THINGS RUNNERS NEED TO KNOW
The achilles tendon is a remarkable structure that originates from the back of the leg calf muscles (Soleus and Gastrocnemius) and inserts into the calcaneus or heel bone. The achilles tendon is the largest and strongest tendon in the body and because of this it has to deal with up to 12X our bodyweight when running (1). It is no surprise that the achilles tendon is commonly injured in runners. This injury to the achilles tendon is described as a ‘Tendinopathy’, which is a term that describes pain and dysfunction irrespective of pathology (2). It is common in middle-aged, male distance runners and stem from a multitude of factors such age, genetics, and medication. Athletes with Achilles Tendinopathy can take up to 6 weeks to 12 months to return to sport and can sometimes persist for years (3,4).
HALLMARK FEATURES:
- Pain when squeezing the tendon
- Pain with progressive loading from heel raises to hopping
- Compromised function (Strength and endurance)
- Often swollen and thickened
- Morning stiffness with initial steps
- Tends to warm up with activity but can be painful during activity if in chronic stages
- Minimal pain at rest
COMMON CAUSES AND RISK FACTORS:
- Hill running, speed work, racing, poor recovery, change to minimalist shoes or barefoot running, alcohol use, and medications, decrease ankle range of motion, and weak calf strength.
MANAGEMENT STRATEGIES:
- Rehabilitation exercise is recommended with the highest level of evidence and should be the cornerstone of treatment.
- Shockwave Therapy is also recommended if after 2-3 months if pain and dysfunction is present and combined with rehabilitation exercises, can work really well. It can take up to 3-5 sessions of shockwave therapy to see good results.
REFERENCES:
- Komi PV, Fukashiro S, Järvinen M. Biomechanical loading of Achilles tendon during normal locomotion. Clin Sports Med. 1992;11:521-531.
2. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14:840-843
3. Silbernagel KG, Crossley KM. A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. J Orthop Sports Phys Ther. 2015 Nov;45(11):876-86.
4. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35:897- 906.
