Carson Robertson
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Achilles Tendonitis and Tendinosis from Running

Runners commonly experience muscle and tendon injuries, especially after increasing their miles, running hills, or trail running. Think of how many miles have you run this year? With each step there is an impact of your body weight against the road. Gravity is pulling you down with each step, and that pounding is absorbed by muscles and tendons. Sometimes your running gait is smooth and there is minimal impact. Other times your gait slows and your foot strike is harder against the road.

We have all felt the times where our legs are Jell-O, and every step is a slow pound against the concrete. The hard impact produces greater forces the Achilles tendon has to absorb. Over time, this stress from running can injure the Achilles tendon producing a painful injury, inflammation, and swelling.

Think of a tendon like a rope tied to a tree. Each tug on the rope places tension and stress on the rope, especially where the rope connects to the tree. If you tugged 10,000 times softly how much strain would be applied to the rope? Compare that to tugging hard 10,000 times. The amount of force absorbed is a multiplication factor of the number of repetitions and force of each tug. Eventually the rope will become damaged and fray.

With enough pulling and fraying the rope can become severely damaged. The rope will show early signs of fraying, but most people wait until the rope is severely frayed before seeking help.

Repeated stress "frays" tendons, and ligaments leading to injuries. This situation is a mechanical problem which requires treatment to decrease stress and promote healing. Multiple therapies are available to speed the healing and recovery process. The most important part of therapy is removing the problems that lead to the injury. For example, Achilles tendinosis is often a function of tight calves and hamstring contributing to a shortened running stride. Scar tissue can further restrict the muscle elasticity and function, leading to more stress on the Achilles. Running up and down hills increases the stress and strain. Many people report feeling their pain after increasing their amount of weekly running miles, or running more hills. Running faster speeds also changes the stress loads which can lead to injury.

After stopping the pain, decreasing the inflammation, and reducing the tenderness the risk of re-aggravating the tendinosis is high. The frayed tendon absorbs force with every step we take during the day. Running produces a dynamic force into the body, and the tendon has to be able to absorb it without breaking down.

Many people report previous episodes of pain disappearing, but returning and getting worse as soon as they start running again. The tendon had healed 85% and was continuing to improve with normal walking stress loads. However, 85% was not strong enough to handle the forces from running, which is why it flared up again after they began running.

The forces can be reduced with a smoother running gait, proper shoes, and when the quadriceps, hamstring, and calf muscles are functioning properly. Proper treatment should address all the factors that increase stress on the Achilles tendon.

Every runner has a friend who has a chronic running injury. They will have stories about trying numerous therapies, tricks, stretches, and periods of rest. The problem keeps coming back because the system is not fixed. They use the foam roller, Prostretch, and lots of Kinesio Tape. They keep trying to work on the sore spot, not what is causing the sore spot.

Running is a gait cycle starting with your right foot hitting the ground, absorbing the forces applied, and then propelling you forward. At that point the foot is behind you and needs to swing in front to land again to complete the cycle. Meanwhile the left foot is going through its own cycle.

Both legs have to work together. What the left foot does affect the ability of the right foot to land, absorb, push, and swing back around. Weakness or problems on the left will alter the right leg's gait cycle, and vice versa.

For some reason we like to pretend that injuries are independent of the system. Injuries are commonly a consequence of a weakness or limitation elsewhere in the body. Next time your running partner complains of Achilles tendon pain look at their running gait. How smoothly do they land? Do they toe off properly? Does one foot sound louder when they land? How restricted are their hip and knee movements?

Running injuries, especially Achilles tendonitis is a consequence of weakness and failure of the running gait cycle. The improper mechanics increase the stress and strain on the Achilles leading to fraying, injury, and tendonitis.

Great treatment will address all the factors that strain the Achilles tendon. Combinations of treatment are often necessary to properly address all the muscle weakness, tightness, spasms, scar tissue, and gait mechanics.

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