Achilles Tendonitis & Achilles Tendinosis

 

Tendons are the part of the muscle that attaches into the bone.  They are made out of dense collagen fibers and are great at managing load and transferring force.  The achilles tendon attaches the gastrocnemius and the soleus muscles to the heel.  TendonITIS is an acute inflammatory response of a tendon in response to a new load.  TendinOSIS is more of a chronic change in the tendon that can cause pain when put under long-term loads that the tendon cannot keep up with.  Conversely, another root cause of tendinosis is for a tendon to be chronically underloaded.  Tendons have poor blood supply and can take a long time to heal.  With tendinosis,  it will tend to hurt at the beginning of a run and the pain will often ease a bit as the tendon gets warmed up.  Typically the pain will return again later in the day.  If you are noticing calf pain while running or calf pain after running you may have an achilles tendon issue.  Read on to see how your strike pattern can affect the load in your legs.

 

 

Which Strike Pattern is Best?  Should you heel strike, forefoot strike or toe strike?

 

If you have increased your running recently you may have noticed other runners.  Some of them have long loping strides landing on their heels; some are tiptoeing along only on their toes; while others have an effortless stride that looks as if they are floating.  The debate over heel striking vs forefoot striking or toe striking came to the forefront with the barefoot running movement.  Many people who run barefoot or run with minimalist footwear will naturally adopt a strike pattern that is more on the forefoot.  Runners often want to know what pattern is better and typically it depends on their strengths and weaknesses.  Those who forefoot strike put more load through the calf and the Achilles complex, while those who heel strike put more load through the knee and patellar tendon.  Therefore if you are someone who is getting calf pain when running or achilles pain you may be better to adopt a heel striking pattern as you return to running.  And those who are struggling with anterior knee pain may benefit from trying a forefoot-striking pattern.  See our blog on anterior knee pain with running.

 

 

 

What else can I do?

As stated earlier, changing your running style may be helpful if you are trying to overcome an injury or pain when running.  If you have made an effort to run on your toes you may need to go back to a heel strike as your tendon pain resolves.  You should also be careful about running uphill as this tends to load the calf and achilleas more.  

There may be other things to consider if you are running with pain, such as load and volume.  Load refers to the part of the body that has the most stress with a movement. When considering load you should also consider running volume.  Volume refers to how much and how often you are running.  If you have increased your running too fast, too far, too often you may be experiencing new aches and pains.  Changing your strike pattern may be helpful, but you may also need to plan for some rest days.  

 

Cadence

Perhaps more important than the strike pattern, you may want to consider cadence.  Cadence refers to the number of footfalls per minute.  Optimal running cadence is thought to be around 180 footfalls per minute, however your optimal cadence may be a little slower than that.  If you are struggling to figure out the right cadence for your body, consider coming into Union PT.  One of our therapists can complete a running assessment to give you advice on what to address. 

 Do I Need New Shoes?

 Just like there is not a single “correct” running pattern there is not a single correct type of shoe.  Finding the type of shoe that fits your type of running is a good place to start though.  If you are a heel striker, having a shoe with a cushioned heel complex will be far more important than having that in the shoe of someone who is a forefoot runner.  Type of footstike aside, the speed and duration of your runs should be an important consideration as well.  If you are running a fast 5k or doing interval training you will typically be looking for a much lighter, more responsive shoe than someone who is logging lots of mileage every week.

It’s also important to note that even if you have the ideal pair for your running style, each shoe does have a shelf life. The more miles you log, the sooner you will have to replace your shoes.  One can expect to get 300 to 500 miles out of a pair of shoes.  You can extrapolate this by averaging your typical miles run in a week and setting a reminder in your calendar to replace your shoes _____ weeks from purchase.  Aside from miles alone, look for holes in the mesh upper, deflated looking foam or worn tread. 

 

 

Three Exercises for Gastroc Soleus Complex

 

As alluded to previously, changing the strike pattern will change where the force is absorbed with running.  A forefoot strike pattern or toe running requires more strength through the gastroc/soleus complex and flexibility at the ankle.  The following exercises may be helpful.

 

Heel raise –eccentric – Raise up on two feet (progressing to on a step), then shift your weight over to one side and slowly lower down.  You should raise straight up onto the ball of your foot and the lowering process should be slow (count slowly to 3 as you lower).  Repeat on each side 2-3 sets of 10.  

** If you have pain where the achilles tendon attaches to the heel then do this exercise from flat ground.   The step increases the compressive load where the achilles goes over the calcaneus (heel) and tendons typically don’t like to be compressed.   

 

Soleus wall sit – this exercise will target the soleus muscle, which is the powerhouse of running when forefoot striking.  Get down into a wall sit position and raise up onto toes – you should not move from the wall.  Alternatively you can do heel raises similar to calf raises like above, but keep the knees bent.  

Knee to wall – this motion can start as a check for adequate range of motion.  Previous injury can cause some limitation in motion that may affect running gait.  Place a ruler or a tape measure on the ground.  Stand with your toe away from the wall.  Keeping your heel down, see if you can touch your knee to the wall.  Ideally you can get your toe between 3-5 inches from the wall.  Previous injury, like an ankle sprain, can affect range of motion at the ankle.  Ankle mobility should be addressed if there is a limitation, especially if there is a difference from left to right sides.  

 

  Seeking Care

These exercises should not be painful.  If you are seeking this advice because of calf pain or heel pain you may want to have your body assessed by a physical therapist.  The physical therapists at Union Physical Therapy in Seattle have advanced training in orthopedics and assessing and treating runners of all abilities.  Schedule an appointment today.