Running after Achilles Tendinopathy: How you can hack your rehab

Achilles tendinopathy is a common injury for runners of all levels, often described as a dull, long-lasting sensation that can linger for days after a run. Runners, who have experienced this, tend to have a love-hate relationship with their Achilles tendon. An increase in pain and reduction of function are usual causes of people stopping their physical activities. If left untreated, this may spiral into a cycle of deconditioning, depending on the severity of the condition. In this article, we dive deeper into how one can return to running after achilles tendinopathy.

How is the Achilles tendon important for running?

The Achilles tendon serves as more than just an anchor for the calf muscle to the heel. The role of the Achilles tendon acts as a shock absorber, also known as the stretch-shortening cycle (SSC). The SSC allows the muscle to store up energy like a coiled-up spring (eccentric phase), before releasing the energy (concentric phase). It optimally transmits forces from muscles and bones to give us a propelling force.

Types of activities suitable for Achilles Tendinopathy Rehabilitation

While most individuals would be inclined to rest a sore tendon, it can end up being detrimental to the health of the tendon in the long run. This is because tendons require an adequate amount of loading using the SSC to stimulate growth, thus improving the functional capacity.

Swimming and cycling are great ways to offload the Achilles tendons, giving these structures time to rest and heal up. Such activities involve working against resistance, strengthening the muscles of the lower limb in the process.
Conversely, activities such as running, jumping, sprinting and hopping are a few examples of engaging the SSC. This will cause the tendons to undergo a phase of restructuring. It is essential to have a balance of these two categories of exercises for a holistic approach to Achilles tendinopathy rehabilitation.

I’m in pain, what can I do in the meantime?

It would be useful to review your current pair of footwear, as having comfortable shoes reduces the risk of Achilles tendinopathy. Our advice is to avoid wearing a pair of shoes that are too small for your feet, to prevent excessive compression on the tendon. Wearing high heels for an extended period of time can potentially promote excessive shortening of the tendon. These examples can lead to further irritation to the already aggravated structure. 

The pain monitoring model is designed for individuals to easily rate and identify the level of pain. This model can be used during, after and the following day to track the irritability of the tendon. Tendons tend to have the latency to flare up 24hrs after an activity. As a rule of thumb, our aim is to keep pain below 5/10 by following the traffic light system. If pain is within 0-2/10, it is alright to continue the activity. 3-5/10 would suggest that we keep closer monitoring of the activity and not allow the pain to increase further. If pain exceeds 5/10, we either modify or stop the activity.
Keeping a diary would assist you and the physiotherapist in tracking and modifying the intensity and frequency of activities to keep pain at an acceptable level.

3 Tips to help you get back to running after Achilles Tendinopathy

1. Allow tendon recovery – Rest up, train smart!
   Firstly, learn to rest! Your tendons will thank you for spacing out your workouts. When planning out a schedule that revolves around work and exercise, it is recommended to begin the day with strength training, followed by at least 6 hours of rest before proceeding with any running activity. This allows your muscles to get adequate rest in order to perform more optimally during your run. The window of opportunity for tendons to undergo a physiological change is within the 36 – 72hr mark, hence having days of rest between runs would be ideal.
2. Manage weekly running load – Intervals, jogging, fast/slow runs
   Secondly, it would be beneficial to understand the capacity your body can perform at. Knowing your baseline running speed is a good way to track and increase the intensity (speed, rest, distance) as you undergo rehabilitation for the tendon. This allows the physiotherapist and yourself to set realistic goals in order to achieve a desirable outcome.
3. Do not just focus on the calves! – Train the rest of your lower limbs
   While reducing pain and restoring function to the Achilles tendon is the primary goal, training other muscles are equally important. This is because your muscles do not work in a silo. Muscle groups you can work on are the quadriceps (front thigh), hamstring (back thigh) and gluteus (hip).  Incorporating lower limb strength training and plyometrics helps you return to running and decreases the risk of future injuries.
   
   An example of how a training schedule could be like:

Seek Physiotherapy Treatment

In conclusion, every individual progresses at a different rate depending on their current level of function. While being in pain is frustrating, your rehabilitation journey does not have to be unpleasant. Here at Core Concepts, our dedicated team of experts will walk alongside you throughout this process and help you achieve your end goal of running after achilles tendinopathy. If you feel that you may be experiencing Achilles Tendinopathy, do contact us to book an appointment with our team of physiotherapist to begin your rehabilitation with us.