Running is a fantastic way to stay fit, clear your mind, and enjoy the great outdoors. However, it can also come with its fair share of injuries, especially for those who are just starting out or ramping up their training intensity. One common issue among runners is Achilles tendinitis. In this blog post, we'll delve into what Achilles tendinitis is, why it happens, and how you can recover and get back to enjoying your runs.
What is Achilles Tendinitis?
Achilles tendinitis is an overuse injury of the Achilles tendon, the large band of tissue that connects your calf muscles to your heel bone. This tendon plays a crucial role in running, walking, and jumping, as it allows you to push off with your foot. When the tendon is subjected to excessive stress without adequate recovery, it can become irritated and inflamed, leading to pain and stiffness.
Types of Achilles Tendinitis: Insertional vs. Mid-Portion
Achilles tendinitis can be categorised into two main types based on the location of the injury: insertional and mid-portion.
Insertional Achilles Tendinitis
Insertional Achilles tendinitis affects the lower part of the tendon, where it attaches to the heel bone. This type of tendinitis is often associated with:
Pain and Swelling: Pain at the back of the heel, especially when running uphill or on hard surfaces.
Bone Spurs: In some cases, bone spurs can develop at the insertion point, exacerbating the condition.
Treatment Considerations for Insertional Achilles Tendinitis:
Avoid Heel Drops: Unlike mid-portion tendinitis, eccentric exercises like heel drops can worsen symptoms in insertional tendinitis due to the added stress on the heel bone attachment.
Heel Lifts: Using heel lifts in shoes can reduce the strain on the tendon insertion.
Gentle Stretching: Focus on gentle calf stretches to avoid overstressing the insertion point.
Mid-Portion Achilles Tendinitis
Mid-portion Achilles tendinitis affects the middle section of the tendon, typically 2-6 centimeters above the heel bone. This is the more common type among runners and is characterized by:
Pain and Swelling: Pain in the middle of the tendon, often during and after running.
Thickening of the Tendon: The tendon may appear thickened in the affected area due to chronic inflammation and degeneration.
Treatment Considerations for Mid-Portion Achilles Tendinitis:
Eccentric Exercises: Heel drops and raises on a step are effective for strengthening the tendon and promoting collagen alignment.
Flexibility and Strength Training: Incorporate exercises to improve calf and tendon flexibility and strength.
Cross-Training: Engage in low-impact activities like swimming or cycling to maintain fitness without stressing the tendon.
The Pathology of Tendinopathy
To understand Achilles tendinitis, it's essential to know a bit about tendinopathy, which refers to tendon disorders in general. Tendons are composed of tightly packed collagen fibers that are aligned to withstand tensile forces. However, when these fibers are repeatedly overloaded, micro-tears can occur. In the case of Achilles tendinitis, the following pathological changes can happen:
Collagen Degeneration: The repeated stress can cause the collagen fibers to break down faster than they can be repaired. Instead of the neat, parallel arrangement, the fibers become disorganized, resembling a frayed rope.
Inflammation: Initially, the body's response to injury includes inflammation. This is part of the healing process, but if the tendon continues to be stressed, inflammation can become chronic.
Neovascularization: As the body attempts to heal the damaged tendon, new blood vessels may grow into the area. While this sounds beneficial, these new vessels often bring nerve fibers with them, contributing to increased pain sensitivity.
Why Does It Hurt?
The pain associated with Achilles tendinitis is due to several factors:
Mechanical Stress: The damaged tendon fibers are less capable of handling stress, leading to pain during activities that load the tendon, like running or even walking.
Inflammation: Chronic inflammation can cause persistent pain and swelling.
Nerve Sensitivity: The new nerve growth associated with neovascularization can make the area more sensitive to pain.
Chronic Tendinopathy: Managing Long-Term Damage
In more chronic cases of tendinopathy, where there is a significant amount of dysfunctional reorganisation of collagen, it can be very challenging, and perhaps even impossible, to fully restore the tendon structure. Instead of aiming to completely regenerate the damaged areas, rehabilitation focuses on enhancing the health of the unaffected tendon cells and increasing the capability of the remaining functional collagen fibers to compensate for the degenerated regions. Here’s how this works:
Healthy Tendon Cells: Rehab exercises and treatments aim to improve the overall environment of the tendon, boosting the health of the unaffected tendon cells. These cells can produce new collagen and other components necessary for tendon repair and maintenance.
Strengthening Intact Fibres: By increasing the strength and functionality of the remaining healthy collagen fibres, rehab helps these fibers to better support the tendon as a whole. This compensatory mechanism can help to improve the tendon's overall load-bearing capacity, reducing pain and improving function.
Enhanced Blood Flow and Healing: Therapies that enhance blood flow to the tendon can help to deliver essential nutrients and oxygen to the area, supporting the healing process and promoting the production of new, healthy tendon tissue.
How to Recover
Recovering from Achilles tendinitis requires a multifaceted approach focusing on reducing inflammation, promoting healing, and gradually restoring tendon strength. Here are some steps to help you get back on your feet:
Rest and Modify Activity: Initially, reduce or stop the activities that cause pain. This doesn't mean complete inactivity; low-impact exercises like swimming or cycling can help maintain fitness without stressing the tendon.
Ice Therapy: Applying ice to the affected area can help reduce inflammation and pain. Use ice packs for 15-20 minutes several times a day, especially after activity.
Stretching and Strengthening Exercises: Gentle stretching of the calf muscles and Achilles tendon can help maintain flexibility. Eccentric strengthening exercises, where the muscle lengthens while contracting, have been shown to be particularly effective for tendon healing. Examples include heel drops and controlled calf raises.
Footwear and Orthotics: Proper footwear with good arch support and cushioning can reduce stress on the Achilles tendon. In some cases, orthotic inserts may be recommended to correct biomechanical issues.
Physiotherapy: A physiotherapist can provide a tailored rehabilitation program that includes manual therapy, ultrasound, and other modalities to promote healing.
Gradual Return to Running: Once the pain has subsided and you have regained strength and flexibility, you can gradually return to running. Start with short, easy runs on soft surfaces, and slowly increase your distance and intensity.
Prevention Tips
To prevent Achilles tendinitis from recurring, consider the following tips:
Warm-Up Properly: Always start your run with a proper warm-up to prepare your muscles and tendons for the activity.
Increase Training Gradually: Avoid sudden increases in mileage or intensity. Follow the 10% rule, where you increase your weekly mileage by no more than 10%.
Strength Training: Incorporate regular strength training for your lower legs to improve overall stability and reduce the load on your Achilles tendon.
Listen to Your Body: Pay attention to any signs of discomfort or pain in your Achilles tendon, and address them early before they become a more serious issue.
Conclusion
Achilles tendinitis can be a frustrating setback for recreational runners, but with the right approach, you can recover and return to running stronger than ever. Understanding the pathology behind the pain can help you appreciate the importance of proper treatment and prevention strategies. Remember, patience and consistency are key to a successful recovery. Happy running!