Road runner Fitness

Beware of Tendinosis

Care first: Use shoes with a slightly elevated heel to protect your achilles tendon. Photo: special arrangement  

For most, the words ‘achilles tendon’ bring to mind stories of Greek mythology. Not for runners, though. For us, these two words are inextricably linked with heel pain and niggling worries about whether we’ve gone on to permanently injure ourselves. Formally titled achilles tendinosis, it is easily among the most common running-related ailments.

Fortunately, there’s hope! The achilles tendon is the strongest and thickest tendon in the body. It connects the calf muscles (gastrocnemius and soleus) to the posterior part of the heel bone (calcaneus).

Most of the force that is generated during the “toe-off” phase of the run, is transmitted through the achilles tendon. These forces can be considerable, and increase especially when running faster, during uphill runs and when one uses a forefoot-strike style of running.

Some other factors that contribute to achilles tendinosis are tight calf muscles, forefoot weakness, poor footwear and a rapid progression to minimalistic footwear, which is the rage among runners these days. In achilles tendinosis, there occur micro tears in the body of the tendon and the structures around it. There are very rarely any inflammatory changes in the tendon, hence the word ‘tendonitis’ is not used to describe this condition these days.

This is a condition where the runner initially starts having a feeling of stiffness in their achilles tendon. This stiffness is followed by pain when they continue to run. The pain usually starts off as a dull ache and can gradually progress to a sharp, stabbing pain around the midpoint of the achilles tendon, a few inches above the heel.

This is a condition, which, if not treated with care in the earlier stages, can become chronic and persist for months and years. One of the reasons I tend to see a lot of chronic cases of achilles tendinosis is because, during the acute phase, the runner is able to continue running in spite of a slight discomfort and most tend to ignore the early signs and eventually aid its progress to a chronic state.

Phase 1

The first few steps are to stop running, ice the area of the tendon that feels sore and start using shoes that have a slightly elevated heel. The logic of using the heel raise is that the pressure on the achilles tendon is immediately relieved and this, in turn, reduces the stress on the tendon, accelerating the healing process. It is imperative to follow this for at least four days, consistently.

Phase 2

The next phase of management is often neglected and is the key to a pain-free achilles tendon. One of the most common causes of the condition is a shortened or tight achilles tendon. Steps to tackle this need to be incorporated into the rehabilitation schedule at this point. A combination of stretches with soft tissue mobilisation (using a foam roller) will help. Stretches for the calf and tibialis anterior stretches must be done too.

Phase 3

The next and final phase of rehabilitation is strength protocol. It consists of eccentric strengthening exercises of the affected achilles tendon. They should be done with a straight knee and a bent knee. Three sets of 15 repetitions of both exercises, done twice daily, for 12 weeks, is recommended.

Eccentric muscle contractions cause the muscle fibres to generate more tension than either concentric or isometric contractions. Hence, eccentric muscle contractions appear to be associated with greater muscle strengthening, which may protect the achilles tendon and thereby prevent recurrent tendinosis. Strengthening exercises for your ankles and forefoot are also indicated if the cause of the tendinosis is related to them.

The runner is advised to consult a healthcare professional if the pain persists and the conservative treatment methods described above do not relieve the discomfort. If the tendinosis is diagnosed to be directly related to altered biomechanics of the foot, a custom orthotic may be prescribed in addition to strengthening exercises and stretches.

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Printable version | Apr 23, 2021 9:03:06 AM |

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