As soon as man was able to walk, he ran.
About six million years ago, since the day humans first rose from all fours, running has become a pleasurable and beneficial pastime for millions of people worldwide.
Thousands of road races, marathons and fund-raising walk-a-thons and run-a-thons are held each year, making running the sixth most popular exercise in the United States.
Though there are many health benefits from this great cardio-vascular exercise, there are also risks.
No matter how well-fitted your running shoes with the latest in shock-absorbing technology– the body does take a pounding.
And one of the main areas of the body to feel the shocks of every stride hitting the track, pavement, grass or even soft sand, is the Achilles tendon– eventually causing the painful condition known as Achilles tendonitis or tendinosis.
Chronic Achilles tendon injury is one of the most common injuries with sports requiring running and jumping. For elite long distance runners studies have shown that there’s a 52% risk of sustaining Achilles tendon injury.
Before we get into causes and treatments let me clarify an important point. Most people incorrectly describe this injury as a tendonitis. In order for an injury to be called tendonitis there has to be presence of active inflammation. Anything with an “itis” means inflammation. There are very few to no inflammatory cells present in repetitive strain tendon injuries, but there is presence of degenerative changes.
Thus the correct term for this problem is Achilles tendinosis or Achilles tendinopathy. Anything ending in an “osis” means degenerative changes. Tendinosis is caused primarily by chronic overuse of the tendon and by not giving the tendon enough time to rest and heal.
The Achilles Tendon
This Calcaneal tendon of the heel bone, is named after the Greek warrior Achilles, who was shot with an arrow in the only weak area of his body— his heel.
The myth continues to plague today’s warriors, since many super athletes and runners have chronic injuries to this tendon.
The Achilles tendon is the large tendon that connects the calf muscles to the back of the heel. Achilles tendinosis occurs as a result of repetitive trauma or from a sudden forceful contraction resulting in injury to the tendon.
Common areas of pain and injury along the tendon:
1. Insertional Achilles Tendinosis: located at the insertion or attachment of the Achilles tendon on the calcaneus (heel). Bone spurs and calcifications are often present at the attachment – seen as thickening, bumps or nodules.
2. Mid-portion Achilles tendinosis: injury along the mid portion of the tendon. Could be anywhere along a 2-3 inch area above the attachment. In my experience injury is more commonly on the medial side (inner side) of the tendon.
Contributing Factors Of Achilles Tendinosis / Tendonitis
Training errors or when the FIT principle goes wrong. FIT = Frequency, Intensity and Time. How often you train? How hard you train? And how long your train? If you train, run or overload the tendon past it’s ability to recover you risk injury. This applies to too much training or running and also to rapid increase in training intensity. A sudden increase in intensity or amount of training is often trigger for tendon injuries.
Mal-alignment or poor biomechanics along the foot, leg and pelvis chain are major contributor to this problem. Imbalances are often caused by weakness, lack of flexibility, poor neuro-muscular control (motor control, balance, coordination, etc.)
- Over pronation or under pronation while running can cause more stress to Achilles tendon.
- Inadequate ankle dorsiflexion – Limited ability to lift foot up towards shin or bring shin over your foot for pushing off while running.
- Missing big toe extension – Inadequate big toe extension will prevent you from loading your foot and big toe for the push off phase. Often resulting in the over pronation or the foot drifting outwards.
- Weak hip muscles – gluteus maximus weakness will result in decreased push off putting more stress on the calf and Achilles tendon. Gluteus medius weakness will result in poor stability of the pelvis and hip.
- Tight front hip capsule and hip flexors – is responsible for all sorts of running injuries.
- Weakness or poor motor control of foot muscles – will result in an unstable lever which is unable to provide dynamic stability when accepting load or pushing off while running.
- Weak core muscles – poor strength of the core muscles will result in a weak base with problems throughout the chain.
- Shortening and lack of flexibility in the calf muscle—Achilles tendon unit.
- Running shoes, that do not provide adequate stability and sufficient shock absorption for the heel.
- Running on hard surfaces, such as asphalt, concrete or cement.
- Inflammatory and autoimmune Disease
- Poor Digestion or absorption of nutrients
The contributing factors above are accompanied by varying degrees of pain. Tenderness and swelling are also usually present. Chronic conditions will result in thickening and adhesions along the tendon at it’s attachment on the calcaneus (heel bone).
Sprains? Strains? Or other pains?
First, let’s be sure we have diagnosed and are treating the correct condition.
If the pain and tenderness is about 2 to 3 inches above the bottom edge of the heel, and we can rule out:
- Plantar fasciitis (injury to the plantar fascia – bottom of foot)
- Bursitis (inflammation of the bursa around the back of the heel)
- Sciatica (prolapsed disc) causing referral pain down the leg to the heel or foot.
- Osteomyelitis (a bone infection)
- Deep-vein thrombosis (blood clot)
- Buerger’s Disease (circulation problem)
Treatment for Achilles Tendonitis / Tendinosis
No pain, no gain, doesn’t apply here.
Those four words are probably the most-damaging in a athletes vocabulary. Whatever validity lies in this practice of many body-building routines, it doesn’t apply here. We are not going through the painful breakdown of muscle tissue to rebuild muscle mass. This is different.
Sudden, sharp pain that persists until the swelling begins– is the body’s way of telling you something’s definitely wrong. So stop. Do not pass go. Do not try to work through it. Stop running, in fact stop walking too much.
This is not to be taken lightly. It could be more than just a strained tendon. It could be a more serious form of Achilles tendon injury, a rupture of the muscle-tendon junction.
Achilles tendon rupture is the most severe of the injuries, often ending the careers of professional athletes, and making walkers out of runners in spite of successful repair surgeries.
Getting Back On Track
Here are some effective treatments for Achilles Tendonitis / Tendinosis
- Avoid running or excessive loading of the Achilles tendon. To allow for adequate recovery, after all it’s an overuse or repetitive strain injury.
- Cross friction massage of the Achilles tendon – to break down adhesions and thickening along the tendon and improve circulation. Use herbal oils like Restore or Chinese tendon liniments or soaks to stimulate circulation, reduce swelling and stiffness and relieve pain. Spend 10 mins every other day for 3-4 weeks.
- No ice – Ice is not nice. Use heat: warm water soak+Epsom salt+baking soda to relieve pain, improve circulation, reduce swelling and stiffness.
- Strengthening and stretching exercises for achilles tendon as the irritation settles down. How to stretch achilles tendon?
- Improve ankle and big toe flexibility for better foot mechanics –Big Toe Flexibility Exercise and Ankle Flexibility Stretch
- Strengthen foot muscles to create a stable base for running – Strong Feet
- Strengthen the core and hip muscles for proximal stability –
- Supplements for faster healing: Turmeric, Omega 3 fatty acids (krill oil, fish oil, flax seed oil), Guggulu formulations.
- Avoid anti-inflammatories – have side-effects, not helpful and can slow down healing process.
This will help get you up and running again in no time.
And now, if anything like this ever happens again– you’re better prepared.
But just in case, there’s always your health care provider.
Slow improvement can be expected in most cases. But, if things get worse despite self treatment, or if there is little progress after a month, it may be time to see a professional.