Welcome, Marathon Training Academy community! Thank you so much for visiting the Physical Therapy Advisor. In podcast episode #154, The Marathon That Got Away, Trevor discusses the difficult decision to not run a race. He chose to avoid risking further injury as he prepares for a more important race in a couple of months. His particular injury and decision provides an opportunity to discuss exactly how to rehabilitate Achilles tendinitis.
As in Trevor’s case, sometimes it is better to not push through an injury to insure that you will be able to safely compete in the near future. Other times, the choice may be to triage and push through. The decision is never easy.
How to Rehabilitate Achilles Tendinitis:
Initially, I highly recommend that you discontinue running. You will want to maintain your cardiovascular fitness as you rest the injury. My top recommendation is to start with aqua jogging. It allows you to maintain cardiovascular fitness without stressing the tendon. If water based exercise is not possible, you may be able to bike or use the elliptical machine. The choice of exercise will be symptom dependent, meaning if it aggravates your Achilles pain, then you will need to choose a different activity.
Most of the time, cardiovascular fitness is not the biggest barrier to completing a marathon. It will be whether or not your legs and back can handle the pounding and time spent upright. If we are honest, the majority of us are rarely on our feet for more than an hour at a time. Assuming you can maintain your fitness with aqua jogging, I recommend finding ways to increase time on your feet without causing further Achilles tendon symptoms. This may mean standing up at night to watch TV or using a standing office desk/work station. Keep your body used to being upright.
Ideally, you will be able to seek help from a physical therapist (PT) who specializes in sports medicine, particularly in running. The physical therapist can evaluate you for other possible biomechanical reasons for developing Achilles tendinitis. He/she should conduct a full lower body screening that at least includes the lumbar spine to the feet.
In Trevor’s case, we identified how he was increasing his training volume of running at the same time as he was increasing intensity in both running and his cross training P90X routine. This may be the cause of the issue, but often other biomechanical issues may predispose a person to injury. You will want to identify these issues and aggressively work toward treating them as an integral part of the rehabilitation process.
In addition, find a PT who is highly skilled in manual therapy and can perform certain mobilization techniques to help the healing process. There are many effective manual treatment techniques, including the Graston technique, in which the clinician utilizes special metal tools to help mobilize the tissue. The Active Release Technique (ART) has specific treatment protocols to mobilize tissue as part of the treatment plan.
The key is to find a provider skilled in sports medicine and manual therapy. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).
Trevor is taking Tissue Rejuvenator by Hammer Nutrition. It contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation. It is a fantastic supplement.
Another supplement I frequently recommended to help recover from injury is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently.
An additional supplement to consider is called CapraColostrum by Mt. Capra. Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster.
I recommend taking either CapraFlex OR Tissue Rejuvenator, not both concurrently. You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator.
I initially recommend trying a 30 day protocol. If the supplements are aiding your recovery, you may choose to continue taking them for an additional 30 days. I sometimes implement this protocol as part of a prevention strategy during times of heavy volume or high intensity training. (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol. Herbs could interact with some medications particularly if you are taking blood thinners.)
Mobility bands are gaining in popularity as a self-treatment tool. Rogue Fitness VooDoo X Bands or EDGE Mobility Bands are a novel way to self-mobilize the tissue of the calf and Achilles tendon. The use of mobility bands affects blood flow to the area and speeds up healing. Mobility bands also help reset some of the receptor cells in the muscle tissue that cause excessive muscle tightness. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of aggressive, deep compression.)
To learn how to properly apply the mobility band, please refer to Mobility Band for Achilles Tendinitis. I also recommend watching Voodoo Band for Improving Achilles pain and/or Ankle Mobility.
Eccentric Muscle Training
An eccentric contraction is when the muscle is elongating or lengthening during the contraction. For example, the eccentric contraction occurs when you lower your foot down while performing a heel raise. Please refer to Achilles Tendinitis Eccentric Exercises for detailed instructions and photos.
Working on this motion and this type of strength is important. Initially start performing heel raises with both of your legs. Then progress to performing the exercise with only one leg. It’s important to move very slowly into the lowering position (meaning the muscle is lengthening or contracting eccentrically). I recommend 1 second up and taking 5 seconds when coming down. Start slowly, but eventually taper up to very high repetitions, such as 20-30 at a time. This should be performed in a relatively pain free manner.
Compression Socks and Kinesiological Taping
Support the tissues with compression socks and Kinesiological taping as you return to running. Compression socks can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and can limit the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression socks and sleeves. I have had luck using the Vitalsox Graduated Compression Socks. Always be sure to choose a pair that is at least knee high.
The purpose of the Kinesiological tape is to assist the muscles of the calf (gastrocnemius and soleus muscles) with their contraction. The tape also supports the tissue, increases kinesthetic and proprioceptive awareness, and helps with swelling and nutrient exchange by assisting the lymphatic system. Taping may also be used in an attempt to decrease the strain on the Achilles tendon.
Kinesiological tape comes in many different brands. I have had luck using the KT TAPE and Mummy Tape brands. I recommend following these step by step instructions for Kinesiological Taping for Achilles Tendinitis. For application and removal tips, please refer to Skin Care with Taping. I also recommend watching the following video on How to treat Achilles pain/tendonitis using Kinesiology taping techniques.
RETURN TO RUNNING
Prior to returning to your normal training activities, insure the following:
- Your involved leg is as mobile and flexible as the other (particularly into dorsiflexion, which is flexing your ankle).
- Your involved leg is as strong as the other leg.
- Your ability to balance is equal in both legs.
- You can jog, run, sprint, and jump without pain.
With proper and early treatment, this condition should mostly resolve in 3-4 weeks. Severe cases will take longer. If you are not progressing after 2-3 weeks of implementing these treatment options, please speak to your medical professional so you don’t lose too much time with your training. As you return to running, taper up the volume and intensity very slowly and be extra diligent about a thorough warm up and cool down. Follow these guidelines:
- Be sure that you have addressed any predisposing issues, such as poor footwear.
- Although you will need to progress and train on uneven ground and hills, initially start with level terrain only. Avoid hills or uneven terrain. Run on a softer surface (running track, grass or a running trail with soft dirt or wood chips).
- Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
- Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.
- Continue with your rehabilitation until you are performing all of the exercises and running normally without pain.
Although Achilles tendinitis can be very debilitating and demoralizing, it can be self-treated if addressed at the onset of pain as in Trevor’s case. By learning how to effectively self-treat and manage the condition, you will be back to running sooner! For other strategies to implement, please refer to 15 Tips to Self-Treat Achilles Tendinitis.
Thanks for listening to the Marathon Training Academy podcast and for visiting the Physical Therapy Advisor. I would love to assist you further in your running journey by helping you prevent and self-treat common running and musculoskeletal injuries. When you subscribe to my e-mail newsletter, I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age. To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.
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