| Running Injuries | | | | the tendon and create a healing crisis response |
| Achilles Tendonitis is very common in runners. | | | | from the body. As we know the achilles tendon is |
| Common belief is that rest works well in the | | | | not blessed with a good blood supply so by |
| treatment of achilles tendonitis. As most people | | | | manufacturing an inflammatory response you will |
| will testify, this in fact is not the case and careful | | | | encourage vasodilation of blood vessels, increase |
| management of this condition is needed. Usually | | | | blood flow to the area and promote healing. |
| the painful symptoms around the achilles tendon | | | | My recommendations would be : |
| return when training resumes. | | | | 3 x treatments per week for the first 3 weeks |
| | | | with no running done. During this time the patient |
| The achilles pain syndrome is divided into two | | | | should wear heel lifts in both shoes to reduce the |
| main areas which involves both tendon and sheath | | | | stress on the injured achilles tendon. By the end |
| ( paratenon tissue ) The achilles tendon does not | | | | of the 3 weeks the fibrous adhesions should be |
| in fact have a true tendon sheath but has | | | | broken down and the painful part of the |
| paratenon tissue which surrounds the tendon and | | | | treatment plan is complete. The treatment plan |
| assists lubrication of the tendon on movement. | | | | has to involve factors such as pain relief, |
| Inflammation of the paratenon tissue usually | | | | increased vasodilation, and breaking of fibrous |
| shows as a thickening and increases the size and | | | | adhesions around the tendon and sheath. |
| appearance of the tendon. | | | | Weeks 4 and 5 should allow the tendon to |
| Palpation over the area is usually painful and any | | | | recover and both ultrasound and interferential |
| running is difficult. | | | | treatments together with soft tissue work |
| Causes | | | | administered 3 x weekly will promote healing. |
| Overuse and lack of conditioning will both irritate | | | | Removal of heel lifts is now advised in order to |
| the achilles tendon as will overstretching, which | | | | provide passive re-stretching of the tendon. No |
| may come from running up hills or steep inclines | | | | running should be done during this time. |
| on a treadmill. Tight calf muscles due to lack of | | | | Weeks 6 and 7 should involve 2 x treatments per |
| proper stretching can also result in a sore achilles | | | | week with active stretching after home exercises. |
| tendon which will result in inflammation and pain. | | | | Ensure a gentle stretch of both soleus and |
| Previously mechanical irritation from badly | | | | gastrocnemius calf muscles and hold the |
| designed training shoes with a high achilles | | | | progressive stretch for 2 minutes at a time. Begin |
| protector used to be a problem but | | | | strength conditioning by performing 20 repetitions |
| manufacturers have altered this by designing a | | | | of calf raises 3 x daily, the stretching can then |
| "V" cut into the top of the protector which has | | | | follow. Complete the process by icing the area |
| helped considerably. | | | | when stretching is completed. |
| Treatment | | | | Week 8 Replace heel lifts in running shoes and |
| This may vary depending on the severity of the | | | | begin half pace jogging for 15 minutes every |
| condition and workload of the athlete. Most | | | | other day, stretch off gently after exercise and |
| runners get twitchy if they are told to rest and | | | | ice. Heel lifts should only be worn in running shoes |
| stop running for a while, so a treatment plan | | | | now and not during daily activities. Treatments of |
| needs to consider this factor. Runners may be on | | | | electrotherapy and soft tissue work should |
| a training regime in preparation for a marathon | | | | continue twice per week. |
| and any gaps in training may have a negative | | | | A gradual increase in distance should follow over |
| effect on their performance. This however needs | | | | the weeks with a gradual increase in pace and if |
| to be balanced with the realization that this type | | | | pain free the heel lifts should be removed. When |
| of injury has to involve rest periods in order to | | | | heel lifts are removed during running, reduce pace |
| allow healing to take place | | | | and distance again to accommodate the extra |
| It is vital that the cause of the injury is identified | | | | stretch on the tendon. This can be gradually |
| before treatment is undertaken. Once the cause | | | | increased as before until back to full fitness. |
| is identified then the correct treatment plan can | | | | During rehabilitation try and avoid running up hills |
| be introduced. Many physiotherapists use | | | | which may stretch and irritate the tendon. |
| ultrasound as their treatment modality and | | | | This treatment plan is only a guide and may be |
| although this is a good choice it will not be | | | | customized to suit different individuals but I have |
| successful if used in isolation. | | | | used this formula many times with great success. |
| If the tendon sheath is thickened it will require | | | | The skill of the therapist is vital in the programme |
| specific deep friction massage to break down | | | | and if they rely only on machines for treatment it |
| adhesions. This will obviously irritate the achilles | | | | will not be successful. A skilled hands on approach |
| tendon and be painful, but if ice is used throughout | | | | needs to accompany the electrotherapy |
| to reduce inflammation and pain, the process can | | | | treatments and the home exercise rehab |
| be administered successfully. | | | | programme has to be undertaken. |
| Friction massage is used in an attempt to re-injure | | | | |