Achilles pain – Rest or Run?

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Achilles Tendinopathy (as it’s called these days – not tendinitis) is a very common running injury, probably the most common we see in the clinic.  Symptoms can vary but typically sufferers experience stiffness upon waking in the morning. They feel tight and sore and feel as if it needs a ‘good stretch’. This doesn’t help, we can do better.

It has been suggested that the Achilles can tolerate up to 10 times your body weight! Tendons are very sensitive to changes in load. If load placed upon a tendon is above its capacity to tolerate load, injury can occur. The good news is they can adapt to gradual increases in load slowly.

Overload is due to many factors, some of the common ones include; Running more than normal, sudden increase in speed or hill work, a reduction in shoe drop, weak calf muscles, weak glutes, running technique deficiencies or a combination of these factors. Once tendons are overloaded they can be very sensitive and difficult to manage.

Have you got stiff ankles? Or hypermobile (flexible) ankles? Research suggests your risk of tendon injury is higher due to this.

As far as returning to running goes, I want my patients returning from Achilles injury to be able to single leg hop pain free before returning.  Then a gradual and guided return is key. Minimise speed work and hills early on. For chronic cases a jog/walk can be appropriate but sometimes I have my patients running more, but in different ways. Ie. longer, slower runs while cutting out the intervals and hills. It depends on your condition.

Keep an eye on tendon pain and sensitivity after running – particularly a day or two after a hard session. There is a latency with tendon pan and often they can feel very good during running, only to respond with symptoms 24-48 hours later. Monitor this when increasing running load. If you flare up, reduce the duration or intensity of your session next time until you recover well.

Addressing other factors is vital. Treatment for Tendinopathy is rapidly developing and in recent years it’s been a changing landscape. Less focus on stretching and more on loading. More on this in a later blog. In addition heel wedges, higher drop shoes, addressing other strength deficiencies and even looking at Running Technique and Training Plans is needed.

In summary, don’t wait around for your Achilles to get better, get an accurate diagnosis, be familiar with how your tendons behave and start managing it better.

Phil de Mestre – Sports Podiatrist and Runner

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