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Matthew is suffering with on-going achilles pain

Apr 25th, 2016

Good morning SIX PHYSIO,

For a year I have suffered with a pain in my left Achilles muscle. This has ranged from unable to walk without shooting pains to a annoying but bearing pain where the muscle meets the heel.

The NHS physio has recommended I work on my glutes, as they’re not ‘firing’ and doing whats required mechanically and the kinetic chain is bearing the brunt of it.

I have being working on weighted squats/lunges, clams, bridging and hip extensions.

IS THERE ANYTHING MORE I CAN DO? The pain seems to have worsened and for no reason except the glute is weak,

Thank you

Apr 25th, 2016

The Guru Responded:

Yessssss.

Quite a lot.

Achilles become problematic because they cannot handle the (excessive) load that is put through them – it’s why stretching is a great idea.

Excessive load comes from a few differing places but the most common one is a lack of control as to how your foot rolls in when you are out and about. The foot rolling in is very normal and natural but it’s the control of this rolling in which is key. Things like orthotics may help this as will things like improving the “firing” of your gluts, especially med as this lift the leg out, back and rotates out from the hip. Following down the chain this now helps control the rolling in of your foot, or pronation.

You don’t just wake up with poorly “firing” gluts – they do work but not effectively at the right time and place in the walking/moving – they’ve changed their timing/control/firing because of something. You need to know what this something is or all the rehab your doing is only trying to improve the “firing” without changing the underlying cause.

Having an Achilles problem will cause an issue with your gluts as will how you move your back cause an issue with your gluts.

It’s chicken and egg – but as long as you roast the chicken and scramble the egg, you still get fed.

I go along the lines of (especially when (good) rehab and load management has failed) do something different to what you’ve done.

I’d be more interested in getting the middle bit of your back to move better to allow your lumbar spine to sit in a more natural position to allow your gluts to function normally/better in things like squats and lunge. I’d also find out just how much load you can take through your Achilles before it says “enough”. It’s a little like Goldilocks and the 3 bears. You don’t want too much load or too little, but just the right amount.

So I doubt it’s “just” your glut, but might be about how you move your back, how you load your tendon or even how your nervous tissue processes pain…..

Far from simple, but you need to do the right stuff for the right amount of time.

Maybe get another set of eyes on your Achilles?

The Guru

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