The Achilles Heel of Running

Luckily for us Vancouverites, running can be done all year round.  However, for either the new runner or the runner who has been increasing their mileage come springtime, a common injury can occur…the dreaded Achilles tendinopathy!

The Achilles tendon joins both the gastrocnemius and the soleus (the calf muscles) to the heel bone.  Bending and straightening the ankle will cause movement through this tendon.

When injured, this tendon hurts because the stress put through it was greater than the strength needed to handle it.  It may be painful to touch along the tendon and there may be swelling and redness.  Walking, running, and going up/down stairs may be painful.

What causes it?  Shoes may not have enough support (for flat feet) or cushioning (for high arches).  Harder training surfaces (road running) create greater forces and uneven surfaces (hills, trails) create shear or sideways forces which are more difficult for the tendon to absorb.  Increasing mileage too soon will stress the tendon too much so a gradual progression (5-10 % per week) would be more appropriate.  Decreased strength in the calf muscles means the tendon will be unable to absorb the impact when lowering the foot after the heel strikes the ground, especially going down hills.  Decreased flexibility will lead to an increased tension being placed on the tendon especially going up hills.

How to fix it?  Rest from running for 1-2 weeks and ice the tendon 15-20 minutes at a time to help decrease the pain and swelling.  Stretch both the gastrocnemius (with a straight leg) and the soleus (with a bent leg) and the hamstrings and hold for 20-30 seconds and repeat 3 times.  Eccentric training is most important for the Achilles tendon.   Have your physiotherapist get you started on a heel drop program.

Will it heal?  The sooner you treat it, the less irritation over time the tendon will have experienced and the less scar tissue will have built up.  Therapy on average may take a few weeks up to a few months for the more persistent cases.

Can pilates help?  As with many injuries, it is often not the part that hurts that is causing the problem.  There may be an imbalance in the hips or the back causing disruption further down the leg.  Once the pain and swelling have disappeared and you are returning back to exercise, pilates can help even out the muscle imbalances that have built up over time and help strengthen the muscles in a lengthened position.  It is a great addition to any running program!

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