Achilles Tendinitis & Tears: What Runners Should Know
Some muscles just work harder than others during running. One of these star players is the calves. Well, they pretty much work during every movement we do. Crossing both the ankle joint and knee joint, the calf is involved with any activity that requires us to push off of our toes. Not only that but they are also highly active when trying to control our descent during downhill running or walking. Since they play key roles during every part of running, we should be taking very good care of them every day. Strengthening and stretching the calves on a regular basis is an important part of training.
Having limited strength and flexibility in the calves leads to numerous injuries and pain including shin splints, plantar fasciitis, tendonitis, knee issues, and even hip and back issues over time. One common injury experienced by runners and many other athletes is Achilles’ tendinitis. The Achilles tendon is a thick band that connects the calf muscles to the heel of the foot. It is a prominent tendon in most people. All of the forces generated during running, especially during the push-off phase, are transmitted to the Achilles’ tendon. Faster running usually transmits more forces leading to injuries in the area.
What is Achilles’ Tendinitis?
When there is increased strain to the Achilles’ tendon, inflammation, irritation, and degeneration occur. The overworking of the tendon creates tiny microtears that weaken over time and can eventually lead to larger tears and ruptures. The most notable symptoms of Achilles’ tendinitis is visible swelling in the tendon, tenderness, and pain when first getting in up in the morning. And when trying to stand on toes. Once it is warmed up the pain will usually subside and runners are able to run through it. As the condition worsens, the pain will gradually reappear and eventually limit the volume and speed of running. Tendon tears and ruptures will either have a visible bump over the area and commonly a gap where the tendon is ruptured.
Although high volume training, speed training, and lack of strength are all causes of Achilles’ tendon issues, many physiological and biomechanical factors can increase the strain on the tendon and risk developing these problems.
You have probably heard about how terrible heel striking is for runners. Well, the truth is that the research is inconclusive and heel striking actually works for some people. The reason this type of foot strike is related to Achilles’ tendon pain is that it involves increased stretching of the tendon. So if you already have tight calves to begin with, then the constant pulling during heel striking can lead to overstretching. Focusing on a flexibility program for these muscles is important in this case. The opposite type of foot strike, forefoot striking, actually creates a worse strain on the Achilles’ tendon. With this motion, you are basically landing on the toes and pushing off for the next stride all without giving the calves a break. In this case, a strengthening program is important.
Foot form is different for everyone. Flat-footed people or those with pronated feet (foot is turned inward when standing) will have a more strained Achilles’ tendon, as well as impeded blood flow to the area. There is already an area with limited blood supply, termed the “watershed area”, where the majority of tendon ruptures occur. This area is located about 4cm above the end point of the tendon on the heel. Limiting blood flow further as in the case of pronation will increase the risk of damage and slow healing on the tendon. Using supinated running shoes or inserts to decrease the amount of pronation is a treatment strategy.
Treatment & Prevention
Runners should focus on incorporating calf strengthening a couple of times every week, especially during their training seasons. Heel raises in all planes—toes pointed straight, toes pointed inward, and toes pointed outward are the main exercise for the calves. Seated heel raises or while in a squat position will help strengthen the soleus muscle, which is a muscle found deep under the gastrocs, the main calf muscles, that also connects to the Achilles’ tendon. Eccentric heel raises are the best way to strengthen the calf muscles as this will prepare the tendon for activities in which it is required to control the descent from extreme positions. To perform eccentric heel raises follow these steps:
- Stand on a step with both heels hanging off.
- Lift both heels together.
- Once completely on toes, shift all weight to only one leg and slowly lower the heel to just below the edge of the step.
- Repeat 10-20 times on one leg, then repeat the same with the other leg.
Essentially this exercise will create a type of damage in the tendon, which strips away the previously damaged fibers and encourages the development of new fibers as a form of healing.
Runners should also incorporate stretching after every run and activity that highly involves the Achilles’ tendon such as hiking and climbing stairs. Stretching with both the knee straight and bent is important in order to include both the gastric and soleus muscles. Foam rolling is also helpful to break up any adhesions and extreme tightness in the muscles. Although strength training is time-consuming during training season, it is very important in order to prevent injuries. Achilles’ tendon injuries can be frustrating as they are frequently overlooked since the initial stages involve pain-free running. Taking care of Achilles’ issues from the start will involve a short rehab time while waiting until the pain is unbearable and affecting your running can leave you out of the sport for several months.