Achilles Tendinopathy

Anyone who runs knows a little bit about or has heard of Achilles tendinopathy. It is a frustrating over-load induced injury. Different factors contribute to tendinopathy. The site of irritation may be a clue, as insertional tendinopathy is commonly viewed as a compressive overload injury where midportion is viewed as a tensile overload injury. Although there is some evidence to suggest plantaris may have a compressive effect in mid portion Achilles tendinopathy (source). Traditionally both midportion and insertional were treated the same way. New research has highlighted the possible differences (source). With that come different loading strategies.

My Incident

Three mile into a ten mile race and I begin to feel a niggle in my right lower calf/upper achilles tendon. I told myself its nothing and will go away. It doesn’t really but doesn’t affect my performance yet. Another mile and I’m running in the middle of the road as the cambers on the sides of the road makes the niggle worse. Another half mile on I round a corner and up my pace slightly. A sudden dart of pain splits my calf down the middle and lingers into my Achilles tendon. I pull up immediately and begin the long walk/hobble back to the start line!

My Recovery Approach

Initially I believed it to be a tear of some description. After thinking about it, doing some tests, but most importantly looking through my training diary, a clearer picture began to appear. I had noted minor calf pain within the previous two weeks on two separate occasions. You would have thought this would have been high on my radar going into the race. However it wasn’t. Its a fine line which niggle to pay attention to and which to ignore. If we stopped training for every ache and pain we got we would never run a mile.

This now looked a classic midportion tendinopathy in a reactive stage. With tendinopathy, unloading initially is paramount. Unless we unload the tendon will stay reactive. However unloading doesn’t mean total rest. A tendon will not change if you rest. It needs to be stimulated by adequatedly loading it. For me, initially this translated to isometric exercises. To achieve the adaptions needed I progressed to concentric heel raises. Further progression required concentric-eccentric exercises (heel raises over a step). From this point I introduced some skipping. This was a good test to see if the tendon could store and release energy without setting off the pain receptors. After a few days skipping with rest days interspersed, I was ready for a test run. Everything went well and I progressed slowly.

This is a short and simplified version of four weeks of frustration, doubt but ultimately perseverance and dedication. For more on tendinopathy see the following link from Tendinopathy Rehabilitation. This is a great resource from a research group dedicated to tendinopathy.