Professor Nicola Maffulli 

The heel thing

Professor Nicola Maffulli explains an 'eccentric heel drop'.
  
  


What on earth is an "eccentric heel drop"? You mentioned it a fortnight ago as a way of overcoming tendinopathy.
Numerous readers

In eccentric muscle action, a muscle contracts while it is being lengthened. This occurs when, for example, we are descending stairs: in this situation, our quadriceps, the big muscle at the front of our thigh, contracts but lengthens while we go from one step to another. Nobody knows for sure why eccentric exercises work, but it is possible that they stimulate the dormant healing process in the tendon, or that they raise the threshold for pain. It is also possible that the heavy load imposed on the tendon destroys the nerve endings present in the tendinopathic area.

Here is the method I teach my patients. In this sequence, the affected tendon is the right Achilles tendon:

1. Stand with the ball of the feet at the edge of a step, holding on to the banister with one hand.

2. Take the right leg away, and stand on the left foot only.

3. Go on tiptoe on the left leg.

4. With the left foot on tiptoe, bring the right foot close to the left foot, keeping the right foot on tiptoe. Both feet are now on tiptoe.

5. With the right foot on tiptoe, take the left leg away.

6. You are now on tiptoe on the right foot only. Gently drop so that the right heel goes below the level of the step. You should feel the right Achilles tendon pull, and possibly hurt. If this does not happen, then you need to add weight. Start with 5kg, and keep on increasing in multiples of 5kg. It should hurt.

7. Keep the right heel down, and bring the left leg close to the right. Both heels will now be below the level of the step.

8. Take the right leg away, and stand on the left leg only. The left heel will still be below the level of the step

Remember, you can do as many of these as you like, but, if you do not stop the activity causing the tendinopathy in the first place, you will not benefit from them.

·If you have a question, email fitness@theguardian.com

 

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