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Entr'acte with Annette
Annette Karim, PT, DPT, OCS
Director, Dance Medicine
Q: Do I have Achilles Tendinitis?
A: A: Perhaps, but if this is a recurrent issue, it's more likely that it is no longer an a tendinitis, which is an acute inflammatory response, and has become a tendinopathy, which is a chronic change in the Achilles tendon collagen, characterized by pain and aggravated with overuse. It is important to differentiate this from a posterior impingement, adverse neural tissue tension, or other possible causes for posterior ankle pain.
Q: What factors contribute to my having an Achilles Tendinopathy?
A: Many factors, such as tight heel cords, a small tendon mass, too much pronation (which can come from a weak posterior gluteus medius-allowing internal rotation and adduction at the hip, or weak posterior tibialis or weak foot intrinsics), not completing the relevé, a cavus or high arch foot with a Haglund's deformity (bump on the heel), altered knee mechanics, are some common findings in dancers with this problem.
Q: What can I do to make this go away?
A: Eccentric loading, 3x15, 2x/day for 12 weeks, knee flexed and knee straight heel drops. Additional hip strengthening exercises may be needed.
Q: When would I need to see a dance medicine PT for this?
A: When the tendinopathy prevents you from performing at your best. It is likely you need help with getting the rest of your body in a correct alignment through manual therapy, and then you will need skilled PT for fine tuning the sequence of muscle activation during your work at the barre, in center, in your dance movement.
Research references available upon request.
Contact me @ Evergreen Physical Therapy Specialists 626-683-8536 or akarim@ evergreenpt.net
(January 2012)
