If you have taken to running during COVID as your means to stay fit, the accumulative effect of ramping up the frequency and distance may be resulting in in some aches and pains not least in your Achilles.
The Achilles tendon is the thick band in the back of your ankle which connects your heel bone to your calf muscles. The job of these calf muscles is to push and propel our bodies forwards through our foot, when walking or running and jumping. The tendons job, apart from attaching the muscle to the heel is to absorb shock & store energy, which when released assists the muscles to propel you forward.
I have seen many clients over the years with Achilles pain, (Tendinopathy) and it can be a stubborn problem. Most of them had ignored it, continued as normal in the hope that it would go away, aggravating it instead. The key to getting rid of the pain has always been modifying activity appropriately and exercises through a graded loading programme, specific to the individual.
The major cause of pain is an overload on the Achilles tendon when it is not resilient enough to cope with new or increased demands placed on it. This could be from intense preseason training after a period of rest or other injury, an increase in walking or running e.g. for a new activity or sponsored /competitive event. And often not enough time for the tissues to recover or heal in between.
Other associated factors can be health issues such as an increase in weight, diabetes, menopause / hormone changes, inappropriate footwear, or new compensation for other areas of your body. Which all have to be taken into account when planning the rehab programme.
It can affect any age and anyone from the professional sportsperson to the less active.
Complete rest will decondition the tendon further. This is unless it is new and acutely painful, when unloading for a few days can help settle the pain. Current evidence suggests that a graded loading programme of exercises tailored to the individuals clinical and pain presentation, is key to increasing resilience and reaching resolution. Getting the ‘exercise load’ correct is imperative to success. This relates to time (repetitions or minutes), frequency of activity and the weight (body weight, additional weights). Static calf stretches generally aggravate the tendinopathies. There are other ways to encourage flexibility when the tendon is sensitive. You should also consider everyday activities when monitoring your overall rehab load.
When rehabilitating it is important to keep any Achilles discomfort to no more than 3/10 on a pain scale (comfortable discomfort) during, after and at 24 hours. Beware the delayed reaction to general exercise such as walking and rehab exercises.
This can be a frustrating condition. There are many documented exercises available for managing tendinopathy. But the art is which exercises are right for you and when to use them, combined with correct load progression? For example, if you have a distal tendinopathy (where the Achilles attaches to the heel bone) exercises over the edge of a step in the first instance can flare up your pain as it compresses the tendon.
Physiotherapy input, can help you manage and succeed in your rehabilitation programme by assessing your movements, advising you on your footwear and providing other exercises to address body areas contributing to your ankle pain. If you can’t make it into clinic this is one condition that can do well with online consultations/ advice and exercise progression.
Do get in touch for help if you are struggling.
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