Tips from Achilles

10th September 2018

This months blog is aimed at looking at the aftermath of the Great North Run. Naturally runners will pick up injuries through preparation and certainly through the race itself. So if you feel like you have more than just the aches and pains than is expected read on…

Running related injuries are common, due to high volume and high repetition we are prone to over use. Reports suggest as much as 60% of runners experience over use injuries in any given year. People starting running in their first year have a greater prevalence of injury which is linked to a lack conditioning specific to the sport.

Often injuries occur due to poor preparation and a failure in your training plan. Tim Gabbet an Australian performance consultant suggests that training volumes of greater than 10% per week will increase your chances of injury. So unless you have the experience and knowledge to formulate a detailed progressive and adaptable plan entering such activities needs to be done with caution and with correct preparation.

A little whistle stop about running. Injuries are likely to have developed from a spike in training load or distance. This is the first step but a vitally important step in understanding that your tissues have a certain capacity to tolerate load. If you don’t have the strength you are likely to run into trouble. As your foot hits the ground the majority of runners will land with their outside of the heel impacting first. As your foot hits the ground you have an apposing force from the ground called the ground reaction force which can peak in the soleus muscle at 6-7 times your body weight,  so as the foot hits the ground and you need to contend with the ground reaction forces, your foot, ankle, knee, hips and back all need to be resilient to those forces. All musculature involved needs to be strong enough to control and accept that load. So you must ask yourself are you strong enough to contend with the load and volume applied to reduce your risk of injury.

Let take a look at these injuries.

Tendinopathy

Lower limb tendons such as your Achilles and patellar tendon are force producing tendons. Therefore they need to be strong. Quite simply a tendon will respond very poorly to an increase in training load without much preparation.
You may feel that squeezing your Achilles is tender or you may hobble first thing in the morning, it normally eases slightly as the day progresses. Please note that there is different management strategies with Achilles tendon pain but ultimately they all require to have strength. A good start would be not to stretch, Do some single leg calf raises and bent leg calf raises, a good amount to look for is 35 on a single leg.

Pain under your patella (wobbly bone in knee cap). Your patella bone sits in the tendon, a tendon attaches muscle to bone. In this case your patellar tendon is attaching some of the strongest force producing muscles in you body. Patellar tendon pain can be initiated again by poor training plans, increases in training load that is beyond its capacity. Pain is normally initiated when your knee may have been flexed for a while and your get up and move, it can be painful on compression. Strengthening this tendon needs to be done in a phased progressive manner to accelerate healing and return to sport.

Gluteal tendinopathy (Bum Pain) is less common, should you have a pain in your ass its probably wise you see the physio to get a diagnosis as this subject alone is another blog in itself.

Plantar Fasciopathy

This is simply pain under your foot. It is an umbrella term used to describe a long term over use problem. As your foot hits the ground your foot will generally pronate through a few degrees, it is the fascias responsibility to stabilise the foot, just like tendons your fascia is exposed to huge forces, although your fascia is not contractile, it responds and works like a tendon therefore you must load this as much as possible.
Generally speaking, problems arrive in your foot when you have increased pronation (flat feet) and reduced 1st ray function ( your big toe does not move to well). Apart from strengthening, Custom orthotics and Shockwave Therapy are very productive management strategies for this. Evidence is showing that Shockwave therapy is a preferred choice in managing fascia pain with a 90+% success rate.

Calf Strain

You will be lucky to go through a running carrier without a strain in the calf muscles. Although the calf muscle is generally consists of the gastrocnemius and soleus there is many other important muscle groups in your lower limbs that need to be considered. However keeping this simple, you may experience calf pain as result again of poor strength training and planning, a calf strain occurs when the force that a tissue produced is beyond its capacity to tolerate it. You will develop microscopic tears where a small number of muscle spindles with have torn up to quite a significant volume of muscle spindles been torn (this will be a dam site more painful) Initially there is a lot of bleeding and swelling so pain is expected. If you expose yourself to an activity that generates any form of force the calf is likely to be painful as its in an injured state. Generally starting off with some none weight bearing activity would be beneficial, as your tissue is able to tolerate exercise and load progress slowly. For example double leg calf raises, go to single leg calf raises. However it would be recommended that if your pain is enough to be concerned about then seek professional advice.

Anterior Knee pain

Unfortunately the knee becomes a culprit of what is going on at the hip and the foot. The knee is directly influenced by what happens in them joints. This can lead to your patella bone mal tracking, think of a ship going through a shipping lane, it needs to stay in its channel, however your down a few engines and start drifting to one side. This is what can happen in the knee, if your strength is not there the knee can pull laterally and rubbing against the outside of its groove, this can create a sharp pain. Normally this is most painful descending stairs or a hill. This would be known as lateral tracking.

Contributing factor are multi factorial If your foot rolls in your shin bone rotates with the ankle bone so it has little choice but to follow its movement. If this is the case an orthotic could be used to help this but it should be noted that this would be used to facilitate rehabilitation and you should not expect it to completely cure your symptoms, there would still be a requirement to strengthen and condition the required muscle groups. Deep tissue massage can also help with reduction in the tightness produced through lateral dominance of the quad muscle groups.

ITB Syndrome

Finally your ITB runs down the outside of your leg, it originates from a muscle called your tensor fascia late as this muscle become over used it gets tight, it can then influence the ITB as this directly attaches into the front of the knee coming around the out side of the knee cap it can create discomfort in many way, it can laterally pull your patella, symptoms normally are sharp pain on the outside of the knee. The ITB inserts into Gerdys tubicle and can often cause friction. This will result in inflammation and pain on the outside of the knee ( four fingers up from the lateral joint line may be painful). This is generally managed with strengthening exercises to improve weaknesses identified in certain muscle groups, deep tissue massage, exercise modification and there may be a possible requirement for an orthotic.