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In Greek mytholog

y Achilles was held by his heel and dipped in the river Styx in an attempt to make him immortal - leaving only his heel exposed1. As runners we too have areas of weakness that can leave us exposed to injury.

Despite the fact that the Achilles tendon is one of the strongest tendons in the body it is one of the most common overuse injuries in runners, particularly those of us who are no longer in our 20’s and early 30’s. An Achilles tendon injury can be both debilitating and completely disheartening.

The Achilles tendon is comprised of the gastrocnemious, soleus and possibly part of the plantaris muscle. It is designed to endure tensile stress that occurs with muscle c

ontractions. Imagine a healthy tendon as a rubber band. It is able to withstand a certain amount of pulling and tugging- i.e. tensile stress. However at some point that rubber band is going to get small tears in it or completely breakdown. The older the rubber band is the more likely is it to slowly breakdown. The more times it is stretched to the limits the sooner it will snap.

Tendonopathy is chronic degeneration of the tissue that makes up a tendon. 

Healthy tendons are made up of primarily type I collagen and some type III collagen. Collagen is the protein that strengthens a tendon. Now imagine that same rubber band after it snaps. You try tying it back together to do the same job but it is never quite the same.   When a tendon is injured it repairs itself by replacing collagen I with collagen III which it not as strong, and it lays down in a disordered pattern. This repair process decreases the tendon’s ability to withstand normal tensile stresses making it even more vulnerable to injury later on.

During running the soleus is responsible for stabilizing the lower leg or tibia in mid-stance and the gastrocnemious is responsible for push off. The Achilles is frequently subject to loads anywhere between 2-10x your body weight!

What causes an Achilles tendonopathy?

  1. Excessive pronation can caused increased stress in the Achilles because it can cause a “wringing effect” in the tendon as your foot hits the ground and accepts weight. Excessive pronation can be a result of weakness in the hips and pelvis, a lack of ankle mobility, shoes or orthotics that are too old or not right for you.

  2.  Too much too soon, too many miles a week with not enough rest or a sudden increase in your training amount. Typically runners that are logging miles > 40/week are at a higher risk.

  3. Weakness or inhibition of muscles in the lower leg or somewhere higher in the kinetic chain.

  4. Running form can also affect how your tendon is loaded. There isn’t any solid research on this yet. However, clinically people that have poor hip extension and great toe extension often show up with Achilles pain. It is likely because they are pulling with their calf rather than extending the leg with their glutes. Also those that run on their toes or jam their forefoot into the ground at impact never letting their heels drop seem to be victims.

What does an Achilles tendonopathy feel like?

  • Sharp or aching pain in the Achilles or heel

  • Swelling in and around the heel

  • Tender to the touch

  • Often a small nodule on the back of the heel develops

  • Pain with walking barefoot or in flats

What to do if you have an Achilles tendonopathy?

If you are having pain in the Achilles or increased calf tightness that is preventing you from running greater than 7 days it is time to see a medical professional. Go see a sports medicine physician or a physical therapist that specializes in treating runners. The sooner you have something taken care of the sooner you are running pain free!

In the meantime make sure your training habits are not hurting you! Overuse the leading cause of Achilles tendonopathy. Examine your training habits: are you doing too much? Are you giving yourself enough rest days between workouts? Do you always push yourself to your limits?

It may be worth consulting with a running coach. Coaches don’t have to be horribly expensive, in fact some of the best are very reasonable. A good coach will help you figure out the perfect combination of training and rest for you. They will give you an individualized plan that fits your life and training style.

Another cause of Achilles tendonopathy is the poor running mechanics. Improve your running form. There is no perfect running form and there is no “right” way to run. However, there are a few common themes that show up across all running forms that might help you.

  • Maintaining good posture: keeping your rib cage stacked over your pelvis and leaning forward slightly from the ankles. This will help improve your ability to tap into your core.

  • Keep your foot close to your center of mass

  • Remember the Phoebe run on Friends? Arm swing is more important that a lot of people think. If your arms are all over the place it is likely your legs are too.

  • Try not to stay up on your toes or too far on your forefoot while running, allow your foot to drop as it moves through gait cycle

If you have already tried to change your running form on your own or it seems a bit overwhelming then find a physical therapist that can do gait analysis to help you. The information you receive will be invaluable.

Looking to improve your Achilles ability to endure stress? Get your strength on! Research has shown that eccentric muscle strengthening can help improve the collagen’s ability to heal in a more organized fashion. For example when you do a heel raise the lowering portion or the heel raise is working the eccentric part of the muscle contraction. So, heel raises, lifting up on your toes and slowly lowering can help significantly to improve the strength of the tendon.

Lastly hydration and proper nutrition allow for improved healing response. For some reason runners often put nutrition on the back burner. A car needs gas to run, you need the right fuel. If you aren’t taking in enough calories or the right kind of calories your body will not be able to heal it’s self.

Achilles tendon injuries often prevent people from reaching their running goals. Be smart, if you are hobbling around trying to run through it don’t. Instead, take it slow and get help. Achilles tendonopthies can take a long time to heal addressing your injury earlier can greatly reduce recovery time. There are so many resources available to runners now its time to take the first step!




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