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How to prevent Achilles pain from derailing your marathon training

Achilles pain, or Achilles tendinopathy, is one of the most common running injuries to throw a spanner in the works of a marathon training programme. This article will show you how to structure your training like an elite marathon athlete, using ‘prehab’ to avoid injuring your Achilles tendon in the run-up to the big race.


How to prevent Achilles pain when marathon training.

In this article:

I've also discussed this topic in detail in this video:


What causes Achilles pain during marathon training?

In short, this is caused by overloading your tendon through overtraining. The line on the graph below shows the phases that your muscles and tendons go through when you train.


At the start of a training session, your muscles and tendons are rested and strong. As the training session progresses, the strength declines somewhat due to microdamage to the various types of fibre that make up your muscles and tendons. This is normal. And then, when you rest after a training session, your body repairs this microdamage so that the fibres are stronger than before, which means that you can train a bit harder next time round.


This graph explains how your body accumulates microdamage when you do marathon training and how it can lead to Achilles pain if you don't allow enough recovery time.

Achilles pain typically happens when you don't allow enough recovery time between training sessions and that microdamage accumulates. Because it’s not an acute injury with sudden pain, it tends to creep up on you, and when you become aware of it, it’s already too late.


What elite marathon athletes do

Throughout their training, elite marathon athletes will have periods of high volume but low intensity running during which they build their base. This is when they do lots of prehab strength training to really make their muscles and tendons robust.


However, as the intensity of their running training increases and they get closer to competition time, the volume of the strength training decreases to allow them to recover better from the hard running, although they keep a low dose of high intensity strength training just to maintain that strength.


What to do before you start your marathon training programme

So, in the case of us mere mortals, the first and most important thing to do to avoid Achilles pain when training for a marathon is to put in some hard yards even before you start your marathon training programme.


First, you can't go from not running much at all to suddenly jumping into a marathon training programme. You'll be very likely to overload the Achilles tendon. So, it's important to build up to marathon training by doing a few years of training for and running shorter races.


Second, you should do specific strength training exercises for the calf muscles and the Achilles tendons to make them more robust so that they can bear the loads that a marathon training programme will subject them to. The stronger these structures are, the less microdamage they will suffer during the training and the quicker they will recover between sessions.


Now, it's not rocket science to figure out what exercises to do. It's basically heel raises – over the side of a step is a good way to do them – and depending on your training status you will likely do them with either no weights, some weights, or heavy weights.


If you are not used to doing strength training for your calf muscles and Achilles tendons, you may find that three sets of 10 heel raises just with your body weight is where to start. Somebody who has already done this type of training may find that they need to add some extra weight.

Heel raise exercises over a step with extra weight is a good way to strengthen your Achilles tendon and calf muscles and prevent Achilles pain during marathon training.

What to do during your marathon training programme

As we’ve seen above, if you've not done strength training regularly throughout the year and you're starting your marathon training program, this is not the time to start hammering your calves and your Achilles tendons with lots of strength training at the same time, because it will cause overload from the running. Your prehab exercise for the Achilles should start in your ‘low season’, before you start your marathon training.


During marathon training, which is typically about 16 weeks or longer, depending on which programme you follow, you should continue with your prehab strength training but restrict it to a maximum of two sessions per week. You want to make them count, so fewer heel raises with a heavier weight is better than lots of heel raises with no or little weight added. Aim for a weight that makes you tired within about 10 heel raises. If you search online for Achilles rehab exercises, you may come across programmes that say you should be doing strength training exercises more than once a day. Please don’t do this, as you are doing prehab, not rehab.


Then, as you get towards the end of your marathon training where your mileage is quite high, you want to reduce your Achilles strength training to just once a week to give the tendons the opportunity to recover sufficiently from all the running while maintaining the strength you have built up.


As you taper towards the marathon, you could stick to once a week and then drop the exercises altogether in the week right before race day.


Consult a physio online for an assessment of your Achilles injury and a tailored treatment plan. Follow the link to learn more.

Is it best to do the Achilles exercises before a long run, after a long run, or on a separate day?

It should definitely not be before a long run, because it is not a good idea to tire your Achilles tendons and your calf muscles and then go running with them. You're more likely to injure yourself and overload them this way.


You'll get the most benefit from your strength training if you do it on a day when you're not doing a large running volume as well. And it is better to do your day’s running first and then do your strength training later on. Strength training on tired legs is preferable to running on tired legs.


Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.