A prior blog about Achilles tendinosis discussed how treating a tendinopathy requires that you answer two questions. First: Does the patient have inflamed tissue or degenerated tissue? Second: Did this injury result in a compensatory movement pattern?
Let’s look closer at the importance of that second question.
Patients with Achilles pain will often favor the outside of their foot to offload the tendon. Pain triggers an adaptive behavior altering the activity of the agonist, synergist, and antagonist muscles supporting the ankle. Patients with Achilles tendinopathy typically demonstrate decreased activity in the tibialis anterior and plantar flexor muscles on the involved side. This may be attributed to the protective mechanism shielding the already injured tendon from further injury. If some muscles are not doing their job, that work has to be transferred to other tissues. There is a subsequent increased activation of the peroneal muscles to compensate for this mechanical deficit and this increased load may cause injury over time. Intermittent pain due to Achilles tendinosis will progressively impact the entire lower kinetic chain.
Check out the following video to see how compensatory movements destabilize the foot.
In short, your body has an optimal way of controlling and executing movements. Your brain initiates and coordinates movement. Your passive system, including the joints and ligaments, is the structural framework of the body. Finally, the active system of muscles and tendons shift the structure for purposeful movement. If any component is injured; other systems must adapt. In this case, if the Achilles tendon is injured, patients must change their movement to offload the tendon. This often requires using their passive system (bony architecture and ligaments) to bear extra load. In the foot, we see a series of reproducible adaptations to specific injuries.
Untreated foot pain will often lead to future injury
Patients with foot pain will often favor a supinated gait. They do this to unload the soft tissue of the foot and arch in favor of their bony architecture on the lateral foot. This lateral column of the foot affords stability but at the expense of a very inefficient gait. Over an extended period, these patients develop a Tailor’s bunion, i.e. 5th metatarsal head bursitis. See picture below.
A rapid increase in activity may overload the bone fast enough to cause a Jones Fracture. An athletic patient may compensate to avoid bony structural failure only to suffer from plantar fasciitis, posterior tibial tendinosis, or peroneal tendinosis.
There are repercussions from compensatory movements.
The most successful evidence-based providers identify and treat not only the chief complaint, but also those biomechanical compensations that will likely trigger future problems. ChiroUp allows you to prescribe preselected exercise protocols that incorporate ideal movement patterns for a given condition. In the case of a tendinopathy, ChiroUp will also include eccentric exercises to facilitate and strengthen the damaged tissue. This improves reliance and helps prevent reoccurrence of the condition. Together, we can redefine the standard of chiropractic care; making our profession the undeniable best choice for patients and payors.
About the Author
Dr. Brandon Steele
Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.
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