Achilles Tendonitis

Originally posted December 10th 2013

Achilles Tendontis: Don’t Let It Be Your Achilles’ Heel…

So you finally felt great on that 12 mile training run, finishing it with both legs underneath you and your dignity intact. You get home, get a quick stretch in, and kick back to relax and rest your tired legs. That’s when it hits you… It starts out as a dull, throbbing pain around your ankle but eventually subsides. The next morning, on your shakeout run, the pain returns and sends you shuffling home in agony. Take a lesson from Greek Mythology and understand that the Achilles tendon is not to be trifled with, as the demigod Achilles can attest. It will send you crashing down to earth, even from cloud nine.

So where is this tendon that reduces even the strongest of men to mere mortals? The Achilles tendon is a thick band of tissue that connects the calf muscles (gastrocnemius and soleus) to the heel bone (or calcaneus). When it gets over-stressed, this tendon becomes inflamed which results in serious pain. Sounds like fun, right?

Anatomy:

Let’s have a crash-course anatomy lesson. The Achilles is a tendon, which means it connects muscle (calves) to bone (heel). It is connective tissue, which means it doesn’t get an overabundance of blood flow, but does get more than a ligament (which connect bone-to-bone). I won’t get too nerdy on you and bombard you with overwhelming technical terms, but know that the tendon is surrounded by a sheath. There is a thin layer of lubricating fluid in-between which allows the tendon to flex and move smoothly.

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Symptoms:

Generally, pain will take one of two forms: dull, throbbing ache or sharp, shooting pain. Discomfort will be localized to the tendon itself, however stiffness of the ankle can also be sign of impending Achilles doom. The initial onset of tendonitis will usually occur post-run, when you may notice the aching pain. As it gets worse, it will slowly encroach upon your running reducing your pace to “hobble”. This is the life cycle of most tendonitis injuries, dull yet manageable at first…but if untreated, debilitating.

There are also some physical signs to be on the look out for. An inflamed Achilles tendon can tend to swell and be sensitive to the touch. The normal width of the tendon is probably around a half-inch, so if your Achilles has gone from from size of your index finger to that of a leather belt, you have a problem.

Causes:

Overtraining – The number one cause? Say it with me, “Over use.” Shocker. Working your body too hard too often, especially if neglecting strength and flexibility exercises, means disaster for any tendon.

Lack of flexibility – Tight calves are another common culprit. Your calf muscles are strong, so when they’re tight or tired it increases the demand placed on the Achilles with each stride.

Types of training – Speed kills. Getting overly ambitious with your speed workouts will mean your Achilles is having to work extra hard during the push-off phase of your stride. Hills (specifically uphill training) have the same effect. The Achilles has a major role in supporting plantar flexion (the action responsible for a runner’s push off the ground) and requires a great deal of stress. Activities that add to that stress are therefore a contributing antagonist to an Achilles injury.

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Footwear – This goes beyond improper running shoes. For ladies, frequently wearing shoes with a heel can actually act to shorten the Achilles tendon over time, making it more susceptible to injury when it is asked to stretch and support load. In addition, footwear that is over- or under-supportive will allow your Achilles to bow (due to pronation or supination), causing it to become irritated because it is no longer tracking linear.

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Shoe gouge – I’m aware this is not a widely recognized concept, but I suspect this phenomenon will catch on like wild-fire. This is the source of all my Achilles issues, past and present. Either as a result of my running form or the ankle-height of my preferred footwear, the top of my shoe will press on my Achilles and, stride after stride, causes severe irritation.

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Why It Lingers:

With excessive irritation (whatever the initial cause), scar tissue starts to build up. This spells disaster because it prevents the Achilles from tracking smoothly within the sheath, causing further irritation. In effect, this injury can take weeks or months to heal. But the real kicker? Once you start developing scar tissue build of the tendon becomes more susceptible to injury. So this means it is extremely important to stay on top of your recovery and treatment process.

Treatment: 

R.I.C.E. – Rest. Ice. Compression. Elevation. Learn it and live it. Rest for as long as it takes, because it is surely better to take the time off now than be laid up for a year with a tendon rupture. Also, making sure to ice regularly for 10-12 minutes in a bucket of ice water (preferred over a bag of your favorite frozen veggies). Investing in some calf sleeves or socks (we sell CEP at Sierra Running Co.) will increase blood flow, which helps to decrease required healing and recovery time.

Massage – Getting a thorough rub down of the lower legs helps to increase flexibility and break down scar tissue. Of course, I’m not referring to the “nap time” Swedish massages we all love, but rather a tendon-release, cry-yourself-to-sleep type of massage. In addition, investing in a foam roller to loosen up your lower legs at home is highly recommended. Trigger Point makes a plethora of goodies designed to keep you mobile while you rehab injuries. It is a worthy investment if you’re someone who battles injuries constantly. Some of the products include a stretching block, massage ball, and calf roller. All of these goodies and more can be found at SRC.

 Stretch – Are you 18 years old? No? Then you are no longer at the peak of limberness. Time to buckle down, and take the time to stretch – for real! You don’t have to be a gymnast, in fact research has shown that too much stretching can have a negative impact on runners (our muscles need a certain level of tightness to be effective), but neglecting a good stretch will mean muscle shortening… It goes without saying that this is not good either. Give major muscle groups at least 30 seconds each of your time, and be sure to do all those stretches that you hate…chances are those are the ones you need most.

Achilles stretch 

Shoe modification – If none of the aforementioned treatments have worked for you, consider the possibility that the heel cup on your shoes may be too aggressive or the heel itself comes up too high. This will be characterized by localized tenderness in a particular spot on the Achilles. If you put your shoes on and the point of pain appears to line up with the top of your shoe heels, this may very well be the source of your pain. A quick fix I employ is to simply cut a small slit into the top of each heel.Warning: It is advised that you attempt this with an old pair of shoes to see if this will alleviate your symptoms before you haphazardly hack away into some brand-new kicks.

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Take-away Message:

As always, listen to you body. It will not hesitate to let you know when it’s ready to roll or when it needs a break. The Achilles tendon has a short fuse and needs to be treated with respect. A rupture would mean total disaster, so make every effort to promote recovery should you fall victim to this injury.

I hope this guide has been helpful, and may your running endeavors be happy and healthy.

Best wishes,

Amanda

 

References:

Runner’s World. “Achilles Tendinitis.”

DISCLAIMER:

The author of this blog is not a physician. The article along with the information contained within it should not take the place of a physician’s care. Please see your doctor to determine the exact nature and treatment options for your injury.

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