Achilles tendinopathy in runners!!! I’ve spent some time in the past discussing related topics in the past (see here, here, and here). Though this week’s blog post may be on a topic that seems like old hat, the current clinic trends have motivated me to re-address this common injury and dive further into how we can manage our training and exercise around it’s presence. Luckily, this same information, when utilized effectively, may double as a method to mitigate the risk of developing this injury in runners and other athletes. I won’t get you bogged down on the scientific details this time around, that is what the previous blog posts were for, so feel free to re-acquaint yourself with those past blog posts before digging in here.

For reasons that are obvious and must remain nameless at this time, many people seem to have turned their fitness routine towards running outdoors. The positive benefits of this sport/exercise modality are countless. As I mentioned above though, I am seeing more people in the clinic in 2020 and 2021 that are experiencing acute and exacerbated chronic versions of a running-related injury, that being achilles tendinopathy. As a gross generalization, this injury generally comes about due to an overloading of the achilles tendon tissue (1). It can be due to an acute or chronic overload which is dependent on a number of factors that I won’t get into here (…check out my other blog posts which already includes some of this info!).

So to set the stage, you’ve been running consistently (or just started) and are now experiencing pain located in/around your achilles tendon. What are your options to continue training and how do you work towards full recovery? Here are some thoughts…

    1. Analyze your training program:

What does it look like this week vs last week? Or this month vs last month? How does your run training differ between sessions or do you consistently execute the same workout? Do you even have a training plan?

Managing your overall training load is critical in managing and reducing the risk of this injury. You shouldn’t add additional kilometers to your weekly running volume until you are ready, and when you do it should be small changes. When running with this injury, you also need to find a training volume that does not worsen your current situation. Some pain is expected with recovery when you stress the injured tissue, but recovery post-run is critical.

Variety is also critical in a sport/exercise modality such as running since it is VERY repetitive. How do you implement variety into a running workout? Simple: change your route, consider trail running if you are confident in managing trails, complete hill workouts (barf), and don’t forget about good ol’ interval training which can be completed on a variety of terrains (track, road, trails). Whether injured or not, not all training variations mentioned may work for you, and we sometimes need to avoid certain workouts in the short term to help manage pain before introducing them into our running schedule.

    2. What do you do that isn’t running in order to BE a runner?

If you’ve worked with me in the past on an injury that holds you back from sport/exercise, you have probably heard me say that you need to do something on the side to keep you in your chosen sport/exercise modality. Just like a pro basketball or hockey player is expected to show up in the gym for strength and conditioning before, during, and after their season, RUNNING IS NO DIFFERENT. When an athlete develops achilles tendinopathy, the overarching goal is to keep them participating as much as possible in their chosen activity, but to build or maintain strength and resilience around the injured tissue. So regardless of whether you have developed achilles tendinopathy or are trying to prevent it, strengthening of the lower body with a focus on the calf muscles and achilles tendon are critical. Research into the forces exerted on the achilles during running can range from 4-6x bodyweight as seen by this study (2). Holy crap. So we need to complete a variety of resistance exercises that facilitate strengthening of the contractile tissue (the muscle belly), and building tendon resilience.

    3. What is your recovery like?

One of the bigger mistakes we see is a lack of rest/recovery between exercise sessions. When we don’t rest appropriately, repetitive application of load to your body can often be the trigger for this injury. Think of your body the same way you think of work: how many days in a row can you work before you feel burnt out and need time off? If you only had one day off a week, how well would your body and mind tolerate it? Exercise is great, but our post-exercise recovery and DAYS OFF from exercise are just as important. There is a ton of info out in the world wide web that tackles recovery: diet, sleep, ‘restorative’ activities, voodoo magic, you name it. Further on this topic, programming your running training appropriately can help with building ‘deload weeks’ that allow you to continue running while facilitating ‘active recovery’. Lastly, I’ll say it here to tie it all together for you: injured athletes need to focus on multiple domains of recovery to promote appropriate healing timelines and maximize their participation in the rehabilitation process.

There are certainly additional factors we could consider, some of which will be athlete specific. If you have questions or concerns of your own (whether injured or not) it is best to contact your most trusted healthcare provider so that they can further guide you towards a successful running season! The information presented here is meant to guide your thought process and improve your understanding of training factors you should consider. An open and thorough discussion is recommended with a qualified practitioner to help you apply a safe and individualized plan of care to manage or reduce the risk of this type of injury. Best of luck, and happy running!

References:

    1. Cardoso, TB, Pizzari, T, Kinsella, R, Hope, D, and Cook, JL. Current trends in tendinopathy management. Best Practice & Research Clinical Rheumatology. 2019; available online 8 March 2019.
    2. Willy, RW, Halsey, L, Hayek, A, Johnson, H, and Willson, JD. Patellofemoral joint and achilles tendon loads during overground and treadmill running. Journal of Orthopaedic & Sports Physical Therapy. 2016; 46(8): 664-672.

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Jordan Fortuna, Physiotherapist

Jordan is a graduate of the University of Toronto Physiotherapy program and has since been practicing in orthopaedic settings. He has developed an interest in sports physiotherapy through his many years as an athlete, participating in baseball, golf, snowboarding, and more recently rock-climbing, cycling, and strength training. He has worked with a variety of clientele including athletes from disciplines such as competitive dancing, running, rock-climbing, and mixed-martial arts, as well as non-athletes of a wide age range and ability. Regardless of activity level, he is dedicated to improving mobility, optimizing function, and strengthening to help achieve your goals through the use of an individualized exercise prescription and manual therapy. He also has additional training in acupuncture and sports taping.

Jordan is available for appointment on Tuesday, Thursdays and every other Saturday. You can book your appointment with him here.

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