Runners: when you
were younger, did
you more often than
not have days of
running when you
felt invincible and
strong - like
nothing could touch
you? In fact, in
many aspects you may
have felt
invincible, like the
Greek warrior
Achilles. Then, as
the years have gone
by, every day
something new hurts
and in general it
feels like you body
is falling apart. On
your last run, the
back of your heel
began to ache and
has been sore ever
since. Should you
ignore it and chalk
it up to old age or
pay attention to it?
If it is your
Achilles tendon that
is acting up,
runners sit up and
take notice- it does
not like to be
ignored (much like
the Greek warrior!)
and it can burn you
if you do.
The
Achilles tendon is
the largest tendon
in your body and it
connects your calf
muscles to your
heel. The
symptoms of injury
are felt at the back
of your leg, near
the heel. The
initial signs of
inflammation include
tenderness,
swelling, pain with
use, warmth, and
possibly a squeaking
in the tendon with
ankle motion. As the
symptoms progress
and the condition
becomes more
chronic, the pain
occurs with any
activity especially
when you rise up on
your toes or when
walking uphill or
climbing stairs. A
constant ache and
ankle stiffness sets
in, in particular
the ability to pull
your toes up. The
last stage is when
the tendon begins to
thicken and small
(often painless)
nodules develop.
So, the age old
question - why me??
Most
Achilles tendon
problems are related
to overuse injuries
and a combination of
other factors.
It is very common in
runners due to the
repetitive
stretching of the
tendon that occurs
during running.
Unfortunately it is
also more common as
we age because of
degenerative changes
that occur in the
tendons. However,
usually more than
one factor is
present. Anatomic
abnormalities
include flat feet,
high arches, weak
calf muscles, and
tight calf muscles
and Achilles
tendons. Training
errors include
sudden increases in
intensity, duration
or frequency of
runs, training on
hard, banked or
sloped surfaces,
large amounts of
uphill running, and
finally poor,
worn-out running
shoes.
The most
important aspect of
treatment is to
catch and address
this early.
Problems with the
Achilles tendon,
almost more than any
other tendon, are
very difficult to
overcome once they
have been present
for a long time.
These injuries
certainly have been
career ending for
some - and none of
us want that!! The
initial treatment
includes rest - at
least 2-3 days
depending on the
severity of pain,
ice massage in 20
minute sessions
every couple of
hours and
nonsteroidal anti-
inflammatory
(ibuprofen)
medications as
tolerated. A heel
lift can relieve
tension on the
tendon (but wear in
both shoes). After
the acute pain has
subsided, begin a
stretching and
strengthening
program - which may
include physical
therapy if the pain
has been more
chronic. While you
are recovering,
switch to an
exercise program
that helps maintain
your fitness, but
does not irritate
your tendon
(possibly swim or
cycle). You may
require orthotics,
either store bought
or custom made,
depending on your
foot. In severe
cases, a cast may be
necessary for
several weeks to
completely rest the
Achilles tendon.
Cortisone injections
are not recommended
for this as they may
weaken the Achilles
tendon and lead to
tendon rupture. As
with any injury, it
is important to try
to discern why it
occurred in the
first place and make
the necessary
changes to prevent a
recurrence!
I cannot stress
enough how important
it is to catch and
treat Achilles
injuries early.
Typically, the
longer symptoms have
been present, the
longer it will take
to get better. Do
not return to
running until your
tendon has recovered
and you are pain
free. If you return
too soon, you could
cause permanent
damage. So, runners,
yes it stinks
getting older, but
if you follow these
guidelines, you can
beat the time clock
- if only for a
while!