It all started a few weeks ago. You distinctly remember one calf being just slightly tighter than the other. “Where did that come from?” you wonder as you finish your 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 foam rolling, strengthening, or stretching until tomorrow. Weeks go by and that tightness is still there. One day you wake up to find its good friends, pain and swelling, have joined the party...
Sadly, those 2 unwelcome symptoms moved down from the calf and settled in nicely around one of the broadest and strongest tendons in the entire body: the Achilles. Now, every step you take is met with a sharp pain. Your gait begins to change. It hurts to move your foot up and down. You may even feel a strange creaking sensation as you attempt to point your toes. You’re heading towards a mandatory few days off, and none of us want to see that. “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. Despite its broad width and strength, we have to forgive the Achilles for occasionally freaking out, after all, we drive a force seven times our body weight through it 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, the traditional way of thinking when it comes to managing runners’ Achilles has changed. Research done during the first running boom (the 1970s and ’80s) led physicians towards trying to mitigate tension in the Achilles by adding a heel lift to runners’ shoes. More recent studies have shown that it is far more important to help lengthen and strengthen the calf muscle than try to accommodate any inherent tightness with a heel lift. This study from Sweden analyzed athletes with chronic Achilles tendon pain and found that a program of eccentric strengthening exercises lead to dramatic and long lasting improvements in pain and tendon health on a microscopic level. More on eccentric strength techniques in a minute…
Because the tissue is already irritated, it’s important to choose the type of stretches and exercises wisely - the last thing we want to do is make it worse! 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 and stress the already irritated tissue. These mild tension stretches should be repeated every few hours throughout the day. Some runners report that pairing this regimen with massage leads to a steep reduction in pain. Remember, the purpose of mobility is always to relieve pain, so that we can do the important work of strengthening the musculature, to address the root cause.
When it comes to strengthening, the latest studies show that eccentric calf raises are the most effective means of combating this injury. Many of us perform a calf raise with a strong contraction up and then drop quickly to a resting position. With eccentric calf raises, you should focus on contracting the muscle as it lengthens as opposed to as it shortens. To accomplish this, stand off the edge of the step, and with both legs, stand on your tiptoes. Remove one leg (hold on to something to help you balance) and slowly lower your bodyweight. Repeat for 3 sets of 15 reps per side. Counting down from 5 as you lower your heel is an easy way to ensure that the muscle is working hard throughout the entire motion. In the Recover App, you’ll find a full Achilles recovery routine, which includes exercises that strengthen muscles up the kinetic chain so you can take some pressure off the Achilles before it becomes a problem! Check out the routine here.
Most tendons in the body would rupture if we asked them to tolerate seven times our body weight once, but the Achilles handles this abuse thousands of times every mile! 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 a regular routine of mobility and strengthening, a more serious, training-altering injury can easily be avoided.
Editor's Note: Dr. Ian Nurse is the founder of Wellness in Motion, a group of runner focused clinics in the Boston area. WIM's staff of acupuncturists, massage therapists, physical therapists, registered dietitians, sports psychologists, and personal trainers are the go to for first timer runners and elite marathoners alike. We’re excited to feature more of Ian’s running health articles on the Recover Athletics blog!