By Ian Nurse, DC
It all started a few weeks ago. You can distinctly remember one calf just being slightly tighter than the other. “Where did that come from?” you wonder as you don’t miss a step and finish off that medium long run. “That will be gone tomorrow,” you think to yourself as you make your way to the couch to relax, putting off any type of foamrolling, strengthening, or stretching until the next day. Weeks have now passed and that tightness is not only still there, but it’s been joined by its good friends, pain and swelling. Yet those two unwelcomed symptoms have moved down from the original area of concern and settled-in nicely surrounding one of the broadest and strongest tendons in the entire body: the Achilles. Now, each running step is met with a sharp pain that has even started to alter your gait. It even hurts to move your foot up and down, and the pain is accompanied by a strange creaking sensation and noise (a.k.a. crepitus). “How did this happen?” you wonder, and, more importantly, “How am I going to get rid of it?”
Achilles tendonitis is one of the most common and frustrating injuries for runners of all ages and abilities but especially those slightly older. Despite its broad width and strength, it understandably becomes overused and injured as we place a force 7 times our body weight each time our foot pushes off the ground. Additionally, the Achilles dramatically weakens with age which explains why this is a common injury amongst veteran runners, many of whom have never had Achilles issues in the past.
Interestingly, many of the traditional means of prevention and treatment have recently been reconsidered and debunked. As Achilles tendonitis is most often seen in the high-arched runner with excessively tight calf muscles, original thinking was to relieve the Achilles of that tension by adding a heel lift. More recent studies have shown that it is far more important to help lengthen the calf muscles than try to accommodate their inherent tightness with a heel lift. Dr. Tom Michaud, an expert in running related injuries and author of Human Locomotion, suggests a regimen of stretching, strengthening, massage, and Graston treatment as a means of not only treating Achilles tendonitis but also preventing it. A weekly routine including a deep tissue massage utilizing a foam-roller and Graston treatment, if possible, to break-up restrictive scar tissue, followed by stretching and strength exercises can significantly help prevent this injury from occurring in the first place.
As this injury seems to affect a particular portion of the tendon, the front side, the type of stretches and exercises performed are important considerations. When stretching, one must apply only a gentle tension and hold for a prolonged period of time, 35-40 seconds. Overly aggressive stretching can actually damage the insertion point and pull it further away from the heel. These mild tension stretches should be repeated every few hours throughout the day with the best results being shown to occur following deep tissue massage. An additional approach is to stand on a slant board several times a day to help lengthen the calf and take pressure off the Achilles.
When it comes to strengthening, the latest studies have shown that eccentric- focused calf raises are the most effective means of combatting this injury. For many of us, calf raises entail a strong contraction up and then returning to a lowered position as quickly as possible. With eccentric calf raises, one focuses on contracting the muscle as it lengthens as opposed to as it shortens. To accomplish this one should raise both heels together and then slowly lower just one heel at a time after reaching the peak elevation. Counting down from 5 is an easy way to ensure that the muscle is working hard throughout the entire motion. As stated earlier, most Achilles issues occur at the front portion of the tendon, and, thus, it is also important to contract the calf muscles to their highest point before initiating the eccentric phase to activate this portion of the muscle.
The Achilles tendon is an incredibly strong player throughout the runner’s gait cycle. While most tendons in the body would rupture with a force of 7 times one’s body weight being applied to it, the Achilles is able to endure thousands of steps in just a single run. Since we ask so much of this small band of tissue, it’s only fair to give it the attention that it needs to stay strong and healthy. By adopting this simple regular routine consisting of massage, stretching, and strengthening one’s calf, a more serious, training-altering injury can easily be avoided.
Ian Nurse gives us his script in every issue of Level Renner. This article was originally published in the July/August issue of Level Renner, which can be downloaded for free (along with all of our back issues). Get your free subscription today, which also will make you eligible for our subscriber only contests.
This wonderful condition has effectively ended my career first as a runner and now as a triathlete! Time to investigate surgery!