Complete Physio Podcast

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What is Achilles tendon elongation, why does it happen, and what can be done about it? In this podcast, Sam, a leading foot and ankle surgeon, and Chris, an experienced physiotherapist, explore one of the most common concerns after an Achilles rupture. They discuss how elongation develops during conservative and surgical management, how it presents clinically, why it's so difficult to reverse, and the surgical options available — including Z-shortening and FHL tendon transfer — when symptoms affect quality of life.

(00:00) Why Achilles tendon elongation matters
(00:35) The function of the Achilles tendon explained
(01:15) Demonstrating how calf contraction moves the foot
(01:53) What happens when the tendon heals too long
(02:30) How elongation presents for the patient
(03:18) Where in the recovery process things go wrong
(03:37) Delay to diagnosis and the initial gap
(04:41) Non-compliance with the boot protocol
(05:24) Re-tearing during recovery
(05:55) Ultrasound vs MRI for assessing the gap
(06:39) Why stretching too early is a problem
(07:12) Why elongation is so hard to reverse
(07:51) Protecting the tendon from week 10 onwards
(09:05) Can elongation happen after surgery too?
(09:38) Living with elongation: lifestyle choices
(10:22) Surgical options for an elongated tendon
(11:17) The Z-shortening technique explained
(13:14) FHL tendon transfer: what it is and why
(15:35) When to use FHL vs Z-shortening
(16:30) Realistic outcomes after salvage surgery
(17:30) When to consider corrective surgery
(19:08) Why clinical tests matter more than measurements
(20:57) Patient factors in the decision-making process
(22:50) Real patient cases from recent weeks
(24:07) How clinicians and patients can help prevent elongation
(25:13) Final thoughts and practical advice

🌐 www.complete-physio.co.uk
📞 020 7482 3875
📧 [email protected]

The information provided in this video is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as your GP or a registered medical professional, before beginning any new exercise program, making significant changes to your diet, or taking any new medication or supplements. Never disregard medical advice or delay seeking it because of something you have seen or heard in this content.

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🦶 Complete Physio: https://rdar.li/4Y3K8Dr
💉 Complete Injections: https://rdar.li/mZP48Vr

What does good conservative management of an Achilles rupture actually look like? In this video, Sam, a leading foot and ankle surgeon with decades of experience, and Chris, an experienced physiotherapist, break down everything you need to know — from diagnosis and early management, to boot protocols, rehab, and the risk of elongation.

0:00 Introduction and why this follow-up podcast exists
1:54 Why time of presentation is critical for conservative treatment
3:15 What happens if you present late after a rupture
4:21 Understanding the tendon gap and why the ends must come together
5:10 The role of ultrasound in diagnosis
8:05 Why "partial ruptures" are almost never real
9:22 Using ultrasound alongside clinical assessment
11:42 Clinical examination: why it remains the gold standard
13:45 Conservative vs surgical: activity level and sport type
14:45 Elite sport and why surgery is always recommended
16:00 What good conservative healing actually looks like
17:00 Boot protocols: back slab, aircast and the VACOped
19:22 Boot options: pros, cons and what the evidence says
21:43 Early weight bearing and why loading matters
23:01 Step count, lifestyle changes and managing activity
24:54 Wearing the boot 24/7: sleep, showering and safety
26:04 The risk of rerupture in the shower and at home
28:15 Week 6 onwards: reducing the angle gradually
29:08 Why elongation is the biggest fear in conservative treatment
30:00 Stretching: what not to do and why
31:43 When physiotherapy actually starts to matter
33:40 Coming out of the boot: heel raises and footwear advice
34:33 When reruptures most commonly happen and how to avoid them
36:26 Muscle stimulators and managing calf wasting
38:25 Realistic return to sport timelines — and why you can't rush it
39:37 David Beckham's rupture and what it tells us about recovery
41:19 Conservative rerupture rates: then vs now
43:00 The SMART trial and when surgery should still be considered
44:07 Top tips for perfect conservative management
45:55 Testing for elongation: the clinical signs to watch for

🌐 www.complete-physio.co.uk
📞 020 7482 3875
📧 [email protected]

The information provided in this video is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as your GP or a registered medical professional, before beginning any new exercise program, making significant changes to your diet, or taking any new medication or supplements. Never disregard medical advice or delay seeking it because of something you have seen or heard in this content.
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Understanding Chronic Pain with Lachlan Sutton | Complete Physio Podcast

In this episode, chronic pain specialist Lachlan Sutton breaks down what chronic pain actually is, why it persists long after injury, and what you can do about it. We cover the difference between acute and persistent pain, why the "wear and tear" narrative around conditions like osteoarthritis is often more harmful than helpful, and how the nervous system plays a far bigger role in ongoing pain than most people realize. Lachlan explains the three types of pain, how to read the signs that something more complex is going on, and why movement — not rest — is almost always the answer. We also get into how physio for chronic pain actually works: from functional assessment and goal setting to graded exposure, fear of movement, and why education might be the single most powerful treatment of all.

We discuss

0:00 Introduction & What Is Pain?

1:13 What Is Chronic Pain & When Does It Start?

2:28 When Should You See a Chronic Pain Physio?

4:56 Signs Your Nervous System Has Wound Up

6:26 Acute Injury Red Flags to Watch For

8:37 Pathways Into Chronic Pain

9:32 Osteoarthritis & The "Wear and Tear" Myth

13:00 Why Movement Feels Dangerous (But Isn't)

17:02 The Body as a Garden, Not a Machine

19:47 The Three Types of Pain Explained

23:01 How to Tell If Pain Is Structural or Central

26:48 When Scans Help (And When They Mislead)

33:00 Treatment Approaches: Where to Start

36:09 Fear of Movement & How Physios Address It

39:35 The Role of Passive vs Active Treatments

46:38 Are Patients Ready for Change?

49:59 Neuroplasticity & How Pain Can Unwind

53:11 Functional Assessment in Practice

56:17 Rethinking Posture & Core Bracing

59:31 Goal Setting for Chronic Pain

1:06:00 Awareness & Access to Chronic Pain Services in the UK

1:10:32 Building Trust With Complex Patients

1:14:00 Education as the Most Powerful Intervention

1:20:14 Lachlan's Favourite Patient to Treat
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This episode outlines key red flags, referral pathways, and when clinicians should consider physiotherapy versus GP or specialist review. The discussion explores transabdominal and transperineal ultrasound assessment, differential diagnosis, and evidence-based rehabilitation strategies for hypertonic and hypotonic pelvic floor presentations. Designed for doctors and healthcare professionals, this podcast highlights early identification, non-invasive assessment, patient dignity, and multidisciplinary management within modern UK physiotherapy practice. At Complete Physio, our clinics across Central London provide expert care in post-operative rehab, tendon and muscle injuries, lower back conditions, diagnostic ultrasound, and ultrasound-guided injections.
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Clinicians at Complete Physio (Central London) address common patient questions about steroid injections and travel. We discuss practical considerations when flying soon after an injection (post-procedural flare), rare but important risks including infection and delayed allergic reactions, and how destination healthcare access and travel insurance may affect decision-making. We also cover safe considerations around driving after injections, expected onset and duration of benefit, and planning injections ahead of key events or holidays. Finally, we outline red-flag symptoms requiring urgent assessment, and discuss injection options, including standard steroid injection vs hydrodistension for frozen shoulder, plus considerations for barbotage in calcific tendinopathy.
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