Injury Education

Achilles Tendinitis

Is this your achilles heel?

Are you a Greek God or Goddess? I think sometimes when you go out for a run, you might think you are.  Even the strongest heroes have pain. Nobody is perfect and no BODY is perfect. Running is hard work on your body and sometimes you don’t know when to stop or rest. Achilles injuries tend to be a common injury among runners due to multiple factors: weak feet, weak glutes, running too much too soon, poor alignment in the pelvis, improper break in or use of minimalist shoes, and the list goes on. If I had to pick a few major influences on achilles injuries I’d have to say:

Weakness in your feet

Do you ever isolate and strengthen your feet? The answer is probably no. Some reasons may include: you don’t know what exercises to do and you think that running naturally strengthens your feet. What you may not realize is that running does not strengthen your feet the way you need your feet to work for stabilization. It actually can overwork your feet and lead to compensation from other areas in your body, such as your calves. Increased work to the calves leads to break down and fatigue, which strains the muscle. At the end of your calf there is a large tendon called your achilles tendon. It attaches your calf muscles to your heel. When strain is placed on this tendon it starts the acute injury process of inflammation, mico-tears, and eventual pain. Working to strengthen your feet can help reduce the amount of stress placed on your calves, therefore reducing your injury risk.

Take a look at a our foot strengthening program:

Weakness in your glutes

Runners’ in general tend to have nice strong quads and calves, but other powerhouse muscles get put on the backburner and forget how to work. These muscles tend to be your glutes and core. Because of the nature of posture at work and home your body dynamics create tightness and weakness in various muscle groups. Day in and day out the tight and weak muscles progressively worsen. Without you even noticing it! When you go out for a run your body positioning is more prone to allowing your glutes and core to shut off. Reduction in glute contraction can lead to many injuries including but not limited to: achilles tendonitis, patella tendonitis, SI joint dysfunction, lower back pain, plantar fasciitis. Working in cross training to strengthen your glutes will allow you to return to a more normal gait, increase your speed as your glutes and hamstrings propel you forward, and reduce injury throughout your body.

Dr. Kim illustrates a few runner specific glute exercises ONE PT’s YouTube Channel:

Poor pelvic alignment

Your pelvic alignment can change the way your entire leg hits the ground with running. If one side of your pelvis is shifted forward, that leg is going to appear longer and hit the pavement at an inadequate angle and intensity than your other leg. It is going to propel you forward using a sub-par utilization of muscle groups from your hip to your ankle, leading to strain. Without a neutral spine and pelvic alignment your body is constantly putting strain on itself. To compensate and correct itself your body  works in a cross pattern. A cross pattern means that if one side of your body is working hard the other side has to work harder to keep your form “neutral” or else you would be running in circles.

A common injury that we see in runners includes a forward rotated right pelvic bone leading to:

  1. Low backpain and issues on the left SI joint
  2. Tightness in the left glute
  3. Right hip flexor tightness
  4. Right ITB pain
  5. Left calf/achilles or ankle pain

Do you see how the body compensates by shifting from one side to the other? By hyper-focusing on treatment directly to the symptom site the potential cause of your issue is still there. Symptom treatment approaches end in short term pain relief, and cyclical return of symptoms hours to days after your visit. With proper diagnostic capability and treatment of the cause, your symptom site may never need to be touched. Focal symptom treatment is commonly performed and will elongate your ability to heal faster.

Due to discrepancies with ability to self-assess alignment the correct technique will not be shown here. It is important to have a trained PT evaluate you to determine which part of your spine and/or pelvic bone is poorly aligned. Once assessed your PT should be able to show you how to properly align at home short term. Keeping proper alignment helps your exercises to work properly by fully engaging the surrounding muscles.

Understanding your body and its limitations is important to injury prevention. Knowing when to rest or stop is equally important. Pain is an indicator that something is wrong and if it lasts more than a few days with or without running you should seek medical advice.  The worst thing that you can do is wait more than a couple weeks. The longer you wait the more chronic the injury becomes and the longer it takes you to heal. Most of the time an acute onset of pain can be fixed quickly, getting you back on the road faster!