Achilles Tendinosis.

In Greek mythology, Achilles was the Greek hero of the Trojan War, and the central character of Homer’s Iliad. This seemingly indestructible warrior was brought down by Apollo, who managed to shoot an arrow into his achilles tendon.

The story of Achilles is unfortunately played out time and time again with seemingly indestructible runners, as the injury develops just above the heel on the tendon.

Where does it hurt?

It is quite simple to work out if you have it; simply pinch the tendon between your thumb and forefinger, and as you move up the tendon you will find some really tender and painful areas.

Development of the injury.

The injury is normally first felt as a runner climbs out of bed in the morning. The tendon has had the night to stiffen, and so as the foot gets placed on the ground a feeling of tightness is felt above the heel. The sufferer will limp around for a while until the area settles.

If the injury is  allowed to develop, the pain will manifest after longer runs and speed workouts. Ignore the issue and you will eventually be aware of almost constant pain.

Why does the tendon get injured?

There are a number of factors that need to be considered.
– Excessive pronation. A pronating foot will cause a moment where the tendon is whipped into added tension and thus damaged. The area has a relatively poor blood supply and thus repairs more slowly than other areas.
– Running gait. The so called, “minimalist running revolution,” that had runners attempting to land on the toes, drop down on to the heel and then take off again, caused the near death of many achilles tendons. 98 percent of runners land on the heel and then push off from the toes. Don’t fall for this fad- it caused way more harm than good.
– Running shoes that are too hard for the particular runner. The tendon and calf muscles very often require a slightly softer landing. This makes running shoe choice so important in this regard. Too soft a shoe can allow too much pronation to go through the system,
and on the other side of the coin; a hard and structured shoe can also injure the system.
– Sudden increases in distance and speed. You need to take time to build up your distances, speed sessions and hill repeats. Fitness is all about adaptation. Allow your body sufficient time to adapt. I am a firm believer of not increasing your running distance by more than 10% per week.
– Not stretching enough. I have met so many runners who have very proudly told me that they never stretch, and then go on to describe the injury that they have.
– Age. Runners who for a long period of time have run both longer and faster than their counterparts are more prone to Achilles injuries.
– Hereditary factors. Tight muscles, very mobile or very stiff feet all play a part. Runners with a wider Q angle can also be more prone. Research indicates that people who are genetically more prone to pronation are more at risk. They tend to land with a more supernated foot, (on the outside of the foot) and then have the foot flick into a pronated position more rapidly than most. Some pronations take place quicker than what the human eye can effectively pick up.
– A tight Superficial Back Line. Myofascial therapists will never just look to the tendon. Work is often needed higher up on the chain. Tight hamstrings, glutes, lower back etc can all play a part.
– Running in flat minimalist shoes.
– Wearing high heel shoes. This will shorten the calf muscle and can even weaken it.

What do you do with the injury?

• Attend to the injury sooner rather than later. Understand that this can take months to get rid of.
• Eccentric muscle strengthening is vital. I advise people to stand with the balls of their feet on a brick or short step. Start in the stretch position with the heels flat on the ground, hold for 3 seconds, rise up slowly over three seconds, hold the heel in its highest position for three seconds, and then move into the eccentric muscle strengthening phase by lowering the body slowly over three seconds. Do at least 3 sets of 10, 4 x a week.
• Anti inflammatory and corticosteroid medicines are usually ineffective. There is also not much proof that laser, ultrasound or electrical stimulation helps.
• Stop speed and hill work until fully recovered.
• Don’t be shy with the ice.
• Make sure that you get into the correct running shoe. The decision can get quite complex. Cognizance needs to be taken regarding pronation levels, heel drop, the stiffness of the midsole etc.
• Make sure that muscles such as the piriformis muscle have not tightened. This will alter the angle that the foot strikes the ground at.
• Throw away all copies of the book, “Born to Run”.
• Get the area massaged. This needs to include the tendon, calf muscles and perhaps even higher up the chain.

I hope this information helps. Give us a call if we can help with shoe selection, a Runner’s Leg Assessment, or Myofascial release of the area.

Regards,

Mike Roscoe.
Kinesiologist.