Achilles Tendinopathy in Runners
Unfortunately Achilles pain can become the bain of many runner’s careers. Whether you are an elite or a recreational runner it can affect you.
Achilles pain can come on acutely or more gradually with a seemingly insidious onset. Acute pain with a loud audible pop is known as an achilles rupture, and one which is difficult to miss. This article will deal with the less acute, grumbly tendons namely- achilles tendonopathy.
What is a tendinopathy?
A tendinopathy is a change is the tendon’s structure. When we overload the tendon, and do not allow it sufficient time to heal the tendon develops a ‘stress shield’.
Unlike what was commonly believed previously, there is not inflammation going on, and so the shift from tendonitis to tendinopathy
Tendinopathy can be divided into 3main stages
- Reactive- acute,painful, swollen, tender tendon following rapid increase in load(mileage, hills, speed)
- Dysrepair-follows on from the acute phase, tendon structure starts to change
- Degenerative- chronic, common in the older athlete, thickened with nodules. There is risk of rupture at this stage.
What to do?
What to do, will very much depend on stage your tendinopathy is at:
*Reactive stage/early dysrepair*
Decrease your running load. This may mean full rest when the tendon is particulararily angry. You need to be pain free at rest and during walking before you consider running.
When you commence running again bear the following in mind- pain should not go above 3/10 pain. Allow adequate rest between runs (24hrs+). Pain should resume to pre run level by 24hrs post.
Purchase a heel Cushion. These can be bought for approximately 7 euro from Murrays Pharmacy. The small elevation the cushion gives you, ensures you avoid compressive load on the tendon which is provocative for the tendon.
Consult with your GP/Pharmacist regarding pain relief. Anti-inflammatory medications have been shown to be of benefit in managing tendonopathies, despite there being no inflammation.
During the reactive stage, exercises such as heel drops are likely to aggravate the tendon. Opt instead for isometrics. Perform these on 2 feet on a step. Go up onto your tip toes, then return to neutral( rather than going into full heel drop) Aim to build toward 10-15reps and 3 sets of these.
Avoid the following:
Although it may feel like this is what the tendon needs, stretching can compress the tendon and aggravate it more.
Very flat shoes/pumps
As with the stretching, flat shoes can aggravate pain with compressive loading
Increase your strength
Unfortunately you can have a reactive tendonopathy going on alongside a degenerative tendinopathy. In this case management is similar to above.
With a more chronic degenerative tendonopathy you can start to increase strength training more without aggravating symptoms. You can progress toward eccentric exercises which ‘strengthen and lengthen’ the tendon such as heel drops
Gradually increase your mileage
As a general rule, increase your cumulative mileage by no more than 10% per week.
Address weaknesses elsewhere along the kinetic chain
As with many injuries, the area you feel pain may not be the source of your problems. Get assessed by a physiotherapist to address any weaknesses you may have. Runners need to perform strengthening exercises at least once weekly to prevent and treat injury.
Listen to your body
If you have a painful achilles which fails to improve with rest, get it looked at. Don’t ignore your symptoms.
Ellie Hartnett, MISCP