I previously covered symptoms, causes and treatments to Achilles tendonitis. Let’s now take a look at how to reintroduce your running routines. Here is a six step process.
Step One: Once you have been given the medical authority’s go-ahead to return to running (or you have decided you’ve waited long enough and are returning to running regardless) you need to tune into your body. You may have always been a “morning” runner or “midday” runner or “evening” runner. Now, your Achilles will play a large role in dictating the best time to run. Some people will do better earlier in the day because later in the day the Achilles become tender (perhaps due to a long day on your feet). Some people find that mornings are much tougher to get going and you now require time to get the body warmed up before getting into any faster motion. One more point, some people will find it easier to do a little “something” everyday instead of taking rest days. That means that complete rest days may not work for you. Learn the patterns that help you run consistently and with reduced or absence of any tightness or discomfort.
Step Two: If you know for certain your Achilles injury was directly due to your training stupidity then go ahead with the next steps. Otherwise, you must remediate your underlying biomechanical problem or you are courting a re-injury. The number one predictor of injury is past injury to the area. If you have not done rehabilitation exercises and/or been fitted for orthotics then you have not affected the root cause of how you got injured. Some of the critical rehab exercises will include: one-legged full squats; squats/lunges and one leg stands on wobble-board; toe-walking; heel-walking. Toe raises are not advised; however you may try to do a reverse toe raise (not stretching). These are done by raising up on both toes then slowly lowering on one. When done working one calf, do the other. Though this is commonly performed on a stair, do not lower your heel below level (90 degrees) until you have progressed pain free.
Step Three: Run easy and run short. This is a relative term so I will not prescribe a pace or distance. I’m accustomed to running 5Ks in 16:00-17:00 range, an “easy” pace is 7:30/mile and for my comeback I might start out at 8:00-8:30 pace or so. You have to know yourself. Nobody can tell you what pace is safe (Though my “sports medicine doctor” told me 10:00 miles. He has no basis for pace estimation and therfore is speaking outside his expertise.) Break your run up into chunks to start out. Even though you aren’t running hard, treat it like an interval workout. Depending on the severity of your injury, you may return to alternate 100 meters “jog” and 100 meters walk. It may be 400 meters “easy” then resting your Achilles by walking around easily for a minute or so then do your next 400. Other than perhaps being out of shape, the pace should give no resultant discomfort to the Achilles region. You might feel a slight stiffness or tightness. That is probably ok. Regardless of how your Achilles feels, get in the habit of icing after workouts. Two times 10 minutes with a few minutes in between should suffice.
Step Four: Let pain be your guide. Remember that profound advice from the treatment list? It is critical to follow. Remember, you got yourself here because you didn’t listen to your body. Get over it and start listening. As you run, get in tune to your “new” Achilles tendon. Tune into your foot-strike, stride length and frequency. Do changes in any of these create different sensations for your Achilles tendon? You may find that altering “how” you run may increase or decrease discomfort. Tune in to the various surfaces you run on as well as any slants that affect your foot-strike. For instance the camber of a road can create more discomfort. Compromise and learn each day. Though it may be imperceptible to someone else, you can make very small adjustments that will make a world of difference. Keep icing after workouts.
TIP: You may find you get a quick start by soaking your lower legs in a hot tub before going for your run. It increases blood flow and helps decrease stiffness.
Step Five: Increase your miles slowly. The old 10% rule for increasing mileage may not apply to you any more. Increase your pace slowly. Do not change running surfaces dramatically and avoid trails and sand (beaches) for sure. Stay on the most level and even footing surfaces possible. Do not – increase pace and distance simultaneously. You will be asking for trouble.
Step Six: At some point you will want to try out getting in racing shape again. You may want to add hill training, track work, beach running, trails and plyometrics. Resist the urge to introduce any of these too soon. And avoid introducing any two of these at the same time. These are high risk activities for Achilles tendonitis sufferers. Read my lips – there is no such thing as introducing or running these too slowly. Try one repeat on a hill or one faster repeat on the track. Before doing actual hill work, test yourself on some stadium stairs. These are short and controls your stride with steps. See how your Achilles reacts over the next 24 hours. Then, the next week you can add another repeat – maybe. Trails, beaches or other varible surfaces need patience and very modest efforts and frequencies on the comeback trail (pun intended).
Though plyometrics are wonderful for strength and speed development they are extremely ill-advised until you have been 100% rehabilitated. These are ballistic movements and very tough on Achilles tendons even when you are healthy. The most elementary level of plyometric exercises may be doable. I would strongly recommend performing lunges, step-ups, medicine ball drills, core exercises and all the one-legged exercises in preparation. There are many variations that will enhance your strength without the risk of plyometrics. If you’re smart and fortunate, you may one day return to full plyometric workouts.
NOTE: You will notice that I have not advised stretching in the process. This is a highly controversial topic. Stretching is correlated with increased injuries for males and has neutral affect for females. Given that, one possible contributing cause to Achilles tendonitis is a tight calf muscle. If that is the case you may need to introduce stretching. Beware, stretching irritates the tendon! So, go slow, go easy, go static. Do not do heel drops to stretch the calf. Do not stretch until you “feel a good stretch”… it’s too far!
Filed under: Running, Training Effectiveness
I wish I found this about 4 days ago! Great information!
Aaron
Aaron – thanks.. I hope it helps. If you have any specific drop me a line. I’ll just tell you that there is indeed hope!
Coach Dean
Great advice! I’m back to a walk/run after five weeks off – just being proactive, positive, and patient – it’s really changed my way of thinking about my training.
Ah yes… patience… that critical element I didn’t really elaborate on… and that I know is a virtue of every runner (NOT!). Thank you. It sounds like you’re doing the right stuff. Keep it rolling!
Coach Dean
Since weight training for legs is the number one cause of off-field lower body injuries, and indeed the catalyst to many on-field injuries, I would strongly advise against this; such training is certainly not suitable for 25+ runners.
Take for example the bar bell squat: injuries such as the following were so commonplace in the military that the exercise was actually stopped in physical training
(i) Adductor magnus strains and tears
(ii) Achilles tears
(iii) Pubis symphysis strain and tears
This is clearly applies more so to dead-lifts and bent-over rows.
In fact, football trainers now actively discourage over-doing lower body weight training in young athletes, as the biomechanical imbalances thus caused reek havoc on ligaments and tendons and have ended careers.
In short, if you have had an Achilles injury, do not train with weights or it may never get better:
Walk…walk…walk….walk…
Then introduce jogging gradually.
Ewan,
I appreciate your perspective. I have not found the research for the data that you mention about lower leg off/on field injuries correlated with lower leg weight work. [But I don't follow a lot of stuff written on other sports.] Though there is potential relation from your military example, they aren’t runners. They do run. In my experience they also do not take care of themselves by wearing appropriate footwear; as well as the other equipment they often lug around. So, though interesting, I would not necessarily use this to advise runners. (Though again.. not totally disregard it.)
I do disagree with the 25+ comment. Weight training is absolutely critical for older runners (40+) since we lose muscle with age. With that we lose power. Power output of muscles is essential to maintaining speed. But, given that, notice i have not prescribed the types of weight lifting you mention at all. I (and most coaches and physiologists today) advocate more running specific strength training with body weight only: “Some of the critical rehab exercises will include: one-legged full squats; squats/lunges and one leg stands on wobble-board; toe-walking; heel-walking.”
But there are some important points here.
1. The exact cure-all treatment for Achilles does not exist. That is why there are so many treatments and some work for some people but not all.
2. The exact rehab approach for all Achilles sufferers does not exist. That is why so many approaches are used and not all work for everyone. (Including stretching and strengthening.. with or without weights)
3. What ever causes the Achilles issue will cause it to recur if remediation of that specific cause isn’t done.
The bottom line is to do everything in moderation; be willing to try many approaches in your return to health; and read your body, on the Achilles-injury return.
Coach…Thanks a lot for posting this topic.
I learned a lot from it.
Will it be alright If I could add you up in my blogroll?
God bless.
I have/had Achilles Tendinitis. My first flare up was during my training for the Charlottesville Marathon. I didn’t end up running that marathon – but I did prevent my Achilles tendonitis from going into high gear. Achiles tendinitis isn’t cut dry. You don’t just have it or not. There are several stages/degrees. I had the “beginning stages” (this was per my orthopedic doctor).
Five Step Treatment of Achilles tendinitis
He told me to continue to run at a limited amount (incorporate cross training) and start a few things:
1. Ice nightly – i fall asleep with ice packs wrapped around my achilles.
2. anti-inflammatory – he started me on naproxcin, but recommended me taking that for only a short time. After a week or so of that he told me to switch to Quertecin/Bromelain mixture (can get it @ The Vitamin Shoppe, or other health food stores). It’s a natural anti-inflammatory. So, I take that (still) 2x’s a day.
3. Avoid walking barefoot. I am currently in my pj’s – and I have a pair of tennis shoes on. It looks ridiculous but it helps.
4. Stretch out your at before you step out of bed. Take your big toe and point it up to the sky for 15 sec – 3x’s before planting your feet on the floor.
5. Stretch throughout the day – and especially throughout your runs.
It took me 4 months to get my Achilles Tendon back to normal, but be warned. Once you get it you are now susceptible to getting it again (I know it sucks). I have had it 2 times in the past 2 years. The first time it took 4 months, the following time I was prepared and nipped it in the butt and it never got out of hand.
I hope this helps a little. I know how much I love to run and even the slightest set back makes me sad.
Good luck to you!
Thanks for dropping by. Overall I would agree with your actions. But, there is a real issue with falling asleep with ice packs wrapped on you. The advice from all medical sectors never advise more than 10-20 minutes at a time and repeat after equal time off. This avoids tissue damage from the cold. It is a case of more is not better.
As for the Quertecin/Bromelain mixture it’s of course hard to say if it makes a difference or not. If you feel it is key to your maintaining health and you aren’t having side-effects then stick with it. I like experimentation… at the same time I am cautious about prescribing anything to others – natural or otherwise – that hasn’t been shown in research to work. But, it’s always worth a try. I may even check that out.
Thanks