Dane Monaghan, Physiotherapist
Tendonitis in Marathon Runners - How Runners Recover from Achilles Tendinopathy
Achilles Tendonitis, or more accurately Achilles Tendinopathy, is a very common condition that affects runners in Melbourne, in particular, distance and marathon runners.
In this blog we discuss
- Terminology of Tendons
- Role of Tendons / Achilles tendon
- Signs and symptoms of an Achilles tendinopathy
- Causes / Treatment of a tendinopathy
- How to recover and prepare for a marathon
Terminology of Achilles TENDONITIS IN RUNNERS
Tendon pain is a common complaint amongst marathon runners, distance athletes and active people alike.
Tendon pain is usually felt directly over the site of the tendon or where the tendon inserts into the bone.
Due to recent research, the term ‘tendonitis’ is being replaced by a more accurate term called ‘Tendinopathy’.
Tendinopathy is a broader term used to describe degenerative changes or damage to the tendon, which can occur over time.
Changes in the tendon don’t need to be inflammatory in nature and hence why tendonitis was replaced.
Achilles Tendon Role FOR mARATHONS
Tendons are tensile structures in our body that attach muscles to bone. Their role is to transfer the force generated by muscles to act on the bone and create movement. Just like our muscles, tendons respond to load.
If you go to the gym and do strength training your muscles will get bigger and if you load the tendon they will become stronger and more resilient to high level forces. We use this concept for recovering from an Achilles tendinopathy
The Achilles tendon is the large tendon located at the back of your lower leg, connecting the calf muscles (the gastrocnemius and soleus) to the heel bone (calcaneus).
It is the strongest and thickest tendon in the body and plays a crucial role in various movements.
The Achilles tendon is key to foot mobility, helping in plantar flexion, energy storage/release, and providing power for activities like walking, running, jumping, and maintaining postural stability.
Its ability to stretch and recoil efficiently makes it essential for efficient, dynamic movements. This is vital for marathon runners, purely due to the kilometres, and need for efficiency.
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What does an Achilles tendinopathy FROM A RUNNING feel like?
It is often worse with initial movement, then as you warm up it may start to feel better, but by the end of your session it may be worse again.
Tendon pain is often worse with dynamic movements such as running and jumping.
Achilles tendinopathy is a condition involving the degeneration or damage of the Achilles tendon, often caused by overuse or repetitive strain.
Its symptoms can vary depending on the severity, but typical signs include:
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Pain and Tenderness:
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Gradual onset of pain along the Achilles tendon, especially near the heel or the midsection of the tendon.
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Pain worsens with activity, such as running, jumping, or climbing stairs, and may be most noticeable in the morning or after long periods of rest.
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Tenderness when pressing on the tendon, particularly at the point of irritation.
2. Stiffness:
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Morning stiffness or stiffness after periods of inactivity, which typically improves with movement or warm-up exercises.
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Difficulty moving the foot initially, particularly when trying to point the toes or walk after rest.
3. Swelling:
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Mild swelling or puffiness around the Achilles tendon, particularly in more acute or inflamed cases.
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Swelling may be more prominent at the tendon’s insertion point on the heel or along the tendon itself.
4. Weakness:
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Weakness in the affected leg, particularly when trying to push off forcefully during activities like running or jumping.
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Difficulty performing exercises or movements that engage the calf muscles.
What causes Achilles tendinopathy IN RUNNERS?
When we load tendons too quickly, in the wrong way or with excessive compressive forces, they can’t adapt in time and will malform into a pathological tendon structure.
There is an increase in water content, disturbance of collagen (tendon cells) type and structure as well as ingrowth of nerve and blood vessels in the tendon. All of this contributes to pain and weakness felt in the tendon.
Tendinopathy runs on a continuum ranging from a mechanically weak tendon to a healthy, strong, resilient tendon to reactive tendinopathy, tendon dysrepair or a degenerative tendon. Depending on the loads applied to the tendon, it will move back and forth on this continuum
Marathon runners are particularly susceptible to Achilles tendinopathy due to the combination of repetitive loading, insufficient recovery, and biomechanical stress from long-distance running.
Adequate rest, proper warm-up and cool-down routines, strength training, flexibility exercises, and attention to running form can help prevent or manage this common overuse injury.
How to Treat Achilles TendiNopathy Properly In Melbourne
The acute pain caused by a pathological tendon can initially be settled down with relative rest from aggravating activities, isometric exercises and a gradual loading program.
However it is also important to identify the underlying cause of the tendinopathy so that it may be addressed. Otherwise the tendinopathy may not resolve completely or it may return in the future.
Common contributing factors for Achilles Tendinopathy include:
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Weakness or underutilization in some muscles
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Poor movement patterns or running technique
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Training errors and poor load management
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Muscle tightness
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Poor joint mobility
How do marathon runners recover from an Achilles tendinopathy?
Relative rest
Planning out some time post marathon or long distance event to rest and reduce your exercise output before gradually ramping things up again is highly recommended. Your body will thank you for it!
This timeframe can be different depending on the individual and how you are feeling. The key is to listen to your body.
Work on deficits
The reduced mileage post race is a time of opportunity. A time to assess for any deficits that you can improve on to help any aches and pains you may have experienced, but also, help your performance!
Getting assessed by a physiotherapist can be helpful to look at your:
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Strength
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Endurance
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Movement efficiency
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Symmetry between limbs
We do this during our screening assessments and also with the use of our VALD force plate and force frame technology.
There are certain metrics we recommend runners hit with regards to calf strength for example. By not hitting these certain metrics, this can increase the risk of injury
Therefore, getting this checked can not only improve performance but also mitigate against an Achilles tendinopathy
This tech is exactly what the AFL clubs use, and you can access this at our Malvern East, Blackburn and Essendon clinics.
Assess and discuss training loads
From your assessment, your physiotherapist can help devise a plan to target any deficits you may have, while also helping you ramp up your training again.
These deficits can be targeted with specific exercises that you can fit into your strength and conditioning plan.
Strength and conditioning in addition to cardiovascular fitness is very important for runners. It can help your running economy which is one of the main predictors of speed.
One of the biggest causes for an Achilles tendinopathy in runners is a ‘training error’ where the athlete has exposed themselves to too much load too soon. It sounds simple but if we are loading up parts of out body that cannot cope then this can be a sure-fire way to develop an overuse injury such as tendonitis or tendinopathy
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Plan ahead for your next major event (Marathon or 10km)
We always are thinking of that next race - so why not start planning it?
A common thought when crossing that finish line is “never again!”. But we know that thought slowly turns into “when can I do another one?” - we get it!
So when you are ramping that training back up, plan your next race (have sensible timeframes in between training blocks!).
Your physiotherapist can help you plan out sensible timeframes and training blocks with milestones to hit so you can focus on your performance.
We excel at helping Melbourne marathon runners get better and improve their performance.
Interested in having injury screening assessments or speaking to a sports physiotherapist in Melbourne? Book below.
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How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!
You can make an appointment by calling or booking online.
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