Achilles Tendinitis from Running

An Achilles Tendinopathy or Tendonitis is a structural change to the tendon that attaches the calf muscle to the heel bone, anatomically known as the calcaneus.

It is deemed a tendinopathy, when the tendon itself becomes inflamed. The Achilles Tendon can absorb up to 6-8 times bodyweight whilst running and affects around 9% of recreational runners.

Symptoms of Achilles Tendinitis from Running

Here are the first signs of Achilles Tendonitis from running:

• Localised pain along the tendon or where it attaches to the heel bone
• Morning pain or stiffness for those first few steps on waking
• At the beginning of a run, and typically settles after a brief warm-up

Causes and risk factors of Achilles Tendonitis

Tendons are known to undergo a process of wear and repair from daily activities. The importance of rest means that whilst these tendons may sustain an element of structural change, they have the ability to repair, similar to that of a muscle.

When running to a high frequency and intensity without the required recovery, the repair process is somewhat limited, and we experience overload; often, this will lead to pain and/or dysfunction.

Risk factors will include poor lower limb strength, poor ankle mobility and altered foot and ankle mechanics. Footwear has always been a hot topic in the running community and trainer selection can certainly contribute, particularly when changing to an aggressive profile.

Lastly, we must consider an appropriate training plan. Often, Achilles Tendinopathies are present in those training to high volume, high intensity and low levels of participation in strength and conditioning.

Management strategies for runners with Achilles Tendonitis

A multi-factorial approach to treating Achilles Tendinopathies is often the most effective, particularly in runners. Often I will encourage the following considerations….

• Physiotherapy: to focus on a graduated tendon loading and strengthening programme of the Achilles Tendon, assess for any bio-mechanical asymmetries, and guide the runner back to their training needs. It is very rare that, as a physio, we encourage a period of rest
• Footwear / Podiatry: consideration of footwear is often necessary. Those suffering an insertional Achilles tendinopathy typically report relief with a temporary heel raise of up to 6-12mm
• Strength and conditioning: following a good strengthening programme often complements your rehab and run-related training. Here the focus will be on core stability, gluteal strengthening, and soles strengthening
• Running coach: finally, it is always worth considering a professional running coach. If you are building to an event, then a coach will be able to construct a periodised training plan to ensure you effectively obtain your desired goals

For those looking to encourage a quicker recovery, I would always discuss further treatment options with tendinopathy clients.

These can include…

Extracorporeal Shockwave Therapy – a non-invasive tendon-focused treatment which encourages the bodies natural healing process to support reductions in pain and improve tissue healing

Platelet Rich Plasma Injections – for those stubborn tendons that are just not settling! A Sport and Exercise Medicine Consultant can discuss the options of PRP injections. Very simply put, this is where a consultant will inject the richest content of your own blood into the injured tendon.

Preventing Achilles Tendinitis

Physiotherapy is often seen as the ‘go-to’ when an injury occurs, but actually seeking a sports physiotherapist prior to injury can really help prevent complaints such as Achilles Tendinopathy.

How to prevent an Achilles Tendinopathy:

• Having strong tendons!
• Consider a periodised training plan
• Focusing on the strength and conditioning element! Remember, it’s not just about running those miles.
• Appropriate trainer selection and considering orthotics to support those foot and ankle biomechanical asymmetries

Jack has created a series of exercises designed to help runners build strength and core stability. These exercises include single-leg drops, hopping, heel raises, and goblet squats. These movements can effectively strengthen the calves and the Achilles tendons.

Achilles Tendinitis from running is a common but manageable condition. Remember, it’s not just about clocking miles but also about maintaining the balance between training and recovery, strength and flexibility, and speed and endurance. It is crucial to listen to your body’s signals and respond appropriately to ensure a successful, pain-free running journey.

To book your physiotherapy appointment with Jack, click here

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