Achilles Bursitis
As you can read in the general blog about achilles tendon complaints, there are different kinds of achilles tendon injury’s. In this article we focus on achilles burstitis. The reason to differentiate between the different injuries is that they need to be treated differently.
What is Bursitis?
Bursitis is an irritation / inflammation of a bursa. This blog is about the 2 different bursas namely the Retrocalcaneal and the superficial bursa. (See image 1)
- The Retrocalcaneal bursa lies between the heel bone and the Achilles tendon.
- The superficial bursa lies between the Achilles tendon and the skin.
Symptoms
- Pain around the heel just above the heel bone.
- Redness, swelling, heat around the heel.
- Pressure pain around the heel.
- Pain when starting sports or immediately after getting up in the morning.
Test yourself
By squeezing the skin on the heel bone with your thumb and index finger, you can test whether the superficial bursa gives the complaints.
By squeezing the net behind the Achilles tendon at the attachment, you test the Retrocalcaneal bursa.
These tests are not perfect and it is always recommended to visit a specialist to check this.
Avoid compression
In the case of bursa complaints, it is important to avoid compression. To reduce compression, it is important to bend the ankle no more than 90 degrees (toes toward you). For example, avoid walking uphill or heel drop exercises.
Do not use shoes where the heel is very tight and therefore exerts pressure on the attachment of your Achilles tendon. Shoes with a higher heel may help to reduce the pressure, you can also use a heel enhancement.
And perhaps most importantly, do not stretch the calf muscles! Stretching the calf muscles causes compression and can make the symptoms worse!
What can you do?
Step 1 Isometric exercises
To reduce the pain and control the tensile forces, it is important to perform the following two exercises.
Exercise 1: Isometric M. Soleus holds
Execution: Stand on the toes, bend the knees to about 90 degrees and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.
Exercise 2: Isometric M. Gasctrocnemius holds
Execution: Stand on the toes, keep the knees extended and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.
Stap 2 Improve strength
When the pain is gone and the symptoms are gone, you can start training the strength of the calf muscles. Calfraises are the right exercises for this. You must do this exercise with both straight and bent knees. Below the explanation of the exercise:
Exercise 1: Heelraise stretched knee
Execution: Stand on one leg. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.
Exercise 2: Heelraise bent knee
Execution: Stand on one leg with bent knee. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.
During this exercise the complaints should not increase, if this is the case the exercise is still too heavy for that moment. What is important in exercise 2 heeled knee is that you do not get an increase in the symptoms. If this is the case, you should bend the knee less. For example, start with 10 to 15 degrees of knee flexion and build it to 25 degrees.
Stap 3 Running!
Now you start running again! It is important that you start up quietly, ask for help from your therapist. Make sure that everything you do is virtually pain-free. It may be that you get some sensitivity during the build-up, as long as it is a maximum of 4 on a scale of 0 to 10 you do not have to worry about it. If the complaints then go away again. See figure 2 as an example.
Besides starting to walk, it is important to do the following exercises.
Exercise 1: Triple extention
Execution: Stand on one leg with bent knee, bend your torso slightly forward. Now stand checked on the toes while simultaneously stretching your knee and hip. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.
Exercise 2: Calfraise stretched knee with resistance
Execution: Stand on one leg. Put a large resistance band around your feet and your shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.
Exercise 3: Heelraise bent knee with resistance
Execution: Stand on one leg with bent knee. Put a large resistance band around the feet and shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.
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