Your Achilles Heel: Tendonitis Prevention and Management
by Teige West
Achilles was a god from Greek mythology known for being a fierce, courageous and loyal warrior. He was undefeated in battle after battle, until he was killed after being shot in the heel with an arrow during the Trojan War. Why do you need to know this? Because his namesake, the Achilles tendon, isn’t quite life-or-death for you as a hurdler, but it is pretty close. An injured Achilles can derail your training and your performance, so you should keep it stretched, healthy and happy. Below we will break down the common tendon injuries, how to proactively prevent those injuries, and what to do if you get tendonitis.
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The Achilles tendon is a strong band of tissue that extends from the mid-calf to the back of the heel bone. The Achilles allows you to move your ankle and foot in all directions, and facilitates walking, running and jumping—sounds like everything you do as a hurdler, doesn’t it? Here’s a depiction of the Achilles with tendonitis:
For many years any pain in the lower back ankle area was referred to as “tendonitis,” however there are various ways in which you may experience Achilles soreness or pain, and the medical community has begun to differential between tendonitis and tendonosis. Here are the common injuries:
Achilles tear/rupture: this is a serious injury that is beyond the scope of this article. If you are training or competing and you feel a sudden tearing followed by acute pain, stop immediately. A tear or rupture must be treated by an orthopedic doctor, has a special protocol and may require surgery. It is a rare injury, and one that can usually be prevented in the same way that tendonitis can be prevented. Those suggestions are covered in the last part of this article.
Tendon soreness: Because your sport is a total-body sport, your training schedule is rigorous. There are many mornings when you may wake up, roll out of bed and find yourself walking like John Wayne after a three-day horse ride. Sometimes everything is so sore, it’s impossible to determine exactly where the pain epicenter is. It’s common to have sore calves and tendons after strength training or drills, but the soreness should begin to subside 24- 48 hours after your workout. Remember to stretch well, use heat and rest if necessary. If you find that your tendons are chronically sore or tight, or you have limited mobility, talk with your coach or trainer & see you doctor.
Tendonosis: This is an Achilles issue that occurs at the cellular level and that can contribute to a tear or rupture. The symptoms of tendonosis are often hard to distinguish from everyday soreness, because this is a condition that develops over time, usually without acute pain or injury. If you have chronic soreness that doesn’t abate well with rest, or if you develop limited ankle mobility, see your doctor.
Tendonitis: Anything ending in “-itis” denotes inflammation, which usually means swelling, acute pain, redness, tenderness and sometimes limited mobility. With tendonitis, you may have some or all of these symptoms, including a lump on the tendon. The difference between common soreness, tendonosis and tendonitis is that tendonitis is an active, acute injury. You will not usually experience swelling and redness with the other two issues.
Plantar Fasciitis: This problem should be mentioned because it is often confused with tendonitis. Plantar Fasciitis is an acute injury to the tissue that runs from the toe to the bottom of the heel. Most sufferers experience heel pain that may extend into the arch. Nevertheless, this injury is located on the bottom of the foot, not above the heel on the leg. See a doctor if you have pain in this area because a quick diagnosis can prevent a long recovery.
Tendonitis Treatment
So, it’s happened. Your leg is hurting, it’s swollen, it’s red, you don’t want to put weight on it, but you’re hoping it goes away with a little warm-up jogging because you’re in your training groove. Well, there’s good news and there’s bad news. The bad news is that you are going to have to rest. The good news is that tendonitis resolves quickly in a few days with adequate care. Tell your coach or trainer and go see a doctor to make sure that you don’t have a more serious injury. The treatment regimen is pretty standard, and you can find it below. Do NOT do the below routine in lieu of seeing a medical profession. Again, your injury may be more serious and you’ll only be delaying the inevitable if it is.
As with any acute injury, RICE it:
Rest: Sorry, but unless your doctor says otherwise, you are off your rigorous workout schedule for at least a few days. Follow this advice. Any time you put weight on your foot, you are using that tendon. Don’t prolong the recovery period by pushing yourself. You’re only off for a few days. Use that time to catch up on work, schoolwork, or whatever needs to be done. You may be told to refrain from any physical activity for a limited number of days, and then to slowly move into walking, then jogging.
Ice: For the first few days you will need to apply ice to the injury site at least 3 times a day for 20- 30 minutes. Use a cold pack if you have one. If not, place a towel between a bag of ice and your skin. After three days, unless otherwise directed by your doctor or trainer, you will probably be told to apply heat, which brings blood to the area and encourages healing.
Compression: Wrap the area with an ACE bandage. Don’t wrap it too tight, but the bandage should provide support and relief. Your doctor will tell you how and when to wrap it.
Elevation: Keep your leg elevated above the heart with pillows as often as you can, but especially while icing. Elevating the leg discourages swelling by bringing blood back toward the body, rather than toward the injured area.
Besides RICE-ing your leg, your doctor may suggest anti-inflammatories, such as ibuprofen. He or she may also suggest stretching and light walking, especially after the first 72 hours. Tendonitis is a frustrating injury, but it can be treated easily and quickly; it can also be largely prevented.
Preventions Against Tendonitis
Stretching is so very crucial when preventing any kind of injury. When your body is cold, the fibers are less flexible and more prone to tearing. Always warm up before cardio, drills or weight lifting. If you are pushed for time and only have 45 minutes to do a 45 minute workout, it’s far better to sacrifice 5 minutes warming up rather than 6 weeks recovering from a tear or pulled muscle. Always follow your trainer/coach’s advice, but generally, warm up for at least 3 minutes with light jogging or fast walking and then stretch lightly. Save your deep stretches for after your workout. Post-workout stretching not only feels good, but speeds recovery and can prevent muscle pain. Here are some Achilles-specific stretches:
- Place your hands on a wall with one leg bent and the other straight behind you. Pressing against the wall, push the heel of your back leg into the ground. Hold for 20- 30 seconds and repeat with the other leg.
- Put your hands on the ground with your hips pointed upward and one leg back. Press with your hands, lowering your heel towards the ground. Hold for 20- 30 seconds and repeat with the other leg.
- Stand with your toes on a stair step. Holding on to the wall or the banister, lower your heel downward toward the step below. Hold for 15 seconds. Repeat with the other leg.
- Sit with your legs stretched in front of you. Bend forward and hold your toes, making sure not to put pressure on your lower back. You can also do this by putting a towel around your feet and pulling on the ends of the towel.
- For post-workout, use a foam or plastic roller to roll and loosen your calves.
Heat is great for sore calves and tendons. A warm bath will best heat your tissues, but you can also apply a heat pack or heating pad to the backs of your legs while resting.
Proper shoes can prevent foot, ankle, leg, back pain, and tendon issues. Avoid high heels and flat, uncomfortable shoes as much as possible. If you have to wear uncomfortable shoes frequently, pick up a pair of insoles with a hard plastic arch support covered in cushioning. If your job requires heavy lifting, wear boots with insoles and use proper form when lifting.
You have probably heard enough about proper running form that you dream about it at night. Not only does proper form increase your speed and general performance, but it also prevents injury, especially to your Achilles. When you run without engaging your glutes, you put too much weight on your toes, which stresses your ankle and tendon.
Rest. Seriously. Do it. A rest day may sometimes seem like wasted time, but it’s not. Your body is processing, repairing and rebuilding, and when you increase your training schedule, you need to honor the recovery process. That means taking a week or two off every 6-8 weeks. That means not overtraining parts of the body on consecutive days. You’re on your feet all the time, hurdling or not, so give your legs some time to rebuild.
Alternate types of strength training so that you aren’t lifting with the same muscles on successive days, which requires a detailed training plan. Meet with your coach or trainer and make sure that you allow recovery time between sessions.
Some people are more prone to tendon issues that others. People who have flat feet (call overpronation) are predisposed to have foot and back issues more often than those who have a “normal” arch build. If you fall into this category, you can still prevent injury with proper shoe support, good running form and stretching. Your trainer may refer you to an orthopedic doctor who can make create custom insoles for your shoes to realign your foot and body.
Get moving and stay moving. It is tempting on non-training days to be sedentary. You should rest, but you also need to move your muscles and flex your joints to stay limber. Take a walk. Get up every hour or so and do some light stretching and pacing.
If you have done all-of-the-above and your Achilles is still sore, get with a trainer quickly. Trainers and physical therapists have special equipment and more advice on how to heal tendon problems. Some people are more prone to pain in certain areas of the body because of their physical composition, and that could be you. Get on top of the pain so that you can hurdle efficiently and painlessly!
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