Running Injury: Achilles Tendinopathy

Do you feel pain behind the heel which limits your training, a pulling sensation when you go down the stairs or even during your first steps in the morning?

One of the most common injuries, but also one of the most persistent in runners, is the Achilles tendinopathy. I'm sure you're wondering, "Is the Achilles tendinopathy the same thing as tendonitis?". Yes and no. In fact, tendinopathies include all tendon pathologies (tendinosis, tendinitis, calcification, tears, etc.). Tendonitis represents the acute stage of a tendon injury with inflammation leading to almost continuous edema, heat and pain. In the subacute or chronic stage, where little inflammation is present, we call this a tendinopathy. It is at this stage that most runners will consult a professional.

How to identify this injury?

This injury can be identified by local pain on the Achilles tendon or its insertion behind the heel. Pain occurs during running, jumping and even walking. Most of the time, we complain of stiffness during the first steps in the morning and when walking down the stairs. It is a load-related injury, that is, it always comes after a mechanical stress overload on the tendon. Runners who suffer from it report having trained at faster paces or included more hills in their running routine. These two activities put a considerable load on the Achilles tendon.

Like most running injuries, the key to a successful therapy for this condition lies primarily in the right balance in your running schedule. Training should be modified to temporarily reduce load on the tendon, control symptoms, and then gradually resume loading. However, in a stage of persistent pain (when the pain has been present for 3 months or more), resting is not the best treatment. To adapt, a tendon must be stimulated. We must put tensile force on it, in short, put a load on it!

How do I find the right balance in my training routine?

To reach the right balance of exercises and running, some pain is allowed and even desired. No pain equals no adaptation. However, the tendon should not be irritated. Pain during the activity is allowed, but it must go away quickly (in minutes), and the tendon should not be stiffer than usual during the first steps the next morning. To do so, running often, in small amounts and at a slow pace is recommended.

When to resume regular training?

Experts agree that training at faster paces or uphill can be resumed when you are comfortable running continuously for 60 minutes. Also, several specific exercises will also help to promote an optimal adaptation of the tendon.

As each case is different, consulting a therapist who has expertise in running is often necessary, especially to be guided in the right balance of training, but also to get the proper exercises for your condition and stage of injury.

Our expert running therapists will be delighted to help you manage an injury, but also to reduce your risk of injury and even increase your performance. Also, our running analysis service will allow you to start your running season with full confidence.

Happy running!
 

Rémi Bergeron
Physiotherapist
Running expert certified by The Running Clinic