The following article is a quick read, take a few minutes to invest in your Achilles tendon!
With my work as a sport med consultant, teaching continuing ed in sports rehab center, and my hands-on work with professional athletes, I constantly witness how Achilles injuries is one of the most frustrating overuse injury for an athlete. At worst case to overcome the injury, patience, time away from competition, maintenance and believing in the rehab protocol is key for improvement. Sooner an athlete deals with the mild discomfort the quickest the result, unfortunately often we hope that the pain will just go away on we keep on running:)
In the dozen mountain running camps I offer each season, I get an average of two runners per camp that have a history with Achilles pain or discomfort. I evaluate runners for lower leg strength, uphill running form, cadence, foot contact… among other things. The runners that have Achilles discomfort usually ‘fail’ two or more of the above, the pattern is repetitive, why? Lets look into it.
The Achilles tendon is the combined tendon of the two calf muscles, the gastrocnemius and soleus, it inserts to the back of the heel bone, the calcaneus. Achilles tendinopathy is a common overuse injury in trail running and a concern to both recreational and competitive athletes.
The Achilles tendon function is to transmit the force of the contracting calf muscles to the calcaneus bone and control movement to provide the push-off/toe-off during running. This force can be as much as three to five times your body weight, that is with good running form!
As such, the runner’s Achilles are prone to overuse injuries.
Much like a climbing rope is made up of strands twisted together, tendons are comprised of small fiber-like proteins called collagen. Pain in the Achilles tendon is a result of damage to the collagen, disorientation of the fibers, no longer parallel, becoming chronically weaker over time. In fact, the true cause is physical damage to the fibers of the tendon itself, which can lead quickly to the degenerative state of the tendon. It’s often way beyond just an inflammation, which is too often diagnosed as.
The causes of Achilles tendinopathy are often related to excessive stress being transmitted to the tendon resulting in mild to severe damage. The runner is abusing the poor Achilles with a few or many of the following factors:
Poor lower leg muscle strength
Calf muscle weakness & tightness
Poor ankle range of motion
Unstable foot & ankle
Excessive foot pronation
Poor foot mechanics
High training volume ( too many hours in a week)
Overstriding and landing on forefoot
Forefoot running style
Poor running form e.g.: leaning forward when climbing, no heel contact…
Worn-out running shoes
Suddenly changing to minimalist shoes
Sudden increase in volume
Months of neglecting Achilles discomfort & pain
Achilles overuse injury often occurs at the end or at the beginning of a season and for the same reason- lack of maintenance in the off-season and avoidance of the issue in the running season. The tendon can be weaker at the end of a season due to too much volume for too long, stress from racing with added fatigue and weakness in the leg muscles. If the tendon is overlooked in the off-season, pure rest does not heal it, so come spring time the runner might start feeling mild discomfort with added volume.
It is the loading and unloading of the tendon, mechanically working like a pulley system, that triggers chemical and structural changes which reaches a point of failure. Continued overuse causes tears to become larger and the tendon weakens beyond failure, causing more tearing, and pain.
Achilles pain does not just disappear by resting
Foam rolling, stretching, ice pack, taping and so on are not cures, and may or not help relief pain short term. Corticosteroid injection give no long term benefits and increase risk of tendon atrophy, shock wave therapy can aid in tendon healing especially combined with rehab exercises targeted in tendon healing.
Rest, ice, compression won’t heal your Achilles tendon!
Typical symptoms starts off as a dull stiffness in the tendon, which gradually goes away after the tendon gets warmed up. It may get worse with faster running, uphill running, or when wearing minimalist or worn-out shoes. If you continue to train on it, the pain in the tendon will be sharper and you will feel it more often, eventually impeding your ability even in short easy runs.
Important: the longer you wait to start rehabbing the Achilles the longer it will take to recover from the overuse debilitating effect – tendons are stubborn!
One main property of the Achilles tendon is to store recoil energy, the more rigid and healthy a tendon is the more rebound you get from the ground contact and less muscular energy is needed in the toe-off. Same as falling from a new climbing rope versus an old frail rope, the elastic energy will be greater and quicker with the new rope – strong lower legs, quick cadence and good running form from head, shoulder, torso, hip, knee down to foot will reduce stress to the Achilles and a quicker ground rebound will be produce.
Achilles injury commonly occur when the muscle is under eccentric action, lengthening- when landing on the ground, because the muscle fails to adapt to the sudden or gradual increase in load. Rehab specific calf eccentric loading is a proven form of rehabilitation, rebuilding the collagen to a healthier stage,
Finding a good sport rehab specialist is key
You need a good musculoskeletal assessment to determine where the stress is coming from. Hands-on treatment such as friction and myofascial release can be very beneficial. Depending of the stage of injury, non-weight bearing exercises to eccentric heel-drops, lower leg & foot strengthening, run specific functional exercises, and progressive ‘half foot’ stair climbing (not the machine but actually staircase!) are good options. Depending of the severity, running can be maintain but it is beyond this article.
Seek professional help: an experienced sport rehab specialist in running will be able to advise and direct you to the best treatment option.
Better prehab than rehab!
I’m a strong believer in prevention, better stronger than injured! Achilles maintenance is very important when you are a trail, mountain or ultra runner due to the terrain and the distance covered. Running is a technical sport, constantly balancing, absorbing and pushing off a single leg. You need a strong foundation- starting at your feet & ankle.
Early season, few weeks leading to a race, or during a high volume training period, I recommend a weekly routine performing single heel raises to failure (same amount each leg, start with your weakest side), and single eccentric heel drops (10reps-2sets), both exercises to do after your training runs. It will help reinforce and protect the Achilles for the force and loads coming-up. Increasing the strength of the calf and lower leg muscles is a great way to reduce stress on the Achilles and increase power output of your toe-off, and the stability and reaction time in the absorption phase – when landing on the ground.
Your running form, individual posture, musculoskeletal imbalances and your training regimen all play an important role in the health of your Achilles, get inspired and take good care of them!
You want to learn more about running injuries, prevention, and run specific exercises & drills? Join me in Chamonix on the evening of April 20th, Injury prevention seminar for mountain runners!
Thanks for reading… Chloë
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