Most of you have probably seen Misty May-Treanor’s achilles tendon rupture on Dancing with the Stars by now.  (If you haven’t look at the video below.  Fast-forward it to about :40 seconds in.)

Achilles tendon issues are a big problem for many athletes, recreational as well as competitive athletes.  Tendon injuries constitute about 30% of all running injuries. For many recreational runners, a painful, swollen Achilles tendon can lead to months of frustration while for elite athletes, an Achilles tendon injury can become an obstacle to successful performance, and in the worst cases, result in the premature ending of a sporting career.

Tendon Structure Inside

Tendons play a vital role in running, providing elastic energy to help us bound along. This is best illustrated by considering the ultimate biological bounders, kangaroos, who have been shown to actually decrease their oxygen consumption as they increase their hopping speed between 7 km/h and 22 km/h. This efficiency is attributed to the storage and recycling of elastic energy within the kangaroos’ long and compliant Achilles tendons (essentially they have springs in their legs, and so do we just not as good as theirs).

Historically, the term ‘tendonitis’ has been used to describe overuse tendon injuries, such as achilles tendonitis. However, analysis of supposedly inflamed tendons reveals an absence of inflammatory cells and chemicals, and the term ‘tendinopathy’ is now used to describe pathological changes associated with Achilles tendon injury. Within the umbrella of tendinopathy, the majority of runners suffering Achilles pain will exhibit pathological changes in the tendon referred to as tendinosis.

Tendon injuries are usually considered to be the consequence of overuse. However, as both endurance athletes and sprinters can develop Achilles tendinosis despite very different loading and training histories, it is difficult to identify what actually constitutes a dangerous overuse running volume. Interestingly, the deep surface of the tendon, which is the most likely area to develop tendinosis, is shielded from maximum loading strain and it has even been suggested that tendinopathy represents an under-use condition!  What is evident, however, is that Achilles tendon injuries lead to an inability to cope with desired running volumes, and in this respect running volume is an integral part of the problem.

The lack of a single, simple explanation for a painful Achilles tendon contributes to the difficulty in deciding appropriate management. It is beyond the scope of this blog to consider the range of medical interventions available. However, accepted opinion is that “controlled loading,” rather than prolonged rest, may be the best way to manage a painful Achilles tendon.  So what does that mean…

Alfredson’s heel-drop exercise
In 1998 a Swedish orthopedic surgeon published excellent results for a group of patients with Achilles tendinosis who undertook a specific 12-week eccentric calf loading rehabilitation program (summarized in the table below). The subjects all experienced a dramatic reduction in pain, a significant increase in calf strength and returned to full running.

Summary of Alfredson’s Heel Drop Program

Getting Back to Running
A short period of rest from running during the initial acute painful phase followed by a specific loading programme is sensible. However, the tendon loading and coordinative challenge of running suggest that running should become a central component of your rehabilitation strategy and indeed there is scientific support for continuing to run during rehabilitation, as long as the pain does not exceed moderate intensity (26). Accepting a tolerable amount of running discomfort may also help avoid the negative tendon and muscle consequences of protracted rest. The margins are vague, however, and the line between acceptable discomfort and disabling pain is very individual.

Running progression should be measured and symptoms monitored over a 24-hour period. Reintroduce comfortable tempo running and progress either running time or distance carefully. Our muscle-tendon unit works harder to generate stiffness on soft surfaces, and it may be that running on harder surfaces initially is advantageous. Speed, intensity and spikes (for track runners) should be introduced gradually, with careful evaluation of symptoms.

Loading is not the only form of management for Achilles tendon injuries. However, without adequate tolerance to loading, few runners can enjoy or succeed at their sport. In light of the complexity of tendon injuries, appropriate loading should be considered a central part of any wise management strategy.

If you need help monitoring your loading program or your steady progression back to running the knowledgeable personal training and physical therapy staff at Athlon Elite are here for you.  Call today to discuss your program and set-up a consultation.