Is your Achilles your Achilles?

Achilles Tendinopathy is one of the most common running ailments. If not treated properly, it can become a major, longterm problem. Here’s how to deal with a cranky Achilles

The Achilles role is to act as a shock absorber and for energy storage and transfer, both components that are vital to running. It’s like a spring that helps us move forward, without it we would not be up on two feet. It’s also something that has a tendency to get injured.

Time and time again we have been told if something hurts or is tight to stretch it. But with tendons this isn’t what you want to do. When it comes to the anatomy of tendons, stretching can cause more compression given the way they wrap around the boney insertion. Specifically, with the Achilles, it wraps under the heel bone so taking the heel to end range dorsif lexion ( bringing toes up) you are actually compressing the injured part of the tendon.

The precursor to the Achilles getting injured is relative overload, which decreases the tendon’s capacity to adapt to a load. Remember the load can be increased distance but also increased intensity. It’s the classic “too much, too soon” issue. This becomes a negative feedback cycle when it comes to distance running. Tendons take longer to respond to load and often get injured when an athlete is coming back from an unrelated injury.

The goal from a rehabilitation perspective is to increase the capacity of the tendon.

There are three stages of rehabilitation for your banged up tendon: the first step is getting back basic muscle and tendon function; then, you’ ll want to focus on power in your lower limb kinetic chain; and lastly, sportspecific function. Remember, with the last step, if you are planning to run a marathon, exercises should not be more than a 2–3/10 rating on the pain scale, and should not cause increased pain the next day. If it does, you have to go back a step.

Along with the specific Achilles focused exercises it is also important to make sure you are moving well biomechanically up the kinetic chain. It is recommended to keep exercises isometric, meaning that you are keeping the joint in a neutral position as you contract the muscle – this has been shown to decrease pain. You want these exercises to be heavy and single leg. And I will stress it again: do not stretch the injured tendon. You will get temporary relief with this but it is not helping to heal the injury long term. The Achilles can often become a chronic issue that will f lare up every so often. You can try to avoid this by being thoughtful with your increases in load (distance and intensity of your running and any other sports you might do). But if it does f lare up you have to go back to stage one in the rehabilitation process. Dr. Brittany Moran is a chiropractor and accomplished runner based at the Runner’s Academy in Toronto. Check out her strength and conditioning video series on our Instagram feed.