taking any drugs to mask the pain as doing so may lead you to believe that you are really cured when you aren’t. Tendons also heal very slowly when injured. Physically active people are generally quite impatient when it comes to injury also.

 

The best preventative by far is stretching.

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Yes, but you must be careful not to overstretch too. Remember to stretch out your hamstrings and calves, and then your ankles. "The leg bone's connected to the, hip bone....." :)

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Mel Johnson

Also, remember that cartilage structures like tendons and ligaments are not very well vascularized, that is, they aren't fed by a lot of blood vessels. This is one reason why friction and hard compression can aggravate tendonitis. Soft compression, like the pressure of the leg on a fleece cushion should be sufficient while the leg is elevated. An Ace bandage or other elastic support is contraindicated.

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Oh dear, now I am very worried. Where last night I had mere tenderness, this morning I have actual pain, and am limping about like a wounded animal. As Garyect mentioned, it was worse when I got up and could not even stand, but as the hours progress, I can now gimp about a little bit. Certainly cannot point to full extension, rise on relevé, or press down into the ball of the foot at all (cannot actively use the tendon without pain.) Can stretch passively to full flexion if all the muscles are completely relaxed. I guess this indicates some kind of pull or strain. I don't have a ballet class till next Monday or Tuesday, and I think I should skip my spins and turns class tomorrow morning - it's not physically taxing and I can do everything flat, but perhaps it's wiser to do nothing? Will proceed with rest and icing and hope it's nothing serious. This being 41 stuff is for the birds.

 

:)

 

BTW, the side this is on is the substantially less flexible achilles (perhaps 1 to 2 inches less demi plié on this left side.) So perhaps once it is healed, I should concentrate on gentle stretching so that it can match my right side?

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Mel Johnson

Once it is healed, yes, but remember, it takes a rather long time for tendons to heal because of their poor vascularization. So, maybe a week after symptoms cease, then you can start up again.

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Oh dear. Well, that's a long time. Okay. Rats.

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ToThePointe

Just a note of sympathy, and to echo the warnings already posted.

 

I have tendonitis in both my ankles. I thought it was gone until recently when the "cold" set in (alright, I know it's Southern CA, but it's cold for us). At this point for me it is pretty chronic, every winter it sets in and feels like I have broken glass for achilles instead of tendons, but had I been smart years ago when it started, I wouldn't be in the shape I'm in now.

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My tendons got instantly better when I started massaging (deep-penetrating) them right after class. I also massage them right before class and make sure that they are warmed up. Since I started massage, I haven't had to take anti-inflammatory medicine. Pointe work is so much more enjoyable when ankles don't hurt :) Frequent stretching of ankles (not just the tendon area but all muscles in your ankles) also seems to help. Give it a try and good luck!

 

Eun Hee

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Victoria Leigh

Eun Hee, massaging the calf muscles helps to keep the Achilles tendon from getting tight, but actually massaging the tendon itself is not something I would recommend. Sometimes the tendon hurts because the calf is knotted up, and massaging that is fine. Not the tendon.

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lovelylight

Hello,

Just throwing my 2 cents into the pot. As a massage therapist, I was trained to use massage directly on the tendon insertions (where they attach to the bones) to help heal tendonitis. This massage, often consisting of cross-fiber frictioning, would be used in conjuction with general massage on the muscle itself, to loosen it and relieve pressure on the tendon. Cross-fibering will help to break up any adhesions which have formed in the tendon fibers, thus allowing them to heal in proper alignment, and massage itself will increase the circulation of blood and healing fluids to and from the area. As Mr. Johnson said, tendon tissues heal slowly because they don't have good blood supply--increasing the flow through the area with massage, along with applications of ice and heat, will help speed healing. It's very important to allow ample time for recovery, which means avoiding movements which cause pain, including stretching. Massage can relieve the pressure and increase elasticity of the tendon and muscle fibers, allowing the tendon to heal properly without further damage. As Garyect commented, athletes (dancers!) are not the most patient of patients and are prone to reinjury because they don't allow themselves enough time for proper recovery. I recommend regular massage for everyone to keep those muscles in good shape!

 

Liz

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Victoria Leigh

Liz, I don't disagree with that in terms of massage being done by someone who knows EXACTLY what to do and WHERE to do it. The idea of the student just massaging the tendon itself does not work for me. A trained professional, working on the muscle area, and the insertion area, is a different thing.

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Mel Johnson

"Kids, don't try this at home!"

 

Massage therapists have to be trained and licensed in most states, so they know especially when, how and where to rub! It's not something you can do yourself unless you've been specifically taught how to do it, and have refreshers now and then.

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