“-Itis” is probably the least favorite suffix out there for runners. Aside from the dreaded plantar fasciitis (discussed previously on our blog here), you also have to be on the lookout for bursitis, periostitis, tendonitis, and doinglaundryitis (OK, we made that last one up).
This post is all about the big daddy of tendonitis injuries in the running world: Achilles tendonitis. How can you tell when an achy Achilles tendon may be the onset of Achilles tendonitis? When is is serious enough to seek medical attention? The bottom line is that Achilles tendonitis is an injury you can bounce back from, but you have to be smart and persistent about treating it.
What to Watch For
Shooting or burning pain in the area of the tendon, typically aggravated by repeated stress of the tendon and worsening through the duration of activity. Other symptoms include swelling and thickening of the tendon, as well as a creaking feel when touching or moving the affected area.
Can I Run on It?
Maybe. It is possible to run while treating this injury, but you have to focus on preventing further harm while also giving the tendon time to heal. Depending on the seriousness of the injury, your best course of action may be to curtail your runs (“relative rest”) until you can complete a few PT sessions to start repairing the tendon and build strength in the tendon and related muscles. It’s always a good idea to talk with a medical professional to get guidance on your situation.
If you can run on it, you’ll likely be told to decrease your mileage, and take several rest days every week. You might also need to avoid any speed or hillwork, as these can put further strain on the Achilles tendon. A shoe insert in the heel of your shoe can decrease the strain placed on the Achilles tendon during your running stride.
After warmups and you hit the pavement, pay close attention to how your Achilles tendon feels. At the first sign of pain, it’s a good idea to stop running. “Pushing through the pain” of Achilles tendonitis is not the best course of action, as you run the risk of causing further damage to, or even rupturing, the tendon.
What Can I Do to Treat It?
Stretching the tendon helps to break up scar tissue, improve circulation and reduce inflammation. Be careful to be gentle and avoid over-stretching. Two of our favorites, and two of the more commonly recommended stretches, are the stair stretch and calf raises.
One employee on staff who has recovered from Achilles tendonitis also recommended what he calls “baby cows” (because it stretches your calf, not because it involves veal). For this one, start on your hands and knees, and straighten your legs so your knees are now off the ground. Keeping your back straight and your abs tight, bend one leg and cross the top of the foot over the heel of the still-straight leg. Drive the heel into the ground (this stretch should be predominantly felt in the calf). Once the calf is stretched, slowly bend the straight leg while keeping the foot flat (or as close as you can get to flat) on the floor. Allow the leg to loosen and never stretch into pain. Repeat on the other leg.
Following a run, another round of stretching/strengthening exercises can aid in healing, and icing and applying compression to the tendon can reduce inflammation. The Pro-Tec Achilles Tendon Support brace is a good option to provide compression post-run (some may be able to wear the brace while running as well). The Runner’s Remedy Achilles Wrap allows for both compression and cold treatment.
What about Massage?
Massaging the gastrocnemius and soleus muscles (where the Achilles tendon attaches to the calf) can provide relief and shortened recovery time. Though the process can be painful, deep massage of these muscles perpendicular to the Achilles tendon reduces tension on the tendon and increases blood flow, speeding recovery. Ice massage after a run has also helped many runners suffering from Achilles tendonitis.
Products such as the Trigger Point Performance Foot and Lower Leg Kit and the Marathon Stick are good tools to help you perform massage at home. You also might want to consider seeing a sports massage therapist for more advanced treatments.
How Can I Minimize the Risk?
There are several ways to help limit the risk of Achilles tendonitis returning:
- Keep your training steady. Avoid any sudden increases in mileage or intensity that your body is not acclimated to. Increasing mileage by no more than 10% per week is the general rule.
- Keep the muscles of the calf loose and limber through regular stretching or massage to reduce the strain loaded on the Achilles tendon, and be sure to properly warm up before running.
- If you normally wear higher (10-12mm) offset shoes, limit time running in low drop or zero drop shoes to reduce strain on the Achilles tendon. If switching to low offset shoes, transition slowly to allow the body to adjust to the flatter platform.
- Run in shoes with the proper amount of overpronation support. Overpronation can increase strain on the Achilles tendon; limiting overpronation will be able to reduce the strain on the tendon. Use orthotics if necessary.
Putting It All Together
Achilles tendonitis is an injury that needs to be taken seriously. Thankfully, you have a wide range of available treatments to tackle the injury, and chances are good that a physical therapist or other medical professional near you can provide a treatment plan to get you back on track. Many runners have completely recovered from Achilles tendonitis, and you can join them with the right treatment plan.