IS YOUR RUNNING AFFECTED BY ACHILLES PAIN?

DO YOU FIND YOU START YOUR RUNS FEELING SORE IN YOUR ACHILLES AND THE PAIN EASES 5-10MINS INTO YOUR RUN?

DO YOU STRUGGLE TO TAKE YOUR FIRST FEW STEPS IN THE MORNING DUE TO STIFF AND SORE ACHILLES’ TENDONS?

Achilles tendon pain is a common presenting complaint in my clinic. It often starts as a minor niggle but soon worsens and can become very frustrating as it interrupts your training programme. A common diagnosis is tendinopathy. We don’t fully understand why it develops but in short, we often see a reduced ability for the tendon to tolerate the loads that are being applied to it.

Do not ignore it, the longer it goes on the longer it will take you to get better and I can promise you, you do not want to be dealing with chronic tendon pain! Seeking advice from a professional at the earliest sign of symptoms will see a better chance of fast recovery. In the meantime consider these 5 simple tips to address your symptoms:

1. ADDRESS YOUR TRAINING PROGRAMME

Significant peaks in training volume are often to blame. You may be a regular runner covering 5K 3 times a week and have decided to enter your first marathon so the weekly mileage is increasing. Alternatively, you may be starting a new HIIT class at the gym.

Though these changes may seem small the Achilles tendon may start to react. Combine this with some of the other factors mentioned below and you create the perfect environment for tendinopathy. Consider reducing the training mileage to decrease loads applied to the tendon or increase rest periods between exercise bouts. Complete rest is not always the answer as return to the same programme will only incur the same issues. Speak to a specialist if you are unsure how best to manage this.

Pace yourself. An increase in training volume is going to demand a similar increase in load capacity of the effected musculoskeletal structures. Pick a programme that best suits you and balance it out with effective strength training. Train smart.

2. IMPROVE YOUR LOAD CAPACITY

As mentioned above, an increase in training volume will require you to be robust enough to cope with the increased loads applied to your musculoskeletal system. The Achilles tendon is the thickest tendon in the body and is designed to plantarflex the ankle (pushing the toes and forefoot into the floor to drive the heel off the ground and propel us forwards). As we run the demands placed on this tendon increase. Poor calf strength and reduced elasticity will render the Achilles tendon vulnerable leading to strain and subsequent symptoms.

A progressive rehabilitation programme is easy to follow and is still seen as the gold standard treatment in the management of this condition. Visit my Instagram page to view some of these exercises further but please bear in mind that you are best to seek advice from a professional to know which level to start at.

3. CHECK YOUR FOOTWEAR

Too often I see patients come into clinic with trainers that are practically falling off their feet. The supportive structure of the shoe will break down as you run and though it is often dependent on the individual we tend to recommend a new pair of running trainers every 500miles. The Achilles tendon will be subjected to increased loads in an old and weathered trainer and can often account for symptoms.

Also be aware that if you have an acute symptomatic tendon wearing a shoe with a slight heel or placing a heel raise into your shoes can reduce the shearing forces applied to the tendon and help settle symptoms. This should not be used long term, only as a short- term method to settle pain.

4. PROXIMAL CONTROL AND GENERAL LOWER LIMB STRENGTH CAN HELP REDUCE STRAIN ON THE ACHILLES TENDON

Numerous muscles are required to propel us forwards as we run. Poor control around the hip, trunk and knee can place greater torsional forces on the Achilles tendon which has been a common finding in tendinopathy.  Movement screening to address your landing control and running style can be used to address these factors. Exercises should then be designed specific to your goals. Your training programme should always include strength and movement control exercises to enhance your physical condition, reduce risk of injury and improve performance.

5. OTHER FACTORS TO CONSIDER

There have been some links with tendinopathy and a group of antibiotics called fluoroquinolones so if you have recently been on this medication it is worth telling you Physiotherapist or doctor.

Tendinopathy is also not the only diagnosis causing pain around the back of the ankle or Achilles. Though the treatment programmes can take time you should be seeing a steady improvement. If symptoms seem to be getting worse or you just aren’t seeing a change it is worth seeing a consultant sports physician for further investigation.

SO IN SUMMARY……….

  • DON’T PEAK TOO SOON. Training programmes should be designed and progressed specifically to your abilities.
  • GET STRONG. If you are increasing your training in intensity or frequency your musculoskeletal system must have the capacity to cope with it.
  • EQUIP YOURSELF. Make sure you get a good pair of trainers and keep an eye on their condition.
  • DON’T IGNORE IT. It will not go away, if anything it will worsen and you will get more and more frustrated. Get professional advice, know how to deal with it and make a plan. You can fix this.
Davina Sherwood
Specialist Musculoskeletal Physiotherapist