Words: Paul Hobrough
One of the most common running injuries is the Achilles' tendon, the calf muscle attachment to the heel bone in the foot. This is becoming one of the most researched running injuries in modern times due to the number of people suffering and the new information coming to light month on month.
Why do we get Achilles' tendon pain?
The mechanism of injury doesn't have to relate to common held beliefs such as 'over' pronation, running style and footwear choice. These can be responsible but increasing age, previous injury and training faults (such as too much too soon) are key factors associated with any injury.
Once injured the Achilles' tendon will be stiff and sore after a period of rest, often seems to warm up during activity with pain levels reducing, only to return during your run, becoming worse the following day.
How should we manage Achilles' tendon pain?
A recent bout of Achilles injury is referred to as a 'reactive tendonopathy' which can be reversed with treatment and the correct loading exercise programme. Those with a long term Achilles injury most likely have a degenerative tendon and this is less likely to be restored to full health. However all is not lost as the healthy parts of the tendon can be maintained and running can be continued with pain tolerances low enough not to alter gait.
Let me simplify this statement: a tendon is like your most boring friend, they hate change! That is change in terms of an increase in activity just as much as a decrease in activity. So you see the runner who maintains a three session week, with pretty much the same programme each week, will more than likely maintain a relatively pain-free tendon, but a two-week holiday and total rest is as damaging as adding in a fourth session to their week and the result to the tendon is the same - discomfort on the next run and then the morning after.
Add to this recent research suggesting the Achilles' tendon is likened to a doughnut, with a central pillar and an outer ring. The outer ring is what we are able to adapt through the correct loading programme, whereas new beliefs are that the central pillar is unchanged by any intervention and actually reached its full potential at about the same time you celebrated your 17th birthday.
What is the best recovery approach?
- Stage 1 (two weeks)
Initially 'isometric exercises' or static holds on your tip toes, help to moderate pain. 3-5 X 45 second holds at about 40 degree angle from the floor.
- Stage 2 (four weeks)
Move on to heavy slow resistance with a three second lift and a three second lower phase in a metronomic fashion for 15 repetitions x3.
- Stage 3 (four weeks)
Lastly moving to eccentric loading, whereby you only load the tendon in the lowering down from tip toes, pushing back to the start on your good leg before repeating. Again 3 X 15 repetitions will suffice.
Both of the heavy slow resistance and eccentric programmes require additional weight to be added. A rucksack full of books may suffice but for the stronger among you a gym visit may well be needed.
The real trick is to make sure that the tendon can repair between sets. Collagen synthesis requires 36-hours to achieve this, so only do the exercises every other day.
For the degenerative tendons, you will need to maintain the heavy slow resistance three times per week for the duration of your running career - remember they hate change and they need constant strengthening for you to maintain the health tendon.
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