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How to avoid recurring Achilles pain in runners

Achilles tendinopathy or tendonitis can be a tricky condition to treat and usually takes in excess of 12 weeks to fully recover from. It’s no wonder that many runners are worried that they would develop it again in the future, but there are several steps you can take to minimise your risk.



In this article:

  1. Learn from the past

  2. Strengthen the Achilles properly

  3. Slow return to running

  4. Analyse your training: Volume, Intensity, Frequency

  5. Watch out for periods of rest/breaks from training

Here's a video I did on the same topic:



Learn from the past


Injury sucks so make sure that you at least learn something from it to apply in the future. Identify why your Achilles flared up in the first place. Did you make a mistake with your training schedule? Should you have listened to your body and allowed more recovery time? Did you up your training intensity too quickly?


Make a note of what you find so that you can make the right decision when you’re faced with the same situation in the future.



Strengthen the Achilles properly


When you have Achilles tendinopathy the tendon changes its structure, loses some of its spring-like properties and its capacity to cope with the forces from running drops.


You have to rebuild the tendon’s strength before you go back to running. Otherwise it may cope for a few runs, but then the injury and pain may return.


You’ll notice that I included the word “properly” in this heading. It’s not enough to be able to do 3 sets of 10 heel raises and then go back to running. When you run forces of between 3 to 6 times your bodyweight goes through the Achilles tendon! So your Achilles exercises have to be built up to a high intensity/volume to strengthen the tendon to cope with this type of load/force from running.


Slow return to running


Forget what you used to be able to do in the past. You will be able to get back to it eventually but you first have to find out what type of training schedule your Achilles is ready for at this moment in time.


It’s not just about doing less distance, but also allowing more recovery time and making sure you keep the intensity down at the start. If you get this right, every running session you do will help to strengthen your Achilles tendon further. If you ramp it up too quickly the opposite will happen and you may reinjure it.



Analyse your training: Volume, Intensity, Frequency


I know a lot of runners just enjoy running and never pay attention to speed, intensity etc. – they often just run on feel. This is fine, but the problem is that you may not realise how quickly you’ve increased your training volume or intensity if you don’t find an easy way to log it.


Achilles tendinopathy is an overuse injury which occurs if you push your volume or intensity of training up too quickly or if you don’t allow enough recovery time after very intense sessions. To avoid recurring Achilles pain it’s vital that you find an easy way to look back on your training of the previous month(s).


Most fitness trackers already provide all of this information in an easy to view format. If you’re doing low training volumes, the research seems to suggest that it could be safe to increase your training by around 20% per week. If you’re doing high training volumes it seems to be safer to stick to increasing it by no more than 10%.


In my experience high intensity sessions are more likely to cause Achilles irritation and they are often difficult to track. What counts as high intensity for the Achilles? Hill running, speed sessions and track sessions all work the Achilles hard. So make sure that you allow enough recovery time after these types of runs and don’t squeeze too many into one week.


Watch out for periods of rest/breaks from training


You know how you sometimes blink and a whole month has gone by where you couldn’t manage any consistent training? It could be that you had a bad cold, travelled for work or just couldn’t be asked to go out in the miserable weather.


Periods of inactivity or decreased activity will mean that you lose some of the strength in your muscles, tendons etc. – if you don’t use it, you lose it.


This means that if your Achilles (and rest of your body) was able to cope with x volume of training 4 weeks ago, it may now only have the capacity to handle three quarters of that volume. Because its capacity to cope with the training load has dropped, you will have to ease back into training and take a few weeks to build it back up again.


Hope this all makes sense! Need more help with getting back to running? You can consult us online for an assessment of your Achilles injury and a tailored treatment and training plan.

Best wishes

Maryke


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.





References:

  1. Cook J, Docking S. “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians. British Journal of Sports Medicine 2015;49(23):1484-85. doi: 10.1136/bjsports-2015-094849

  2. Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016;50:273-280.

  3. Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports medicine and arthroscopy review 2018;26(1):16-30.

  4. Murray NB, Gabbett TJ, Townshend AD, et al. Calculating acute:chronic workload ratios using exponentially weighted moving averages provides a more sensitive indicator of injury likelihood than rolling averages. Br J Sports Med 2017;51:749-754.

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