Preventing and managing the most common and annoying running injuries – Achilles tendonopathy

One of the most common running injuries I come across in recreational runners is Achilles tendonopathy, more commonly known as Achilles tendonitis – suggesting there is inflammation in the tendon, however this is not the case (more on this later). I’m going to talk you though how to prevent this running injury, and how you can manage it if you are already suffering from it.

Achilles tendonopathy is a debilitating condition and can be devastating for your preparation for a long distance running event and seriously hamper your performance. It can get so bad that you wake up in the morning with very stiff and painful Achilles tendons, it can be agony getting out of bed and down stairs in the morning and there is no chance you will be able to put in that early 5k before work.

This condition is wrongly thought of as an inflammatory condition – thus the outdated term tendonitis, however it is not. What happens is that the tendon gradually fails to adapt to the load that is put through it (your running volume) and the collagen fibres within the tendon begin to degenerate. The tendon cells that reside between the collagen fibres, known as tenocytes, begin to produce more ground substance, which is water and proteins that help to support the collagen fibres. This extra ground substance produces a thickening in the tendon that is perceived as swelling. The more pronounced the thickening, the worse the degeneration and pain generally is.

The extra ground substance requires more oxygen and so new blood vessels and nerves begin to grow in to the tendon from the underlying fat pad. This neovascularisation can be seen on a Doppler ultrasound and it is the new nerve growth into the tendon that can create the pain.

If the tendonopathy is severe enough surgery is required where a surgeon will literally scrape the new blood vessels and nerves off the edge of the tendon and stitch the wound back up. However, this condition can oftentimes be managed without surgery. A good physiotherapist can use soft tissue techniques or Graston technique where they literally try to breakdown and shear off the new blood vessels and nerves through the skin. These techniques are effective but quite painful, but a few sessions of painful soft tissue work can reduce the discomfort you get whilst out running. Assessing and correcting any biomechanical defects at the foot and pelvis is also very useful to correct this condition and any good physiotherapist, osteopath or chiropractor can help you. It might also be worth visiting a podiatrist or going to a shop such as Sweatshop where you can get your feet analysed and you can buy trainers that suit your feet and your running style.

The best exercise to manage, prevent and treat Achilles tendonopathy is to do calf eccentrics. This is where you do a conventional two legged calf raise lifting yourself up on to the ball of your toes. You then switch all your weight on to the affected limb and slowly lower yourself down, letting your heel drop below the level of your toes so you feel and strong stretch in your calf and Achilles tendon. You then lift yourself back up with two legs and repeat for 15 repetitions. You can perform this exercise with a straight and a bent knee to hit different portions of the calf.

The best ways to prevent yourself from suffering Achilles tendonopathy are:
1. Make sure you have a good pair of running shoes such as Asics or Nike. Go along to one of the specialist running shops, such as Sweatshop where they can analyse your feet and provide you with the best running shoes.
2. Get you biomechanics checked by a manual therapists (physiotherapist, osteopath or chiropractor) to make sure your pelvis and spine are aligned and that you have good range of motion in the feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury. This is how top athletes avoid injuries – they have people assessing and working on them to prevent injury.
3. ALWAYS warm up the calf, Achilles and ankle joints prior to exercise. See my video blog post where I show you how to do this.
4. ALWAYS warm down after exercise by gently stretching the major muscle groups of the legs including the two muscles in the calf.
5. Use some self myofascial release on the plantar fascia and calf with a prickle ball and foam roller. See my video blog post where I show you how to do this.
6. Use an undulating periodised training plan to peak before your main run of the season, also make sure you taper your volume leading up to your main event. Don’t just go out and run as far as you can each time you train. This is a sure-fire way to breakdown at get injured.

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