Running Doc: How to prevent & treat problems with your Achilles tendon  - NY Daily News




Running Doc: How to prevent & treat problems with your Achilles tendon  - NY Daily News

Dear Running Doc:

I've been running for just a year, but I already know the Achilles tendon is nothing to fool around with. Mine has begun to feel just a little sore, usually after a run, and friends have suggested I get heel lifts for my shoes right away and not rely on stretching. Should I? What will happen if I don't? What is Achilles tendonitis and how do I get rid of it? Amy M. , New York, NY

Thanks Amy. This time of year I see tons of Achilles tendonitis, so this question is really timely. Any sport that keeps you on your feet and uses a pushing-off motion can produce Achilles trouble. Orthotics are usually prescribed, but stretching is always your first defense.

The Achilles tendon, which is formed from your calf muscles, can be pushed beyond its limits and become inflamed. That's the tendinitis to which most athletes ascribe pain -- and perhaps some swelling -- above the upper heel. But every time the tendon gets inflamed, and certainly every time the pain comes from more serious microtears in the overused tissue, which can easily be mistaken for tendinitis, the Achilles grows just a little weaker.

What brings the condition on, besides simple overuse? The Achilles is vulnerable to misuse. Designed to do its job of guiding the heel in a vertical plane, it is intolerant of the inward rolling of the ankle when it over-pronates, or supination (rolling outward).

But a calf muscle routinely loosened by conscientious stretching every day and after a workout cuts the tendon some slack, particularly in stiffer athletes, reducing the tendon's role as a shock absorber for which it's not very well suited anyway. So on those impatient days when stretching seems too much of a bother, it pays to remind yourself that a neglected and partially torn tendon needs to rest and time to heal.

If not you are looking at PRP treatments to heal quickly or surgery with a long recovery.

And if that tendon does completely pop?

The gulf between the two ends creates a hole you can actually feel. A clock has just started ticking, during which the tendon's two ends will drift apart.

As soon as possible you must decide if you want the rupture re-paired by surgically reattaching the ends -- the best choice for most athletes.

It involves an operation and then a cast or cast boot at first and probably 9-12 months of therapy. The sooner it's done, the easier the repair. Or you can just go into a cast for maybe 8-12 weeks and accept whatever healing nature is able to provide -- probably a weaker result and longer recovery.

Given all this, a couple of minutes of prevention do not seem like such a bother after all. Do both the gastroc (upper calf muscle) stretch and the soleus (lower calf muscle) stretch whenever you're near a wall and have the time.

As for the Achilles tendon stretch, once a day for a minute should do it. For both, the more, the better.

1. Gastroc stretch. Lean into a wall, keeping affected leg back straight, heel on floor and turned slightly outward. Stretch should be felt in calf.

2. Soleus stretch. Similar to above with affected leg back but knees slightly bent, lean into a wall until stretch is felt in lower calf.

3. Achilles tendon stretch. Stand with toes on stair, heels off the edge. Raise up on toes, then down as far as possible. Return to starting position.

Heel lifts alone are a big NO. They shorten the muscle tendon complex.

Yes, you "feel" better wearing them but next time out running, when you stride a little further or speed up, that shortened complex will now tear. That, you don't want or need! So please, stay away from those heel lifts.

So what do you do if stretching alone doesn't work? The longer you take to seek help, the longer it will take to fix. All structures in the body constantly remodel (at different rates). The Achilles tendon gets its strength by its fibers lining up in parallel. If its originating calf muscles are inflexible, living in an environment of over-pronation and inflammation (the "tendonititis"), remodeling proceeds with the fibers lining up every which way instead of parallel.

This results in a weakened swollen, painful tendon: tendinosis (instead of tendonitis). This tendon is more easily prone to tear and will take a full-length flexible orthotic (worn full time instead of only when you are running) and physical therapy for sometimes six months to remodel the tendon without that weak swollen tendon and its propensity to completely tear.

The therapist is specifically trained to bring blood flow into that tendon without breaking it. Of course, a series of PRP treatments can shorten the remodeling period to just under a month.

If you have developed tendinosis, I know your next question is: Can I run?

You can run in that flexible full length orthotic if you can maintain your running form. This may require slowing down and shortening stride length. Realize that your sports doctor should clear you before returning to speed and when you do, I suggest getting with a good coach and progressing back to your old speed; don't rush, you will only hurt something else!



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Lewis G. Maharam, MD, is one of the world's most extensively credentialed and well-known sports health experts. Better known as Running Doc(TM), Maharam is author of Running Doc's Guide to Healthy Running and past medical director of the NYC Marathon and Rock 'n' Roll Marathon series . He is Medical Director of the Leukemia & Lymphoma Society's Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

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