If you’ve ever had an injury to your achilles tendon, you probably know why they call extremely difficult or impossible tasks your “achilles heel.” Achilles tendon pain can be debilitating, and a torn achilles makes it nearly impossible to walk. Achilles tendon pain is largely due to achilles tendinopathy, which is a sudden or prolonged irritation or breakdown of the achilles tendon. This injury is very common in runners, so as we get closer and closer to the 2024 Boston Marathon, I figured I would give a quick overview of 5 things that you need to know about achilles tendinopathy to keep you healthy while you run.
The achilles tendon is a band of connective tissue that connects the calf muscle to the heel and is responsible for pointing the toe.
The calf muscle is primarily made up of the gastrocnemius and soleus muscles. The gastroc is the bumpy one that you see when you go up on your toes, and the soleus is a flat muscle that sits underneath that you don’t see as much. As you run, a healthy, stiff achilles tendon helps you spring from one foot to the next. Achilles tendinopathy generally describes pain in the achilles tendon, and includes achilles tendonITIS (acute injury within the last 7-10 days) and achilles tendinOSIS (chronic, greater than 14-21 days).
With the anatomy under our belt, let’s get into the list of 5 things that you should know about achilles tendinopathy:
1. The achilles tendon transfers LOTS of load from the calf to the ankle joint when you run.
The plantarflexors, especially the soleus muscle, are the most active muscle group during the running gait cycle, especially for distance runners. There is a graph below showing how much muscle activity was generated during the running gait cycle, and you can see that the plantarflexors were more active than the glutes, hamstrings, and hip flexors. Because running is such a repetitive movement, runners are at increased risks for developing achilles tendinopathy.
Image credit: Dr. Rich Willy, Montana Running Lab ig: @montanarunninglab
2. You are more likely to injure your achilles tendon when doing hill workouts.
When running on an incline, you are putting the calf muscle, and therefore the achilles tendon, in a lengthened position and then contracting hard to propel your body up the hill.
This puts more strain on the achilles tendon. Runners should pay close attention to when and how they are incorporating hill work into their training to make sure that they are avoiding a significant increase in intensity. If you are already sore in your calf or achilles tendon area before starting a hill workout, you may want to consider giving your body one or two more days of rest so that your tissues can recover before introducing significantly more load.
3. People with strong calves and flexible ankles may have less risk of developing achilles tendinopathy
According to the Dutch multidisciplinary guideline on achilles tendinopathy published in the British Journal of Medicine, there is some evidence that people with normal ankle mobility and stronger calf muscles had less likelihood of developing achilles tendinopathy. (1) Though this is based on only a few studies, these are risk factors that can be modified with a strength and mobility program. You can’t control everything, so control what you can!
4. Achilles tendinopathy responds well to progressive exercise
General guidelines for treatment of achilles tendinopathy suggest temporarily limiting painful sporting activities and a progressive strengthening program to be completed over a 12 week period. That’s three months of progressive strength training! This condition can often take a lot of hard work and time to recover. One of the tricky things with achilles tendinopathy rehab is that the treatment is not usually pain free. Below are some guidelines for determining what intensity of exercise to start with. Take note of what pain ranges are acceptable:
From the Dutch Multidisciplinary Guideline on Achilles Tendinopathy published in BJM.
5. The majority of people with achilles tendinopathy return to sports
Have hope! 85% of people with achilles tendinopathy return to sports at some point. Achilles tendinopathy can be a tricky condition to recover from. I find that my patients often have a difficult time zooming out on their rehab journey to see how far they’ve come, and where to go next. Have you been struggling with achilles tendinopathy? Drop us a line, maybe we can help you go from this:
To this:
Treatment of Achilles Tendinopathy for Runners
At Alterra, we specialize in helping runners resolve any and all of their injuries that limit their running ability or performance. If you're local to Boston's Back Bay area and are dealing with achilles tendinopathy, we'd love to help! Book a free discovery call to chat with a therapist today.
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Disclaimer: The information provided in this blog post is for general informational purposes only and is not intended as medical advice.
Sources:
de Vos R, van der Vlist AC, Zwerver J, et alDutch multidisciplinary guideline on Achilles tendinopathyBritish Journal of Sports Medicine 2021;55:1125-1134.
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