With Achilles tendinopathies accounting for nearly 11% of all running injuries, The Wharf quizzed Physiotherapy London’s lower limb specialist Jody Chappell on how best to tackle the pain of an injury.
How would I know the difference between tendinopathy and a tear?
A tear is always a sharp event that usually leaves you hobbling for at least a few days whereas a tendinopathy gradually creeps up on you.
Symptoms for a tendinopathy are usually morning stiffness in the ankles, pain or discomfort at the start of exercise and then an ache post-exercise.
It is possible however to have a tear on a tendinopathic tendon. If in doubt, get an ultrasound scan – this is the best way to identify a tear and to differentiate the site of the tear.
As soon as I resume running my Achilles hurts again. Why?
Tendons are funny things and respond as poorly to rest as they do to being overloaded.
They like a predictable routine with sufficient stress to help stimulate the collagen to repair and adapt without leading to further tissue degeneration.
Does stretching help to improve tendinopathy?
No, stretching aggravates it. There should be an eccentric (lengthening) component to your strengthening programme – this stretches and strengthens the tendon simultaneously, which provides much better results and is more relevant to your activity.
Does my running style affect my Achilles?
Yes. Research suggests those who toe strike increase the stress to the Achilles.
If I run when I’ve got Achilles pain, could it rupture while I’m out running?
It’s unlikely this would occur. There are factors that can increase the risk of rupture such as corticosteroid injections into the tendon, or treatment that’s been focused on removing pain without simultaneously rehabilitating the tendon effectively.
But pain is your body’s way of telling you something is wrong.
I’ve been prescribed loading exercises. Why is this?
Tendons need load – they crave it. This helps stimulate the collagen within the tendon matrix to form in a much more effective way.
The Achilles is the strongest tendon in the body and it can tolerate huge forces being transferred through it normally. The accumulated stress of running is vast.
You need to strengthen these tendons so they can withstand that stress.
Anatomically the gastrocnemius (calf) and soleus both insert into the Achilles tendon so there are usually slight variations to target the different muscles.
Why has my physio prescribed so many sets?
The accumulative stress the Achilles has to withstand is so high that we need to condition it effectively so it won’t break down.
The calf muscle is also the second most stubborn muscle in the body to train after the heart, so it takes a lot to work the calf and Achilles effectively.
This always needs to be personalised from one individual to another though – too much and you’ll make it worse; too little and you may not stimulate it enough to heal.
If I suffer Achilles pain will I ever run a marathon pain-free?
Quite possibly if you find the right rehabilitation and preventative plan.
Tendinopathy is about much more than just heel drops, correcting running technique, optimising muscle strength and tweaking your training regime to allow adequate rest periods but it is a condition that can be managed.
Would you recommend either a corticosteroid injection or shock wave therapy?
Corticosteroid injections should be avoided as research shows they leave the tendon structurally weaker.
Shockwave therapy or a high volume injection may be beneficial in providing you and the physiotherapist with a window of reduced pain to really optimise training and rehabilitation.
Our fitness guru – Isle of Dogs resident Laura – is a leading personal trainer and offers personal training sessions and classes in and around Canary Wharf via her website .
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