The Runners' Achilles Heel

In the beginning, achilles pain won't affect your running. Sure, it feels a little achy, a little tight, but then one you're warmed up those sensations dissipate. Within a few minutes you're running without a care. Just like the mythical Greek hero, Achilles was fine for quite some time, too.

Fast foreward 6+ weeks from now, and your achilles is starting to bother you more and more. Maybe you feel it descending your steps in the morning. Quite possibly your runs are taking a much longer time to get comfortable, if they ever do. You don't stop though--you never do.

Achilles Rehab - Physical Therapy - Philadelphia.png

You start to question that RIP5k or 1/2 marathon you signed up for. Should you give your bib to someone else, or push through?

"Am I going to make it worse..like actual injury, worse?," you ask yourself.

Achilles tendon injuries are a common occurence. That thick tendon on the back of your lower leg, near your heel bone is your Achilles tendon. It can become inflammed and painful for a variety of reasons.

Achilles.jpg

Inflammation of your tendon is called tendonitis. This is painful. If you've had achilles pain for just a week or 2, it's generally considered acute or recent, and "tendinitis" is the correct term.

This happens due to an increase in running mileage, or any sharp increase of activity that your body isn't use to. On the other hand, if it just came on out of the blue during your normal training, there is likely a mechanical deficit (weakness, tigtness, or poor control) somewhere on your body that needs to be addressed. When achilles pain is caught at the acute stage, it's easily treatable.

But, I'm guessing thats not you.

If this is a chronic pain that you've had for many weeks to months, its not as simple a fix, but don't worry, we'll get you there.

At one point in time, there was thought to be no inflammatory cells around the tendon, however you still have pain.

A new term was created, "tendinosis," which esentially means you have a slowly degenerating achilles tendon void of inflammatory cells. Thus your pain is coming from the degeneration, and it needs to be treated a different way than the acute tendonitis.

History update: there still does appear to be some inflammatory cells in your chronic achilles tendinosis, thus the newest term is a catch-all: "Tendinopathy," meaning "problem with your tendon."

Here's how you can treat both kinds of achilles pain, acute or chronic.

Achilles Tendonitis management:

One of the quickest things you can do is adjust your running form. If you've had your running form examined, and you show a long stride--shorten that stride up. Discussing running mechanics is beyond the scope of this article, but shortening your stride or increasing your cadence (taking more steps) is one of the quickest things you can do to reduce stress on your body, and achilles.

If you run on your toes, try to land a little less on your toes and more on your mid-foot. This is all easier said than done, but there are strategies you can learn to help you with this. I'd suggest getting your running form analyzed-- it can be a real eye opener. We don't do this yet at MSPT (due to space restrictions), but Drexel does, at their Running Performance and Research Center in center city.

Besides running form, here's a quick list of action items that you can check yourself against, and perform, to help with your achilles pain.

1. Rest from the aggravating activity. If running bothers you, you need to stop running. If running is fine, but jumping bothers you--stop jumping. Understand?

Heel Lift.png

2. Heel lift wedge. Bumping up the height of your heel, will cause the achilles to stretch less, and thus irritate it less. In essence, it will keep the achilles on more slack and allow it to 'rest' more. Go to any running store or perhaps even a pharmacy, and you can purchse a heel wedge for your shoe, like the one shown below. Place in your shoe under the insole. I'd start with a 10mm (or 1cm) wedge and see how that feels; you can always add to it.

3. Use ice..maybe. There is some evidence coming from testing mice and rats that ice may not be the best modality to use. In these studies, tendon strength was measured less, once healed. My take on this...go without ice for 2-3 days. If you still have pain after 2-3 days, then use ice to aid your rest.

4. Check your arches. Your arches can have a profound effect on your achilles pain. If you have high arches like the "supinated" image on the right, no force is being dissipated by your foot, and a lot of force is being transmitted up your achilles. In this is the case, stretching and strengthening your calf is going to a key component of your rehab. If you have a low arch, or over-pronate when you walk/run (image on the left), this may cause too much side-to-side motion at you heel and your achilles will feel like it's getting pulled like a weed (how do you pull a weed out?--you rock it back and forth from side to side). If this is the case, custom orthotics may be a good option for you (they were for me) to help maintain the arch, in your arch! Sometimes, a good over-the counter orthotic may help. Superfeet are my go-to over-the-counter orthotic, and my friends at Philadelphia Runner in Manayunk will hook you up!

  All feet are a RIGHT FOOT

All feet are a RIGHT FOOT

5. Stretch your calf. There could be a chance that your calf is tight. There are two muscles that join together to form your achilles tendon, and you need to stretch both of them.

6. Strengthening. There is a 'tried and true' way to strengthen calfs for an achilles injury. It's called eccentric strengthening, and this is how it's done.

7. Hip control-->Knee stability. Hip strength is very important, because your hip muscles control the wiggle or wobble in your knee. Your knee is meant to bend forward and back, but if your hip muscles are weak, they allow your knee to wobble inward and outward. Generally, where your knee goes, so does your foot and heel....and your achilles, again, gets pulled like a weed. For the #1 hip strengthening exercise, click here after you finish this article.

8. Balance and unstable training. Once you have good mechanics on flat ground, the next step in the rehab process is to make your footing unstable. Not only does this challenge the stability of knee, but it also places the foot and achilles in compromised positions..just like when you are running outside...the ground isn't flat--it's constantly changing, and challenging your achilles in a multitude of ways.

Here some examples of unstable and balance training:

 

Sign up for the RIP5k Race, right here!

The Details:

RIP5KLogo.jpg

When: Saturday, October 7th at 5pm (registration and FREE pre-race prep/stretching from McKenzie Sports Physical Therapy begins at 4pm).

Where: Laurel Hill Cemetery 3822 Ridge Ave, Philadelphia PA 19132

How Far: 5K..3ish miles. Unique and challenging, you'll wind through beautiful (or creeeeepy) headstones at Laurel Hill.

What to wear: Runners and spectators are encouraged to wear their favorite Halloween costume. Prizes will be awared afterwords for the best costume.

Post race: Awards, drinks and post race care by McKenzie Sports Physical Therapy.

To learn more and register for the RIP5k race, click here. Cya at the cemetery!

Dr. Chris McKenzie2 Comments