Sara's mother stood tensely concerned as her daughter came off the tennis court. "Honey, are you hurt? You're limping?" "I'm fine, Mom. Really. I ran too hard is all."
The ten year old was determined to play at Tennis Nationals in six weeks. "It will go away. I'll be fine," she told herself as she subconsciously rubbed her left heel cord. She vividly remembered the moment it happened. Two days ago rushing from one side of the court to the other, Sara tripped and felt her left foot stick suddenly on the court causing her body to lunge forward. After rapidly stretching her heel cord beyond capacity, she had a nagging feeling something was wrong and it was getting worse.
Even after another week she couldn't run, walking hurt, and her left heel cord was very sore, swollen and even warm to the touch. Sara and her mother both wondered what was wrong and what to do. The tournament was just over a month away.
After another week of unresolved symptoms, Sara ended up in my office. She seemed older than her ten years. She explained to me what happened and then asked:
1. What's wrong with my leg?
2. Why does it hurt?
3. What do I do?
4. Will I be able to play in the tournament?
The simplicity of her questions was penetrating. She went to the heart of the issue in a matter of seconds. Unlike adults who might feel the need to be careful with their questions or hesitate, children just say it. And, they know when you don't know. I discovered from Sara that answering her four questions is what every client wants. Simple but not easy.
Sara had achilles tendinitis which is caused by too much physical load. Exposure to too much force too quickly or for too long causes damage to the tendon sheath. The ensuing pain, swelling, warmth and dysfunction are all hallmarks of inflammation. The warmth comes from an increase in blood as small blood vessels dilate. The exudation of plasma and leukocytes from the leaky microvessels into the small space between the cells causes the swelling. The pain is from excitation of sensory nerve endings caused by mechanical compression from swelling and by chemical irritants released from the cells such as prostaglandin and bradykinin.
Many people think of tendon strength in physical terms as if an injured tendon is "torn" much the same way you tear a piece of paper. While this makes the injury easy to visualize, it is not exactly correct. A tendon is held together by a chemical bond referred to as a "cross link". The number and strength of these bonds determines the tensile force capacity of your tendon. As the oxygen levels within the tendon drop, the number and strength of the cross links drops as well resulting in a weakened tendon. Think of the cross links as a twisted rope. Twisting a rope increases its tensile strength. Collagen creates its strength as the cross links twist in much the same way. A weakened rope is often frayed and an injured, weakened tendon looks very similar.
If you follow certain rules, tendinitis is a short term condition lasting no more than three to four weeks in most cases. Stop the offending activity, start low load intermittent motion and protect the area from excessive force. Gradually increase load and motion week by week. The problem is most people fail to follow these rules. The result is a prolonged inflammatory cycle, weakening of the tendon and chronic symptoms.
For every client, think about Sara's four questions. When you answer each one clearly and concisely, your client list will grow, problems will be few and your days will be fun.
Make today count.
Author. Teacher. Therapist.