Important things to know about your achilles tendon:
- It’s the largest tendon in the human body, measuring around 15cm in length.
- It accepts a load of between 4 and 8 times your body weight when you run. I weigh 51KG. Thats anything from 204-408KG. Or in other words, upwards from quarter of a tonne. Crazy!
- It attaches three of your calf muscles to your heel bone (gastrocnemius, soleus and plantaris)
- It’s job is to act like a spring, driving you up onto tiptoes when you walk, run or jump.
- It’s an absolute bugger when it’s not happy!
If I’m honest, my achilles started to hurt about 6 weeks before Edinburgh. Obviously I ploughed on anyway. Not sensible, but necessary. The problem is, now it’s aggravated by EVERYTHING. Even wearing trainers that press on it make it feel bruised. It’s completely tolerable, but I know that if I don’t want it to ruin my next training block, particularly because there’s likely to be a lot of speed work, then I need to give it some time to get better. So, even though I am desparate to start hitting some hard sessions again, I’m branching out from my usual approach of burying my head in the sand and thought I’d better crack on with some rehab!
What is achilles tendonitis?
Over the last ten years, medical understanding of achilles problems has improved greatly. Research now suggests that the problem isn’t just inflammation of the tendon like we used to think. In fact, often there is no inflammation present at all.
Instead, imaging and histological studies have shown that a degenerative process is likely to be the cause of the problem, with small micro tears to the tendon itself. This is why it is now more commonly called ‘achilles tendonosis’ (the suffix ‘itis’ means inflammation and is therefore no longer appropriate).
FYI, it’s just as evil! You actually need a degree of inflammation to kick start your body’s healing process, so the lack of it may well be why the problem can be so persistent and grumble on for such a long time.
Treatment therefore takes hard work and perseverance with pretty much no short cuts. Yawn!
How do you treat achilles tendonosis?
The million dollar question!
Let me introduce you to somebody….. a Swedish chap called Hakan Alfredson who just happened to be an Orthopaedic surgeon. In the mid 90’s he developed pain in his achilles tendon. After being declined surgery as his symptoms were not yet severe enough and the clinic couldn’t manage with him off on sick leave, he set about deliberately trying to aggravate the problem by repeatedly loading his tendon in the hope that it would snap. That way, he’d be forced to have surgery to fix it. Seems a little bit extreme if you ask me, but perhaps desparate times call for desparate actions! To his surprise though, instead of getting worse, his pain gradually disappeared. And bingo, to this day, the best evidence to get rid of an achilles tendonopathy is to repeatedly load it.
Obviously numerous studies since Alfredson have tested his theory. Most agree that an ‘eccentric loading programme’ is the way to go. This involves pushing onto tip toes on the good leg, then slowly lower back down on the affected leg. This slow lowering is the eccentric loading. Or in other words, working the muscle and tendon against gravity whilst it is in a lengthening, not shortening like a normal muscle contraction.
What I’m doing to fix my achilles
- Not running. I’m not happy about it, but I’m doing it! Or not doing it as the case may be.
- Not wearing trainers than put pressure on the mid part of my tendon.
- Avoiding any other high impact exercise, particularly grit and even barre as constantly raising onto toes is one of the aggravating factors. Basically, I’ve been avoiding anything that hurts.
- 3×20 eccentric heel raises twice a day. Pushing up on my good leg and then slowly (3 seconds) lowering down on my affected leg. There’s a lot of controversy over how many reps is the right amount. I went with these numbers as it seems to be enough to load the tendon to fatigue, but is still manageable.
- Cross training. To try and maintain my fitness, I’ve substituted a lot of my running with spinning or bike sessions. I’m also doing loads of lower limb strengthening like weighted squats and lunges, as well as stability work like bosu ball single leg dead lifts and single leg squats.
The light at the end of the tunnel
The good news is, it’s now been 10 days of doing everything as above and the day to day pain has almost fully subsided.
Not running in this beautiful sunshine is killing me, but my sensible brain knows I can’t just dive straight back in. My plan is to gradually add some full heel raises, with the pushing into tiptoe part as well as the slow lowering, and gradually increase the number of reps.
Realistically, I think it’s going to take me another two weeks to gradually re-introduce running and obviously I’m going to continue cross training and strength training meanwhile. Fingers crossed, that will be enough to get me back on track because I am so excited to start the new training plan I’ve found. And I really, really, don’t want this to become my achilles heel!