6 weeks ago I was feeling invincible!! I was training for my next Hyrox event and was starting to get a bit of pace in my running again. Then Bam!!! the dreaded injury struck. I was doing some short speed pieces on the treadmill and had recently bough some vivo barefoot trail running shoes. I started to feel my Achilles during the session but didn't really give it much thought. Later that day it felt really sore and the next morning it was really quite sore when I got up and put weight on it. I could have cried!! As a physio I see lots of stubborn Achilles injuries and know how difficult it can be to manage. As a runner, my first thought was 'bugger' as I had several little local league events coming up.
So what is your 'Achilles Tendon?' The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus).
The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. Small sacs of fluid called bursae cushion the Achilles tendon at the heel.
The Achilles tendon is the largest and strongest tendon in the body. When the calf muscles contract, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it. For more info on the Achilles click here
Achilles injuries can strike at any time and your risk is increased by :
increased/change in load during training
ankle instability
tight calves
high arches/flat arches
poor running style
change in running surface
being over 30
certain types of arthritis
There are different types of Achilles injuries:
Achilles tendon tear: Tears of the Achilles tendon can be tiny (microtears), or large, causing pain, swelling, and impaired movement. They may occur suddenly during activity, or gradually over time.
Achilles tendon rupture: A complete rupture of the Achilles tendon may make a "pop" sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle.
Achilles tendinitis: Frequent activity (running or walking) causes an over use of the end of the Achilles tendon, causing pain and stiffness at the back of the heel. Early intervention and reduction in load can help ease this over several weeks.
Achilles peritendonosis: pain occurs in the tissue surrounding the tendon caused by over use, often two or more inches above the heel.
Achilles tendinosis: Gradual thickening of the Achilles tendon, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to further injury or rupture.
Achilles tendinopathy: A general term for tendinitis or tendinosis affecting the Achilles tendon.
Achilles or heel (calcaneal) bursitis: Low-riding shoes can irritate the bursa, a sac of fluid cushioning the Achilles tendon at the heel. Pain in the back of the heel, worse with shoes on, is the common symptom.
Phew what a lot of Achilles info!! So what did I do? Well first I didn't run for a couple of weeks to offload the tendon. I continued to do weights at the gym as tendons still like to be loaded. Its vital you don't just stop doing everything as this can lead to the muscles becoming weaker over time which means when you return to the aggravating activity the muscles are even less able to do their job. Things settled down over 2 -3 weeks then I stupidly decided to try a track session but straight away as I tried to put some pace on I felt it grumble. I stopped straight away and went home and stuck my bottom lip out for a bit. Its horrible being injured as most runners will know. We run because we enjoy it and often for social reasons so when we cant do it it feels like the world is ending. I gave it another week to let it settle. I did some tendon massage every night before bed to try to stimulate the healing process and when it was sore I took ibuprofen. As it started to feel less grumbly I started to run 2-3 miles in the morning. I kept my pace really slow and used pain as my base line. I often talk to patients about using a pain scale to help them continue to train. 4/10 is the line you shouldn't be crossing both during and after training.
Its now been about 6 weeks and its about 90% better. I had a few set backs when I went off too quick at a park run and had a little 2 mile race that I didn't want to miss but apart from that I was sensible. I've continued to run in my sandals as it forces me to run well. I know its not quite right as I cant do more than about 10 single heel raises without it feeling really fatigued and I'm not quite running right on it yet, there's just a lack of push off on the right side but its slowly getting there.
As I get more experienced as a physio I know that the biggest part of my job is education. If a patient knows how long their injury will take to recover form then they can build that time into their recovery plan. Patience is absolutely key for recovery. If you get an Achilles niggle then stop running for 2-3 weeks but don't stop training. This is one of the reasons its so important to build S&C into your training plan. You've always got this as a fall back if you do get injured. When you do return to running reduce the speed and distance initially and listen to what your Achilles is telling you. As my very lovely friend often says to me 'don't be a dick!' Don't ignore things. You're better to have 6- 8 weeks with reduced training load than months out with a chronic injury. As you start to build up your running again work on building some slightly faster strides into your runs and continue to keep the distance down.
If you have any questions about Achilles injuries please get in touch and as I say regularly 'DON'T IGNORE IT'
(Me being a grumpy runner!) I’m slowly getting less grumpy again now :-)
