Vivian Grisogono

Achilles tendon soreness

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Achilles tendon soreness and pelvic imbalance

A: Many thanks for your kind e-mail. I am very glad you were able to access my website through Google.

I would agree with the advice not to use a heel-lift to correct your leg imbalance. Where the difference is caused by a tilted pelvis, the term is "apparent shortening" of the leg. It is generally better to try to do rehabilitation exercises to reduce muscle imbalance round the pelvis, rather than allowing the imbalance to remain. it would probably get worse if you used a heel lift.

It is important to try to sit and stand in good alignment as much as you can, and avoid crooked or twisted positions which increase the imbalance round the pelvis.

It might be different if there was a real difference in leg length, shown by measuring the leg bones on either side. If there is a direct relationship between the shortening and any physical problems, then a heel raise can help.

In cases of Achilles tendon soreness , the shoes are most often the major or only cause of the problem, so they have to be corrected or replaced. Stiffness in the hip(s) can be an important contributory factor. As you have a tilted pelvis, it is likely that your left hip is limited, if only slightly. The way to tell is to lie on your back with your legs straight, and let your legs relax completely. If one leg turns outwards less than the other, the hip is stiff, and should be corrected gently by turning the leg outwards at every possible moment, also stretching the adductor (inner thigh) muscles.

It's also useful to do hip abductor exercises: for instance stand on one leg and lift the other out sideways 3-5 times; if it's harder to keep your balance on one side, you need to practise the exercise until both sides are evenly balanced. Another is to lie on your back with your knees bent; lift your hips up, straighten one leg, bend it to replace the foot and straighten the other leg, then lower your hips; if it is harder to do on one side than the other, do more repetitions on that side. If you don't have any shoulder problems, you can do the side-raise exercise: lie on one side, with your body straight, and rest on your elbow; lift your hips up sideways, slowly lower; repeat 5-10 times on each side, depending on how difficult you find it.

Of course you need to be doing calf stretching and strengthening exercises, especially slow movement work for soleus. But never do exercises which cause or exacerbate pain - that's a golden rule.

Q: I very much appreciated your kind and detailed reply and have looked seriously at my shoes since receiving it! I'm not, and have never been, a high heel wearer but I am at fault for wearing trainers with rather high and stiff "achilles heel" guards/supports! Ironic that a selling point can cause actual damage.
Q: First of all, a big thanks. After googling sore Achilles tendon, your page came up with an exact description of my problem, including a thickening in my Achilles tendon and the fact I only suffer the problem on my left hand side.

I have a tilted pelvis which means my left hand leg is roughly 1/2 to 1 inch shorter than my right leg. I've been told not to wear a left heel lift to correct this, as the subsequently disturbed mechanics of my lower back might actually cause additional problems.
However, I'm now wondering if the shorter leg, alongside shoe problems, is also factor in the inflamed tendon.
I would be interested if you had any comments on this.
Female, 56, UK

My current trainers have a shaped piece in the achilles tendon area but it is quite soft and malleable so I'm assuming it will be okay. However, the previous two pairs could both be the cause of my present problems.

I don't think I have too much of a problem with stiff hips. I tried your test and found both feet fell sideways about equally. My lower back is fairly rigid due to quite a history of back problems (starting in my teens and generally continuing to date - I'm now 56) and I compensate with my hips when bending. I also kayak quite a lot so have fairly good inner core muscles in my lower back and pelvic area. Since I began kayaking I've found my lower back problems have generally lessened. Upper back problems are in the process of being dealt with! An osteopath once said of me "I don't know whether you're an osteopath's dream or an osteopath's nightmare!"

I walk quite a bit - nothing too far or strenuous, but enough - and I think my posture and leg muscles are all fair. However, I shall try out your exercise. Sideways leg lifts are possible to about 65-75 degrees. The hip lift is a bit hard! The lying on the back, hip lift and leg straightening is no problem.

I'm gently massaging the achilles tendon - I can feel a slight lump on it - and am rubbing it with arnica cream from time to time.

A: Thank you for the update on your Achilles tendon problem.
Firstly, don't worry about the slight lump in the tendon. That will heal in time, with the gentle massage, provided you don't wear shoes which irritate it, even to the slightest degree.

The newer shoes with the slightly raised, softer back will certainly be better than any you were using with rigid high backs, but I still recommend modifying them, to avoid any possible friction. The best way is to do the two cuts. on either side of where the Achilles tendon lies, so that the back becomes a loose flap. Once the tendon is sensitive, even the slightest pressure causes irritation. It may also help to use shock absorbing (polymer) heel pads.

It is good that your hips are apparently evenly balanced. The side raise exercise is worth persevering with (with due care) as it will help your kayaking. It's also good that the kayaking has helped your lower back problems, presumably by helping to stretch the area out. If I may suggest, as a help for your upper back region, it would probably be a good idea to do the prone head-and-shoulder exercise: lying on your stomach, arms alongside you, lift your head and shoulders just a little way and brace your shoulders back, then slowly lower, 10-20 times. It's also most helpful to use a lats pull-down machine, if you ever go into a weights gym. It's very common to experience pain and inhibition in the upper back / shoulder girdle in conjunction with the menopause, so exercises to protect these areas are strongly recommended, if your practitioner agrees of course.