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Cross Training For Runners

Achilles Tendonitis in Runners: Causes, Symptoms, and Solutions

17 Mins read

Have you ever experienced that dreaded pain in your Achilles tendon while out on a run? Or maybe it strikes just as you’re catching your breath after a satisfying workout? Well, brace yourself, because you might be dealing with a formidable foe known as Achilles tendinitis.

Now, let me tell you, Achilles tendinitis is no joke. It’s like that unwelcome guest who crashes your running party and refuses to leave. But fear not, my resilient friend, because I’ve got your back. I’ve put together the ultimate guide to Achilles tendonitis in runners, and trust me, it’s going to be a game-changer for you.

By the time we’re done here, you’ll be armed with knowledge that will help you tackle this relentless injury head-on. I’m going to dive into everything you need to know, from understanding the ins and outs of Achilles tendonitis to learning why us runners seem to be particularly susceptible to it. Oh, and I’ll explore the fascinating anatomy of the Achilles tendon too, just to give you a complete picture.

But that’s not all. I’ll also unveil the secret sauce of treating Achilles tendonitis, providing you with practical tips and strategies to get you back on your feet in no time. And hey, prevention is key, right? So I’ll equip you with the tools you need to protect yourself from future bouts of Achilles tendinitis, ensuring you can keep pounding the pavement without worry.

Sounds like a lot to digest? Well, let’s get started.

Basic Anatomy & Functions

The Achilles tendon is a strong and resilient that takes the spotlight as the heavyweight champion of your body’s tendons. It sits right behind and above your heel, connecting the powerhouse duo of calf muscles—the gastrocnemius and soleus—to the back of your heel bone, also known as the calcaneum.

Think of the Achilles tendon as the power conduit, the trusty bridge that transfers all that force and energy from your calf muscles to your ankle during the magnificent acts of walking and running.

Now, brace yourself for this mind-blowing fact: The Achilles tendon is so incredibly robust that it can withstand the mind-boggling pressure of over 1,000 pounds! Yes, you heard that right. It’s as if it possesses Herculean strength, ready to take on whatever challenges come its way.

But here’s the catch: Even with its impressive fortitude, the Achilles tendon isn’t impervious to injury. In fact, it can still succumb to the forces of strain and stress. Just like any formidable hero, Achilles tendonitis can sneak up on you when you least expect it, ready to put a dent in your running aspirations.

The Trouble With The Achilles Tendon

Let’s unravel the mystery of Achilles tendonitis, shall we? Brace yourself for a journey into the world of overuse injuries and the tenacious Achilles tendon.

Imagine Achilles tendonitis as an unwelcome guest that crashes the running party. It occurs when the Achilles tendon, that hardworking band of tissue, gets overwhelmed by the demands placed upon it.

You see, the Achilles tendon is like a finely tuned instrument, designed to adapt and handle the strains of your running adventures. However, sometimes it falls short of keeping up with the relentless pounding it endures.

Here’s where the plot thickens. The exact causes of Achilles tendonitis are still a topic of debate among researchers, but one thing is clear: tendinopathy, the underlying culprit, occurs when the tendon fails to adapt to the strain it experiences.

It’s as if the tendon’s resilience reaches its breaking point, resulting in a cascade of micro-damage within the delicate fibers.

In response to this relentless strain, the Achilles tendon springs into action, attempting to mend itself. Picture a team of tiny repair workers diligently patching up the damaged fibers, all while trying to keep up with the demands of your running regimen.

As a runner, you might find yourself caught in the Achilles tendonitis web when you make the classic beginner’s mistake: overtraining or pushing your limits too quickly.

Your Achilles tendon, bless its resilient soul, tries to keep up with your enthusiasm but ends up feeling sore, swollen, weak, and stiff.

Risk Factors For Achilles Tendon

When it comes to Achilles tendinitis, knowledge is power. Understanding the factors that may raise your risk of falling victim to this nagging condition can help you take proactive steps to protect your Achilles tendon fortress..

First on the list is the unavoidable ticking clock of age. As the years go by, the risk of Achilles tendinitis tends to creep up, especially from the age of 30 onwards. The “elasticity” of the tendon takes a hit, making it more vulnerable to micro-tears.

But wait, there’s more. Gender also plays a role in this tendon tale. Sorry, gentlemen, but studies have shown that male runners are more prone to Achilles tendinitis. It’s like the tendons are playing favorites, leaving you with an extra hurdle to overcome.

Next up, let’s talk about biomechanical challenges. If you have flat feet, consider them a double-edged sword. While they might make you an ace at limbo competitions, they also put extra pressure on your Achilles tendon, paving the way for tendinopathy to march in uninvited.

Now, let’s lace up our detective shoes and investigate the case of the culprits known as bad running shoes. Picture this: you’re out on the road, putting in the miles, but your worn-out or ill-fitting sneakers are secretly plotting against you. They’re like the villains of the running world, increasing your risk of Achilles tendinitis. Time to invest in a trusty pair of running shoes, my friend!

Speaking of running surfaces, let’s navigate the treacherous terrains that can leave your Achilles tendon vulnerable. Think of asphalt and concrete as the foes of your footwork, offering little forgiveness and amplifying the strain on your tendon. It’s like running through a minefield, risking injury with each step.

But wait, there’s a twist in the story. Certain medical conditions can also act as accomplices to Achilles tendinitis. If you have high blood pressure, diabetes, or immunological issues, consider them as potential red flags that warrant extra caution. It’s like Achilles tendinitis has a knack for targeting those already facing health challenges.

Last but not least, let’s stretch our focus to the importance of flexibility. Tight calf muscles, akin to a clenched fist, put additional strain on the Achilles tendon.

It’s like pulling on a rubber band that’s already taut, increasing the tension and leaving the tendon susceptible to tendinopathy.

The Early Signs of Achilles Tendinitis

You’ve just finished a run, feeling that post-workout glow, when suddenly a mild ache starts to creep in. It’s like a warning sign from your Achilles tendon, located either above the heel or in the back of your leg. It’s a subtle message, but one that shouldn’t be ignored.

As the hours pass, you may notice stiffness or tenderness, almost like a mischievous cramp playing hide-and-seek around your affected foot. But fear not, as these sensations often subside with mild activity, leaving you with a sense of relief.

But wait, there’s more. Your Achilles tendonitis might have a few additional tricks up its sleeve. You might experience a redness or sweltering sensation in the Achilles area, as if the fire of inflammation is dancing beneath your skin.

What’s more?

Heel pain can strike during your run or ambush you right after, like a relentless opponent determined to throw you off your feet.

Swelling becomes another player in the Achilles tendonitis game, lurking in the back of your heel or even within the tendon itself, causing discomfort and pain.

And let’s not forget the morning rituals. As you rise from your slumber, you may encounter pain and stiffness in your Achilles, like an unwelcome morning guest who overstayed their welcome.

Your ankle may also become a key player in this Achilles tendonitis drama. Poor flexibility and tightness during plantar or dorso flexion, like a stiff gatekeeper, can hinder your ankle’s full range of motion..

Lastly, prepare yourself for the unexpected soundtrack of cracking sounds during ankle movement. It’s like a tiny orchestra of pops and clicks accompanying your every step, reminding you that your Achilles tendon is in a state of unrest.

Additional resource – How to run in deep water

Achilles Tendonitis – The pain scale

At the milder end of the spectrum, you may experience pain while running or shortly after. It’s like a gentle reminder from your Achilles tendon, a whisper rather than a shout. However, the pain is not overly disruptive and tends to subside during rest. You might feel this discomfort along the Achilles tendon as you continue your run, a nagging companion that doesn’t want to steal the spotlight.

Moving up the scale, the pain becomes more assertive. Not only does it accompany your activities, but you also notice swelling in the Achilles region. This swelling can be tender to the touch, as if the area has become sensitized and responsive to even the slightest contact. In some cases, you might even detect the formation of a lump within the tendon, a small intruder that adds to the complexity of the situation.

Now, brace yourself for the higher end of the pain scale. Weight-bearing activities become a battleground for your Achilles tendon. Each step brings a surge of pain in the Achilles region. The swelling along the tendon may intensify, accompanied by sharp points of pain that catch you off guard. It’s as if your Achilles tendon is protesting vehemently, demanding your attention. In extreme cases, the Achilles tendon may even tear completely, causing a level of pain that is nothing short of severe.

Remember, this pain scale is a guide to help you understand the progression of Achilles tendonitis and the potential severity of your symptoms. If you find yourself higher on the scale, it’s crucial to seek professional medical advice to ensure proper diagnosis and treatment.

Complications of Achilles Tendonitis

When Achilles tendonitis is ignored or left untreated, scar tissue starts to make its presence known. Picture it like a stubborn invader, setting up camp in the delicate balance of your tendon. This scar tissue hampers the healthy flow of blood to the tendon, obstructing the crucial process of healing. While some remodeling may still occur, it takes a detour into fibrosis territory.

Now, fibrosis is no friend to your Achilles tendon. It’s like a mischievous character that brings trouble wherever it goes. The fibrotic tissue tends to be weaker and less elastic than the healthy tendon, posing a higher risk of tears. And we’re not talking about a minor hiccup here; we’re talking about a tear that demands serious attention, potentially even surgical intervention. It’s a scenario that no runner wants to face.

Over time, if left unaddressed, the complications can progress further. The Achilles tendon itself may succumb to a degenerative tear, forming a lump that serves as a painful reminder of the neglected tendonitis. This is a sign that things have taken a turn for the worse, and action needs to be taken promptly.

As if that weren’t enough, Achilles tendinosis, a chronic inflammation accompanied by fluid accumulation, can rear its head. It’s like a stubborn foe that limits your ability to even engage in a slow jog. It puts a damper on your running aspirations, leaving you longing for the freedom and joy that once accompanied your strides.

Surveys and studies have shown that roughly 66 percent of Achilles tendonitis cases strike the midpoint of the tendon, a few inches above the heel. So, this isn’t just a rare occurrence—it’s a prevalent problem that demands our attention and proactive measures to prevent its progression.

How to Treat Achilles Tendonitis In Runners

So, you’ve found yourself caught in the grips of Achilles tendonitis. But fear not, my running friend, for there is a road to recovery that leads to renewed strength and pain-free running. Let’s explore the steps that will guide us along the way.

Stop Running

Giving your Achilles tendon a well-deserved break from the repetitive impact is crucial for its recovery. Take a step back, lacing up those running shoes can wait for now. But fear not, for rest doesn’t mean you have to stay idle. Embrace the wonders of cross-training, engaging in activities that are gentle on your Achilles tendon.

Picture yourself gliding through the water, the pool becoming your sanctuary as you swim with grace. Or imagine the rhythm of your pedaling as you conquer the miles on a bike ride, feeling the wind against your face. You might even find solace in the strength training arena, sculpting your body while giving your tendon the respite it needs. And why not explore the benefits of yoga, where stretching and mindful movements can nourish both body and soul?

During this rest period, it’s essential to listen to your body and respect its limits. Non-weight-bearing exercises are your allies during this time. Allow yourself at least three weeks of dedicated recovery, refraining from pushing through the pain. Remember, healing takes time, and patience is your greatest companion on this road to recovery.

Studies have shown that it may take at least three months or more for the pain to fully dissipate, according to The American Academy of Orthopedic Surgeons.

Ice Therapy

Imagine your Achilles tendon as a fiery battleground, with inflammation and discomfort raging within. Ice therapy swoops in as a hero, armed with its icy touch to calm the flames. Applying ice to the Achilles tendon can provide much-needed relief, reducing swelling and numbing the pain.

But here’s the catch: timing is everything. Remember not to overstay your welcome with the ice pack. Keep it to a maximum of 15 minutes per session, several times a day. Studies have shown that applying ice for less than 10 minutes has minimal effect, while over-icing for more than 30 minutes may damage the skin. So, aim for that sweet spot and let the cooling sensation work its magic.

Take Meds

Intense pain can be a formidable adversary, but fear not, for there are allies that can lend a helping hand. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be your go-to companions in combating both pain and swelling. However, it’s crucial to approach medication with caution.

Remember that while NSAIDs can provide temporary relief, they merely address the symptoms and don’t tackle the underlying issue. So, be mindful of using them as a short-term solution and seek comprehensive treatment for long-lasting results.

But hey, why stop there? Let’s explore some other techniques that can aid in your Achilles tendonitis recovery.

When To See A Doctor

If pain around your Achilles tendon persists despite rest and proactive measures, it’s time to bring in the experts. Consulting a doctor becomes essential when symptoms fail to improve.

Resist the temptation to reach for painkillers before your appointment, as they can mask the true extent of your condition, potentially leading to misdiagnosis. Instead, opt for an open discussion with your doctor, addressing your concerns and exploring the best course of action.

While surgery may be necessary in some cases to remove scar tissue around the tendon, my research indicates that it is not always the optimal solution, as it can stimulate further scar tissue formation.

Instead, experts recommend focusing on the root causes of the problem, rather than solely treating the symptoms. Improving flexibility and mobility in your calf muscles becomes paramount, and one tool that has shown promise in achieving this is the mighty foam roller.

Return To Running After Achilles Tendonitis

Congratulations! You’ve made it through the initial stages of Achilles Tendinitis and are now ready to embark on the road to recovery. It’s time to gradually reintroduce running into your life, one careful step at a time. Let’s explore the three key stages of Achilles Tendinitis rehabilitation for runners.

First stage – The Injury Period

The injury period is a time that demands patience and discipline. Research papers have shown that this stage typically spans from two to five weeks, during which rest becomes your closest companion. Yes, it may seem boring, but remember, it’s a crucial step in your journey back to full strength.

During this phase, prioritize resting your injured limb as much as possible. RICE (Rest, Ice, Compression, Elevation) becomes your trusted daily routine, offering relief and aiding in the healing process. Cross-training can be a great way to maintain fitness levels without aggravating your Achilles tendon. However, keep this golden rule in mind: if any activity brings about pain, it’s a signal to steer clear.

Second Stage – The Dynamic Work Period

Welcome to the dynamic work period, where the focus shifts from resting to gentle yet impactful exercises. This stage typically spans up to three weeks and introduces a range of dynamic drills aimed at familiarizing your Achilles tendon with controlled impact.

Embrace drills such as hopping drills, where each hop becomes a step towards building resilience. Strengthening and mobilizing the injured area take center stage, with heel rises and foam rolling becoming your trusty allies. Progression to the next stage is within reach once you can perform toe raises, engage in free hops, execute jumping jacks, and gracefully navigate backward lunges—all without experiencing pain.

Pay attention to your ankle’s flexibility and mobility during dorsiflexion (bringing your foot towards the shin) and plantarflexion (pointing your foot away from the shin). Once these movements can be executed without discomfort, you’re ready to level up and embrace the final stage of rehabilitation.

Third stage – The Return To Running Period

In most cases, expect to be back to running in in six to eight weeks—depending on the severity of your condition and your recovery plan.

The rules are simple:

  • Pick up running again but in a slow and gradual manner.
  • Back off or stop training altogether if you feel pain either during or after your runs.
  • Alternate between running days and rest days, or make the rest day longer than usual.

This stage should take you up over two to three weeks to build up your weekly mileage to the pre-injury levels.

Keep in mind that this is just a suggested guide.

It’s not written in stone.

Every runner will respond to this differently, and each Achilles injury is unique.

Listen to your body and re-adjust accordingly.

Re-assess every two weeks how your progress is going on.

You call the shots.

How To Clean Running Shoes

Preventing Achilles Tendinitis In Runners

Although it may not be possible to prevent Achilles Tendinitis—especially if you’re keen on running—there are a few measures you can take to reduce your risk.

Here a few of the measures:

Three Achilles Tendon Exercises

To keep your Achilles tendon in tip-top shape and fend off potential (re-)injuries, incorporating targeted stretching and strengthening exercises into your routine is crucial. Numerous studies and research papers have highlighted the importance of these practices in maintaining a resilient Achilles. So, let’s embark on a journey of flexibility and strength that will elevate your post-run routine to new heights. Are you ready?

Calf Raises: Building Resilient Pillars

Imagine your calves as the mighty pillars that provide the foundation for your running endeavors. Calf raises are the secret weapon that will fortify these pillars and enhance the resilience of your Achilles tendon. Here’s how to perform them:

a) Stand tall on both feet, aligning yourself with unwavering determination.

b) Find support from a sturdy wall or a reliable chair, as you prepare to embark on this strengthening journey.

c) Slowly rise up onto your tiptoes, feeling the burn in your calf muscles, as if you’re reaching for the sky.

d) Hold this elevated position for a moment, savoring the strength that emanates from within.

e) Now, with deliberate control, gradually lower your heels back down to the ground, focusing on the eccentric part of the exercise—the descent of your calves.

f) Begin with your body weight alone, aiming for four sets of 12 to 15 reps each day, nurturing your calves with a touch of resilience.

g) Once you’ve mastered the basics and feel the yearning for an extra challenge, venture into the realm of the gym, where the calf raise machine awaits to elevate your strength training routine.

The Seated Calf Stretch: Unleashing Flexibility

After an invigorating run, it’s time to reward your Achilles tendon with the gift of stretching. The seated calf stretch will become an essential post-run ritual that unleashes the full potential of your flexibility. Here’s how to do it:

a) Find a serene spot on the floor or an exercise mat, and sit up straight, like a regal monarch overseeing their kingdom.

b) Bend your left knee, while gracefully straightening your right knee, flexing the power within.

c) Embrace a towel or a long piece of elastic, securing it around the ball of your right foot, like a gentle embrace that nurtures growth.

d) Pull your toes towards you, keeping your knee straight, as if drawing your dreams closer to your heart.

e) Hold this captivating position for a rejuvenating 30 seconds, as your muscles surrender to the embrace of the stretch.

f) Now, as the symphony of balance and harmony plays its melody, gracefully switch sides, ensuring that your back remains straight throughout the stretch.

The Calf Runner’s Stretch: Embracing the Wall of Progress

As you progress on your journey to an Achilles of steel, it’s time to embrace the wall of progress with the mighty Calf Runner’s Stretch. This stretch adds a touch of variety to your routine, while providing a satisfying stretch to your calves. Here’s how to perform it:

a) Position yourself before a wall, placing both hands on its sturdy surface, as if connecting with a symbol of strength.

b) Allow your feet to settle slightly apart, with one foot confidently positioned in front of the other, ready to take the next stride.

c) Bend your front knee with grace, while keeping your back knee straight, as if mastering the art of balance and resilience.

d) Lean gently towards the wall, pressing through your back heel, until you sense a delightful stretch resonating through your back calf, like a gentle whisper of progress.

e) Hold this captivating position for a triumphant 30 seconds, as you immerse yourself in the embrace of the stretch.

f) As the dance of balance continues, gracefully switch sides, offering equal devotion to both your calves.

Wear Proper Shoes

As a runner, your journey is fueled by passion, determination, and of course, the perfect pair of running shoes. These shoes act as your trusted armor, safeguarding you from the perils of injuries that lurk along your path. But beware, my fellow runner, for without the right shoes, you risk stumbling into the realm of aching Achilles tendons and shattered dreams.

First and foremost, your running shoes should be a haven of cushioning, providing a gentle embrace for your heel as it strikes the ground. But that’s not all. They should also bestow upon you the gift of stable arch support, alleviating the tension that can plague your Achilles tendons.

To uncover the perfect pair, venture forth to the nearest specialty running store, where the guardians of knowledge await. These wise souls, the pro staff, will analyze your running gait and foot type, unraveling the secrets that lie beneath your every stride. With their insights, they will bestow upon you the recommendations that align harmoniously with your unique needs.

But heed this advice, dear runner: Shoes, like all things in life, age and wear. Every 400-500 miles, bid farewell to your faithful companions and welcome new ones into your fold. Running in worn-out shoes is akin to donning a tattered suit of armor—it defeats the purpose and exposes you to unnecessary risks. Remember, the road to greatness demands fresh footwear.

Now, let us delve deeper into the realm of shoe selection. Consider embracing shoes with a slightly higher heel-to-drop ratio. This subtle adjustment can serve as a balm for your Achilles tendon, relieving it from excessive stress. Think of it as granting your mighty tendon a luxurious cushion to rest upon, allowing it to rejuvenate and prepare for the challenges ahead.

However, tread with caution, my friend, and beware of the perils that lie within the realm of barefoot wandering or zero-drop shoes. These sly provocateurs can further irritate your Achilles tendon, undermining the very essence of your running prowess. Make it a sacred rule to provide your Achilles with unwavering support, especially during the delicate recovery period when it yearns for tender care.

Stick to The 10 Percent Rule

You’re lacing up your running shoes, ready to embark on a glorious journey. But remember that as you traverse the miles, let not your ambitions soar too high, for the 10 Percent Rule shall be your guiding light. Its essence is simplicity itself: Thou shalt not increase thy running mileage or time by more than 10 percent from one week to the next.

The heart of our journey lies in striking the delicate balance between progress and preservation. The 10 Percent Rule is but a tool in our arsenal, a safeguard against the perils of overexertion.

Yet, in the grand tapestry of running, it is merely one stitch among many. As the saying goes, the devil is in the details, and so we must pay heed to the intricacies that shape our running destiny.

Now, let us shift our gaze to those brave souls who are venturing into the realm of running for the very first time. To you, courageous newcomer, I offer a unique perspective.

Release yourself from the constraints of the 10 Percent Rule, for you are embarking on a journey of cardiovascular empowerment. Focus on building the strength to run continuously for 30 minutes, leaving behind the huffs and puffs of novice exertion. Your mission, my intrepid friend, is to forge a path to fitness without the burden of injury.

Proper Warm-up

Start off your runs with a proper warm-up.

An ideal warm-up consists of 5-minute brisk walking, some light stretching, then you could steadily break into your normal running pace.

Here’s a fantastic warm-up routine to perform before your runs.

Achilles Tendonitis in Runners – The Conclusion

Here’s the bad news.

We are not robots, and there’s no spare part for our bodies.

No real cure for an overuse injury.

Achilles tendonitis occurs because of damage to the tendon, and if if you run, you’re bound to cause some damage.

Healing damaged tendons requires recovery time and acute attention.

Understanding the injury and incorporating the tips above into the recovery plan is a good place to start.

If symptoms don’t improve, seek out a physical therapist to help you with your recovery.

Feel free to ask for second opinion if you’re still in doubt about surgical issues.

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