viernes, 27 de julio de 2007

UN POCO DE INFO


Corto y pego lo más interesante que, sobre la tendinitis aquílea, aparece en la web http://www.achillestendon.com/. Está en inglés, y siento no verme con coraje de plantar una traducción decente. Me lo dejo ahí de recordatorio, para evitar tentaciones, porque tengo unas ganas locas de calzarme mis nuevas asics y el tendoncito de las narices dice que cuidadín con tocarle las ídems.



The Achilles tendon is fibrous tissue that connects the heel to the muscles of the lower leg: the calf muscles. Leg muscles are the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body. Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward. This contraction enables: standing on the toes, walking, running, and jumping. Each Achilles tendon is subject to a person’s entire body weight with each step. Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-12 times a person’s body weight during a sprint or push off. For more information on Achilles tendon anatomy see: Physiology.


Larger version of Achilles Tendon IllustrationsCauses of Injury Overuse, misalignment, improper footwear, medication side effects, and/or accidents can all result in Achilles tendon injuries. Multiple causes often contribute to the same Achilles tendon injury. For information on each of these Achilles tendon injury causes, see Causes of Injury
Preventing Injuries
The best way to prevent an Achilles tendon injury is to a) stay in overall good shape, and b) warm-up, stretch, and strengthen the Achilles tendons. The best way to prevent an Achilles tendon injury from getting worse is to address the injury immediately: it will get worse if not addressed. For more information on preventing Achilles tendon injuries see: Preventing Injuries.

Injuries
Undue strain results in over 230,000 Achilles tendon injuries per year in the U.S. alone. The undue strain could be caused by a variety of factors, including: tightness or weakness of the leg, knee, hip, or back; high or low arches; uneven leg lengths; alternating between high (2”) heels and exercise shoes; and/or sudden (rather than gradual) increases in training, such as running faster, further, or up steeper hills. The most common Achilles tendon injuries are Achilles tendinosis (formerly called Achilles tendonitis) and Achilles tendon rupture. Achilles tendinosis is a soreness and stiffness that comes on gradually and continues to worsen until treated. It often starts with stiffness and creaking when first getting out of bed in the morning. Lightly pinching the Achilles tendon with the forefinger and thumb will indicate soreness. Achilles tendinosis is a common injury among middle and long distance runners.



Treating Injuries
Treatment for Achilles tendinosis includes: relative rest, muscle strengthening, physical therapies (i.e. ultrasound, laser photostimulation, electrical stimulation), and ice.



Footwear
Correct footwear can be one of the keys to preventing, recovering from, and preventing the reoccurrence of, Achilles tendon injuries. Incorrect footwear can cause or exacerbate Achilles tendon injuries. Selecting the right shoe or sneaker in terms of cushioning, arch height, and pronation is always beneficial. Some people experience a tremendous temporary benefit from a little extra padding or cushioning under the heel. The temporary heel padding reduces the length of Achilles tendon stretching made with each step or stride.



Treatment includes five simultaneous steps. In cases of tendonitis an anti-inflammatory may also be used.


Relative rest. Stop doing the activity that caused the injury for between a week and a few months, depending upon the degree of degeneration. Relative rest should last at least 1 week for a grade 1 or 2 injury, at least 3 weeks for a grade 3 injury, and at least 1 month for a grade 4 injury. For an understanding of injury grades see: injuries. During the relative rest period also stop performing activities and sports that are similar to the one that caused the injury, i.e. soccer is similar to running, handball is similar to tennis, etc.
Achilles tendinosis is not an excuse to get out of shape: relative rest is the treatment, not total rest. During the relative rest period do alternate sports that are easy on the Achilles tendon, such as swimming, moderate cycling, upper body weight lifting, etc. After the relative rest period, resume gradually. For example, if you are a runner with a grade 3 injury resume with jogging until you are sure that you are down to at least a level 2 injury, then resume running moderate distance with no speed work or hills until you are down to at least a grade 1 injury, then resume running at the same intensity as prior to the injury.

Stretch the calf muscles
for 20 or more minutes per day. If the other leg muscles, the hip muscles, and the back muscles are tight, they may be causing tightness of the calf muscles, so stretch these other muscles as well. In addition to standard stretching, muscles can also be stretched by strengthening their opposing muscle group. For example, strengthening the anterior tibialis, the small muscle group on the front of the lower leg, stretches the calf muscles. As part of stretching, consider massage.


Eccentric strengthening of the leg muscles, particularly the calf muscles. Do daily or every other day calf raises on a stair or using a calf raise machine in a gym. Start slowly using just your body weight doing three sets of 10 or 15. When this can be done without pain, gradually increase the speed, number of repetitions per set, amount of weight, and number of sets. Concentrate on the eccentric rather than the concentric portion of the exercise (the calf lowering rather than the calf raising portion of calf raises). On each repitition, be sure to go all the way down for a full stretch of the Achilles tendon. Do the calf raises after, rather than before, any other exercises that you are doing.


Physical therapy. Therapies applied by professional physical therapists to repair tendon degeneration include: ultra sound, electric
stimulation, and laser photostimulation.


Ice therapy. Apply ice to reduce the degeneration. Ice should not be applied directly to the skin, use an ice pack instead. Apply the ice pack to the Achilles tendons after exercise or physical therapy. Apply as often and as for as long as possible.


Avoid anti-inflammatory and pain killing drugs. The anti-inflammatory drugs will not help because Achilles tendinosis is a degenerative injury rather than an inflammation (see injuries). The pain killing drugs will mask the problem, which is likely to cause the degeneration to get worse. In addition to being ineffective, anti-inflammatory and pain killing drugs are also expensive.
In the very worst cases of Achilles tendinosis, surgery may be required, but only as a very last resort. Consider surgery if all the above steps have been taken completely and repeatedly, and the Achilles tendinosis has not improved for at least six months.

12 comentarios:

Luzcecil dijo...

He llegado aqui por recomendación de Pablo, lo único que te puedo decir es que las asics pueden esperar, jejeje, llevo dos meses con el tendón lesionado y en parte por estrenar unas asics cuando aun no estaba recuperado el tendón, paciencia paciencia!!! Que lo que sobra es tiempo (no estoy muy convencida de ello pero trato de mantener la calma).

Saludos desde Mexico

Jorge Reynal dijo...

Pepe,

Paciencia hermano. No queda otra. Como veterinario me tomo el atrevimiento de prescribirte lo siguiente:
1. Fisioterapia (laser, ultrasonido, masajes, onda corta u otro de esos)
2. Plantillas hechas a medida. Me imagino que en Espana tambien se deben poder conseguir.
3. Evaluacion de tu forma de correr. Lo mas probable es que estes empujando hacia arriba en el momento de dar el paso. Lectura obligatoria: Chi Running por Danny Dreyer. Me cambio la vida.

Un abrazo y mucha suerte,

Jorge.

IRISHDECAI dijo...

El año pasado tuve que ir a Urgencias, y mira que he ido 2 veces en mi vida, por una Tendinitis Aquilea. Es decir se me puso el Tendon como una butifarra, pero al verlo el medico que me tuvo esperando 3 horas me dijo vale es una Tendinitis. Descanso, antiinflamatorios y tal. Desaparecio pero a los pocos meses volvio a aparecer, un poco menos inflamado pero volvio. Hay que mirar bien esa pisada, pero sobre todo lo que a MI, digo a MI, me curo del todo fue: la Tecnica de carrera y pasar de 108 kgs a 86 kgs y no quiero decir nada con esto pues aun con bajo peso si estas corriendo por superficies inadecuadas o con calzado inadecuado te vuelves a lesionar. Perdon por el tocho.

SlowPepe dijo...

Luzcecil: Lo primero bienvenida a esta página. Me voy en cuanto conteste a tu blog para devolverte la cortesía. Me parece que estamos en las mismas, con la cabeza diciendo eso de "paciencia" y el corazón pidiendo guerra. Pásate por aquí cuando quieras.

Wild: Eso pone, has leído bien. Lo que hace el artículo es distinguir entre tendinitis (más leve, para la que sí recomienda los anti-inflamatorios) y tendinosis (traducción libre). Para esta última patología, por sus características más degenerativas que inflamatorias recomienda evitar antiinflamatorios y analgésicos. Es un poco un galimatías para los que no estamos muy puestos en el tema.
Puedo andar (nos han jodido...) y hago estiramientos. También nado y en breve empiezo con el ciclismo moderado. Esto es muy lento, pero algo sí noto la mejoría.

Jorge: Agradezco tu prescripción facultativa. Está bien que venga de un veterinario porque la verdad es que a veces soy un poco animal (jejeje). Lo de la fisioterapia lo tengo en la cabeza si la cosa no mejora en breve (muy poquitos días). El médico deportivo me recetó unas taloneras de silicona que me elevan el talón descargando la presión sobre el aquiles y me mejoran la amortiguación del calzado. Debo decir que me analizaron la pisada en una tienda especializada en atletismo para comprar unas zapatillas adecuadas a mis características: mi pisada es neutra, y el calzado (asics gel nimbus) responde a ese perfil. El libro lo tengo, lo he leído ya un par de veces y coincido en que es altísimamente recomendable.

Irish: Seguramente has dado en el clavo. La lesión se produjo por sobrecarga. El incremento en los ritmos de entrenamiento y mi físico, poco etíope por decirlo así, se han unido para machacar ese tendón, que cuando no ha podido más ha reaccionado inflamándose. Esa es la realidad, y lo demás probablemente sean milongas.

De 108 a 86...mmmmmm...suena bien...

Un fuerte abrazo a todos

Syl dijo...

Pues te has quedao más ancho que largo, mira el tío...

Me lo voy a copiar por si algún día me lo tengo que leer con detenimiento (ojalá que no).

Haz mucho caso a los consejos que te dicen...no tengas prisa...que además las asics van a tener paciencia suficiente para esperarte lo que haga falta.

Besitos y mucho ánimo bonico.

SlowPepe dijo...

Sor Sylvie, siento el palazo de entrada. Estaba usando el blog casi como archivo de cositas relacionadas con la lesión.

No hay prisa, claro que no, porque hay un riesgo cierto de recaída a peor. Eso sí, por lo que respecta a mí, todo lo que corra este año es A TERMINAR, y punto.

Un besote, guapísima.

Luzcecil dijo...

Cómo va ese tendón?, paciencia y más paciencia, conciéntelo mucho que si se enoja luego se pone algo necio y ni quien lo soporte, jejeje.
No está de más un masajito con alguna pomada para desinflamar y hacer ejercicios para fortalecer el tendón. Consejos de tendón a tendón.

Un abrazo

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