Imagine you really love running, feeling the wind as you go, but then your heel starts hurting a lot. It's kind of like the story of Achilles, a Greek hero from a long time ago, who had to stop doing heroic things because his heel got hurt. Today, let's talk about the pain in our Achilles tendon, the part near our heel. It's like having a pebble in your shoe when you're running. It's not easy, and if you've felt this way, there are other runners who feel the same. We'll see how this little pain might make you take a break from running and explore some new ways that we know about now to help you feel better and get back to enjoying your runs, unlike Achilles who didn't have these tricks up his sleeve.
In the world of running, when it comes to Achilles tendon pain, many physical therapists and doctors often highlight calf muscle strength deficit as the primary culprit. They emphasize the importance of building strong calf muscles to alleviate the discomfort associated with Achilles tendon issues. However, the reality is more nuanced, particularly for experienced runners. While calf muscle strength certainly plays a role, it is crucial to recognize that Achilles tendon pain is often a complex interplay of various factors. In many instances, especially among seasoned runners, the calf muscle strength deficit might be more of a consequence than the root cause. Achilles tendinitis, a common ailment in the running community, can result from a combination of factors such as overuse, biomechanical issues, or even inadequate recovery. Therefore, understanding the broader context of Achilles tendon pain is essential to develop a comprehensive approach that goes beyond solely addressing calf muscle strength deficit, ensuring a more effective and tailored treatment strategy for runners seeking relief from this prevalent and sometimes persistent issue.
As a physical therapist, I've assisted many runners facing Achilles tendon problems, helping them return to running—even those who've been away for years. I've noticed two major reasons for the discomfort, pain, or tendinitis in the Achilles tendon. In this discussion, we'll explore both, because understanding the main reason helps you use your time and energy in a way that gets you back to running sooner than you might expect. It's like having a special map to guide you back to the joy of running faster and more efficiently.
Altered Biomechanics of the foot and ankle
With every step you take – whether it's walking, running, or jogging – your foot needs to do something called supination and pronation. When your foot pronates, the heel bone and toes move away from each other, giving a stretch to your foot fascia and muscles. This stretch is like a spring, helping your foot propel forward and distributing the running forces on your foot and lower leg muscles. But if there's an injury or your foot doesn't move well for any reason, it can become stiff, and the arch might not be flexible. This can make your foot feel stiff and inflexible. For experienced runners, a stiff foot might not hurt right away, but as you run more miles, it can become a problem. When running your body experiences strong ground reaction forces – 2.5-3 times your body weight – and when these forces aren't used right in your foot muscles, they go to your Achilles tendon, the part after your foot. With short runs and a history of running, you might not feel pain, but when you run more, it can be too much for your Achilles tendon. It gets inflamed, trying to make more tendinous tissue because of the heavy load. This is your body trying to adapt, but it leads to a sore and swollen tendon that hurts instead of helping your runs. To fix this, you need to work on making your foot move better first and then make your calf muscles stronger. Fixing the strength issue comes after dealing with pain, inflammation, and improving biomechanics. Check out this video I made to learn more about foot mechanics in detail.
Overuse
In the previous section, we discussed how excessive loading can lead to inflammation in the tendon. However, this extra loading isn't solely due to altered foot biomechanics. Often, weakness in one leg can force the other leg to compensate, resulting in overuse and potential Achilles pain or tendinitis. This scenario commonly arises in individuals who have undergone surgery on the opposite leg but didn't receive proper rehabilitation or guidance on how to use it post-surgery. To address this issue, a comprehensive approach is necessary, involving a thorough analysis of the entire body, an examination of running form, and movement screens to pinpoint the weak link causing the heightened stress on the Achilles tendon. Once identified, we focus on resolving the underlying problem while incorporating heavy isometric exercises to alleviate inflammation in the tendon.
In conclusion, understanding the intricacies of Achilles tendon pain is essential for every dedicated runner. It goes beyond merely addressing calf muscle strength deficits and necessitates a holistic approach that considers the broader factors at play. By identifying the root cause, whether it be biomechanical issues or compensations due to weakness or surgery, we pave the way for a more effective recovery. Remember, a stiff foot today can lead to discomfort tomorrow. So, whether you're a seasoned runner or just starting, prioritize the health of your Achilles tendon, and seek professional guidance if you encounter persistent issues. With a comprehensive strategy that includes restoring foot mechanics and strengthening calf muscles, you'll not only overcome pain but also pave a smoother path back to the miles you love. Happy running!