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 The London Marathon 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 going 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outdated term tendonitis, however it is not.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 damaged
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 mostly 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 in
preparation for the London Marathon 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 heels 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 again 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:
- 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.
- Get you biomechanics checked by a manual therapists (physiotherapist or
osteopath such as at Re-Centre in Balham) 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.
- 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.
- ALWAYS warm down after exercise by gently stretching the major muscle
groups of the legs including the two muscles in the calf.
- 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.
- 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.
The second most common running injury I see in recreational runners is knee pain,
oftentimes also called iliotibial band syndrome, patella femoral joint pain or
chondromalacia patella syndrome. These slightly different knee problems very
often also involves the patella tendon, whereby there is tendonopathy in the patella
tendon – much like what happens in the Achilles tendon or irritation of the fat pad
that lies underneath the patella tendon.
These problems happen due to muscle imbalance in the lower limb and poor
biomechanics leading to the patella not tracking properly over the underlying
patella. The quads typically get tight which can pull the pelvis out of alignment,
this causes the IT band to get tight and rub on the femur (causing ITB syndrome),
and causing mal tracking of the patella that can inflame the underlying fat pad.
As the patella is ridged on its underside that corresponds with a grove in the femur,
when there is poor tracking of the patella and these surfaces are not well aligned
the underside of the patella rubs on the femur. This irritates the cartilage on the
underside of the patella and causes pain (chondromalacia patella syndrome).
Much like in Achilles tendonopathy, the increased loading (how much running
you do) through the patella tendon causes degeneration and breakdown in the patella
tendon, new blood vessel growth and pain. Correcting these problems is quite straight
forward in most runners as long as they are willing to reduce their ruining volume
whilst performing the necessary exercises to stretch and strengthen the right areas.
It is a good idea to see a manual therapist (physiotherapist, osteopath or chiropractor)
who can check your biomechanics to make sure your pelvis and spine are aligned
and that you have good range of motion in the patella femoral joint, feet and ankles.
A quick check up visit is a lot cheaper than a series of treatments after you have an injury.
As running is a very hip flexor dominant sport, runners become tight in their psoas,
TFL and quads. Tightness in these muscles causes the patella to move to the outer
side of the knee and weaken the VMO muscle on the inner side of the knee compounding
the problem. Therefore stretching and doing self myofascial release for the psoas,
TFL and quad muscles whilst strengthening the VMO is warranted. Runners with knee
pain have also been shown to have weak glutes, especially the gluteus medius so
strengthening this area also helps prevent this condition.
The best ways to prevent yourself from suffering knee pain are:
- 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.
- 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 and flexibility in the knees, 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.
- ALWAYS warm up prior to exercise.
- ALWAYS warm down after exercise by gently stretching the major muscle
groups of the legs including the quads (see my video blog post).
- Use some self myofascial release on the quads and ITB with a foam roller.
See my video blog post where I show you how to do this.
- Do bridges, step ups and the calm (Pilates exercise) to strengthen the glutes
and VMO.
- 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.
