Achilles Tendonitis in Runners

The Achilles is the largest tendon connecting the two major calf muscles (gastrocnemius and soleus) to the heel. Its inflammation is called Achilles tendonitis.

When the calf muscle becomes tight the Achilles is forced to work hard. Inflammation is due to repetitive stress, which leads to micro-tears to the tendon. If left untreated, scar tissue can form, which limits the flexibility and blood flow to the tendon, hence preventing the ligament from repairing. It can also develop severe degenerations and bone spurs, or rupture completely, requiring an operation and a much longer healing time. It is therefore important not to run with the injury as it will only reoccur or worsen. Recovery can take up to 6 months, so it is advisable to get professional help when the first signs appear.

Symptoms of Achilles Tendonitis

• Pain above the back of the heel, as well as stiffness (especially in the morning)
• Pain after running
• Pain while running, which worsens a few hours after the run
• Tight and stiff calves
• Swelling; forming of a bump

Causes of Achilles Tendonitis

The Achilles tendon is the biggest tendon of the human body, taking a huge amount of strain. The cause of its inflammation is not always so straightforward, and to treat it, it is important to find out the source and investigate what changes might have brought it on. The source might lie in the foot, calf, knee or other body parts.Some of the most common causes of the inflammation are:

• Sudden increase in the amount or intensity of running
• Wrong or old running shoes
• Repetitive activity
• Tight muscles (especially calves)
• Differences in biomechanics of the runner's body (one foot might be flatter, or leg shorter; to adjust to these differences muscles have to work differently).

Treatment

• Ice – Put ice pack on the affected area for up to 20 minutes when required, but stop if you feel anything strange, for example skin numbness. A bag of frozen peas wrapped in a cloth is a common tool for this, but I'd recommend the Hot/Cold Pack. It offers more flexibility, as you can freeze or heat it as required.
• Rest - give the tendon time to heal, reduce running or stop completely.
• Stretching and strengthening exercises
• Anti-inflammatory - Painkillers like Ibuprofen will reduce the inflammation and pain, but avoid using them for long periods.
• Heel Pads - Placing these into your running shoes will lift the heel and reduce the impact and stress on heel, Achilles tendon and calf. You could try the Sorbothane Heel Pads.
• Operation - In the most severe cases (like Achilles tendon rapture) an operation will be required.

Aiding Your Recovery

• It's important for every runner to incorporate a minimum of three strength and conditioning training sessions a week into their programme, which includes flexibility training. Having a strong core will keep an upright posture and less strain going to areas of the body, strengthening all muscle groups so that you do not get a weaker muscle.
• Magnesium will help with the muscle repair process. It is crucial for energy production and muscle function, making it of critical importance for physical performance. A lack of magnesium results in reduced performance, lactic acid build up and muscle cramping. Over time this causes the muscles to be inflexible and ligaments to be pulled under strain. For the best absorption use a spray or liquid form. It's best to direct the magnesium to the injured area. I personally get the most effective result by applying the spray directly to the injury.
• Heel pads may be worn. These lessen the strain on the Achilles. However, it is important to stop wearing them when the injury has healed, as they will weaken the ligaments by encouraging the body to rely on them. Once healed, start removing the heel pads gradually.
• I would strongly recommend exercising a lot of caution when returning to your training. Before you start to run I would spend a week on a cross trainer so that the body adjusts back into training, this needs to be on a low resistance level and at a steady pace. If you feel at the end of a week there are no ill effects on the body, running could be re-introduced. I would start off by alternating between walking and running for two minutes. Only begin to build on this if you do not experience any pain. This will allow the body to gradually build strength back into the muscles. It is better to add another day of running each week and keep to the same distance, until you reach six days and you are certain that the body has no pain. When you increase your mileage this needs to be a 5% increase your training, only by time rather than distance. For example, if you can run for 20 minutes for the first week without any effects then the next week try 25 minutes. After the first 10 minutes I would stretch. Hold the stretch for thirty seconds in order to warm the muscle.
• Avoid any weight training for the legs, both during injury and during the process of returning to running, as you will only put more stress on the muscles. Weight training shortens the muscles and they become tighter.

Prevention

The best advice I can give you to avoid the injury is to always listen to your body! Failing that, or with some unexpected surprises popping up in your running life, here are some other tips:

• Increase gradually - When increasing your running, distance or intensity, do it gradually (follow the 10% rule) and give the body time to adjust to the new amount before you start adding more.
• Cross-train - try swimming, Pilates, yoga, strengthening exercises. This helps to strengthen and stretch all the muscles for better flexibility, strength and balance. Alternating the running surface will also strengthen different muscles in the legs and feet.
• Get fitted for the right shoes and update them regularly. Find out more here »

Achilles Stretching Exercises

More Achilles Stretching Exercises

1. Facing the wall take one step forward, leaving the back leg behind, feet flat on the floor. Put your hands against the wall in front of you, then bending them slowly, start leaning forward from the hips. The front leg bends in the knee, the back leg stays long and straight. This will stretch the calf and hip flexor of your back leg. Don't forget the other leg!

2. Facing a table, take a smaller step towards it, keeping the other leg behind. Bend your knees as if you were going to sit down, keeping more weight on the back leg and using the arms for support. This will stretch the Achilles tendon of your back leg.

3. And one of my favorite torture stretches: standing straight, give yourself a hug behind your back, placing the hands on the opposite elbows. Take a step forward, keeping the other leg behind flat on the floor. With your legs straight slowly start to bend forward from the hips. This will nicely stretch the back of the leg.

Note: Get into these stretching poses slowly, go as far until you feel the tightness and hold. Stretches should be held for 20-30 seconds (ideally 30). Again, listen to your body. Never force your body into anything uncomfortable or too painful. You are stretching to make running more fun, not to get another injury.

Achilles Strengthening Exercises

1. This exercise is recommended for calf and foot strengthening. Stand straight, one foot over the edge of the stairs, the other bent behind. Make sure the forefoot and the heel of the foot on the stair are in one line. Support yourself with the arm on the wall, but do not lean against the wall. Slowly push your heel away upwards, and then lower it down. Repeat 8 times. If this feels comfortable, make a few repetitions. If you find balancing in this exercise difficult, start off simply standing on the floor and move to stairs whenever you are ready.

2. This exercise will work your calves, hams and glutes and more. Hands on hips, take a step sideways, pointing your feet about 45º outwards. Bend your knees, making sure they stay above your heels and don't go out beyond. In this position, slowly push your heels away from the floor and then lower them. Remember, your hips stay at the same point. You are only lifting the heels, not the hips.

What About Your Shoes?

It's important to replace your trainers after a six to eight month period. I personally would avoid keeping shoes for a year as there is a high risk of picking up an injury. Ensure that you get your gait reassessed each time you replace your running shoes, as the shoes are constantly upgraded which often alters the support in some form. Anyone who wears orthotics should also have them assessed every year, as the body will always change with time. Visit one of our stores for a free personal shoe fitting.

In addition to your running shoes, you might also want to consider the shoes you spend most of your time in. When the foot is not being held securely in a shoe with no arch support it can develop a flat arch, which causes the Achilles to be bowed. This means the runner's entire body weight is being directed into the Achilles at an angle, which can lead to a possible rupture or tear.

Alternating between different shoe profiles, for example a pump shoe and a trainer, can alter the length of the Achilles. It is always best to keep footwear consistent if you can.  Both as adults and as children our bodies are constantly changing and our feet are altered by what footwear we use. If we gain or lose weight then areas of the body are being altered, and during this process we can pick up injuries. Our feet are what take all of our weight. In order to support the body properly, it is important that we see shoes not just as a fashionable item, but also as an important tool for our bodies to function correctly.

These are exercises that we've found very useful and want to share with our customers. But we're not certified instructors. Always consult your specialist before beginning any exercise programme. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.