Managing achilles tendinopathy in runners
First, if you haven’t already read the previous blog post on why stretching is not the most beneficial route in managing Achilles tendon pain, go check it out here first.
INITIAL STAGES: SWELLING, PAIN, ACTIVE INFLAMMATION
Recovery mode
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This is when we want to avoid activities that aggravate our symptoms. Modifying your training plan during this phase is important. This may look like temporarily bringing down your training intensity, volume, and finding good cross training options. Wearing a shoe with a higher heel-toe drop ratio can be helpful because it will help reduce tension into your Achilles tendon.
Look for something around a 9 mm heel drop or add a small heel wedge insert. Know that this may change your running form, so you’ll want to let your body adjust. If you’re coming from a zero drop shoe, this may be a big leap.
Shoes with zero drop (no difference in height from the heel portion of the shoe to the toe portion of the shoe), can be aggravating to the Achilles tendon because it will place it on more tension. Avoid these during the initial stages of rehab.
Isometric exercises
Isometrics are a form of muscle contraction that make the muscles work, but at a set position instead of making your joint move through a range of motion that can stretch and aggravate the angry Achilles. Isometrics are also effective at reducing tendon pain. These are best done with the guidance of a physical therapist - they can help you find the right amount of force and which position(s) would be best to target during this initial phase of your rehab.
load it!
Once past the acute “angry” Achilles phase, it’s time to load the tendon and strengthen the calves. Often times, the Achilles tendon will take a beating because of calf weakness and/or a poor ability to keep up with your training volume. It’s not uncommon for sudden changes to training intensity, switching to super shoes too quickly, or a big ramp up in training volume to cause this issue.
When we run, our Achilles can take on 6x our body weight! But when recovering from an Achilles flare, we don’t want to aim for that type of load right away. Graded exposure to double leg exercises and progressing to single leg exercises takes time and expertise. We want to work against gravity first, then start adding on weight as your tissues adapt.
Our Achilles tendon is actually made up of two calf muscles. The gastrocnemius and the soleus. And these muscles are targeted differently - the gastroc with a straight knee and the soleus with a bent knee. There are also various types of muscle contractions that are beneficial for strengthening our calves: isometric (muscle contracts without a change in joint position), concentric (muscle fibers contract and shorten), and eccentric (controlled lengthening of muscle fibers). The videos demonstrate examples of calf raises targeting each of these muscles and some of these different types of loading.
PLYOMETRICS
Our next phase gets you more sport-specific. Running demands that our muscles and tendons can stretch and immediately contract. Over and over again. Enter plyos! By the time we get to this phase, you want to have little to no pain at all. Progressing your plyos follows a similar pattern to your strength training, start with double leg then transition to single leg focus. For example: hopping in place (double leg activity) versus skipping (single leg progression).
PREVENTION
Once you overcome your bout of Achilles Tendinopathy, you want to maintain the resiliency of your Achilles. You’ll want a proper strength program that takes your former injury into account and incorporates exercises for both the gastroc and the soleus muscles, as well as plyometric drills.
Jumping rope is a great plyometric exercise to do 2x/wk. It’s also a great coordination challenge! If this is new to you, start with 30 secs of jumping rope the best you can, followed by 30 secs of rest. Repeat this cycle 5 times. As you get better, the goal is 5 consecutive minutes of jumping rope eventually.
Collagen. If you have a history of Achilles tendon issues or an active Achilles issue, supplementing with 15-20g of collagen powder paired with a vitamin C source helps give your body the building blocks for resilient tendons. Mixing some collagen powder up in some OJ is super easy. My personal fav is tart cherry juice and chocolate flavored powdered collagen, it tastes like chocolate covered cherries! Drink your mixture 30-60 minutes before your workout to optimize collagen absorption and the protective tendon benefits!
As always, I really appreciate you taking the time to read this! If this is something that you’re dealing with, I encourage you to set up your FREE Discovery Call today so we can help you get out there to run at your full potential!
