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!