Found on Competitor.com and written by Matt Fitzgerald
Q.
Dear Matt,
I’ve been dealing with pain in my right Achilles for several months. It goes away when I rest but comes right back when I start running again. Will it ever get better?
Jim
A.
Jim,
Achilles tendon injuries are one of the most difficult of running overuse injuries to overcome, and are, unfortunately, one of the running overuse injuries that are most likely to be “career ending.” But don’t panic: There are many effective treatments for Achilles injuries, and chances are very good that yours can be overcome through one or more of them.
One of the reasons Achilles tendon injuries become chronic is that the healing process in that particular tissue actually makes it stiffer and less elastic, which makes it even more susceptible to damage during running. The Achilles tendon also becomes stiffer as we age, which is why Achilles injuries are especially common in older runners.
In addition to age, a forefoot landing style is also commonly seen in Achilles injury sufferers, as this landing style puts tremendous eccentric strain on the Achilles tendon. Faster runners (who are often forefoot strikers) are also more prone to these injuries, as eccentric stress on the Achilles tendon increases geometrically as running speed increases. Even slower runners are more likely to injure their Achilles tendons when doing speed work.
Various other stride abnormalities and muscle imbalances are known to contribute to Achilles injury. For example, tight hip flexors, which are common in runners, may cause a runner to push off the ground early, with an inadequate degree of hip hyperextension, which puts undue strain on the Achilles.
Rest allows the damaged tissues to heal, but it does not allow them to heal in the most functional way, nor does it correct the underlying cause of the injury. So while you may need to stop running for a time when dealing with the injury, you should not simply rest. Stretching you calf muscles and Achilles tendons three times a day and performing heel dip exercises every other day will both help to correct muscle imbalances in the lower legs and minimize the loss of elasticity in the tissue as it heals.
I strongly recommend that you work with a physical therapist that specializes in the treatment of runners to identify and correct any other muscle imbalances and stride abnormalities that may have contributed to your injury. While forefoot striking is generally not considered a stride flaw, some runners have had to modify their footstrike style to overcome recurrent Achilles injuries, including former marathon world record holder Haile Gebrselassie.
Some runners get relief from bodywork therapies such as Rolfing, active release, and the Graston Technique. It can’t hurt to try one or more of these, but I wouldn’t count on it helping.
One of the reasons Achilles tendon tissue is slow to heal is that it doesn’t get a lot of blood flow. A relatively new treatment known as platelet-rich plasma therapy has been developed to deal with this issue. There is a lot of hype about PRPT currently, but solid evidence in support of its effectiveness is still lacking. Like bodywork, it’s worth a try in stubborn cases that don’t respond well to initial measures.
If your Achilles tendon pain is severe and/or the injury is severely debilitating, you should seek an MRI to determine if there is a tear. Serious tears require surgery, which stinks, but the outcomes are typically very good. In fact, Gebrselassie set his world record after two Achilles tendon surgeries.
When you’re healthy again and able to return to running, avoid speed work for a while and then introduce it very cautiously.
Matt