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Running Injuries
Achilles Tendonitis by John Williams Atlas Pain Relief Centre, Tamworth, UK
Achilles Tendonitis is very common in runners. Common belief is that rest works well i n the treatment of achilles tendonitis. As most people will testify, this in fact is not the case and careful management of this condition is needed. Usually the painful symptoms around the achilles tendon return when training resumes.
Continual bouts of exercise and rest periods develop a chronic situation and will eventually prevent the runner from performing. A programme of rehabilitation is needed to assist full recovery and prevent further bouts of this irritating condition.
The achilles pain syndrome is divided into two main areas which involves both tendon and sheath
( paratenon tissue ) The achilles tendon does not in fact have a true tendon sheath but has paratenon tissue which surrounds the tendon and assists lubrication of the tendon on movement. Inflammation of the paratenon tissue usually shows as a thickening and increases the size and appearance of the tendon.
Palpation over the area is usually painful and any running is difficult.
Causes
Overuse and lack of conditioning will both irritate the achilles tendon as will overstretching, which may come from running up hills or steep inclines on a treadmill. Tight calf muscles due to lack of proper stretching can also result in a sore achilles tendon which will result in inflammation and pain.
Previously mechanical irritation from badly designed training shoes with a high achilles protector used to be a problem but manufacturers have altered this by designing a “V” cut into the top of the protector which has helped considerably.
Treatment
This may vary depending on the severity of the condition and workload of the athlete. Most runners get twitchy if they are told to rest and stop running for a while, so a treatment plan needs to consider this factor. Runners may be on a training regime in preparation for a marathon and any gaps in training may have a negative effect on their performance. This however needs to be balanced with the realization that this type of injury has to involve rest periods in order to allow healing to take place
It is vital that the cause of the injury is identified before treatment is undertaken. Once the cause is identified then the correct treatment plan can be introduced. Many physiotherapists use ultrasound as their treatment modality and although this is a good choice it will not be successful if used in isolation.
If the tendon sheath is thickened it will require specific deep friction massage to break down adhesions. This will obviously irritate the achilles tendon and be painful, but if ice is used throughout to reduce inflammation and pain, the process can be administered successfully.
Friction massage is used in an attempt to re-injure the tendon and create a healing crisis response from the body. As we know the achilles tendon is not blessed with a good blood supply so by manufacturing an inflammatory response you will encourage vasodilation of blood vessels, increase blood flow to the area and promote healing.
My recommendations would be :
3 x treatments per week for the first 3 weeks with no running done. During this time the patient should wear heel lifts in both shoes to reduce the stress on the injured achilles tendon. By the end of the 3 weeks the fibrous adhesions should be broken down and the painful part of the treatment plan is complete. The treatment plan has to involve factors such as pain relief, increased vasodilation, and breaking of fibrous adhesions around the tendon and sheath.
Weeks 4 and 5 should allow the tendon to recover and both ultrasound and interferential treatments together with soft tissue work administered 3 x weekly will promote healing. Removal of heel lifts is now advised in order to provide passive re-stretching of the tendon. No running should be done during this time.
Weeks 6 and 7 should involve 2 x treatments per week with active stretching after home exercises. Ensure a gentle stretch of both soleus and gastrocnemius calf muscles and hold the progressive stretch for 2 minutes at a time. Begin strength conditioning by performing 20 repetitions of calf raises 3 x daily, the stretching can then follow. Complete the process by icing the area when stretching is completed.
Week 8 Replace heel lifts in running shoes and begin half pace jogging for 15 minutes every other day, stretch off gently after exercise and ice. Heel lifts should only be worn in running shoes now and not during daily activities. Treatments of electrotherapy and soft tissue work should continue twice per week.
A gradual increase in distance should follow over the weeks with a gradual increase in pace and if pain free the heel lifts should be removed. When heel lifts are removed during running, reduce pace and distance again to accommodate the extra stretch on the tendon. This can be gradually increased as before until back to full fitness.
During rehabilitation try and avoid running up hills which may stretch and irritate the tendon.
This treatment plan is only a guide and may be customized to suit different individuals but I have used this formula many times with great success. The skill of the therapist is vital in the programme and if they rely only on machines for treatment it will not be successful. A skilled hands on approach needs to accompany the electrotherapy treatments and the home exercise rehab programme has to be undertaken.
Treatments for Achilles Tendonitis are available at Atlas Sports Injury Clinics in Tamworth and
Solihull UK www.atlaspainrelief.com
Marathon Runners seek help with training injuries
Avoiding sports injuries when training for marathons is vital if you want to achieve a good personal time and in some cases guarantee you make the starting lineup. 26 miles is a long way to run and as all distance runners will be aware, requires much hard work with regular runs over long distances.
The season for running injuries will soon be upon us as we get closer to the London Marathon. The closer we get to the race date, the more the training distance is increased and overuse injuries are developed.
Novice runners tend to follow training plans from running magazines and articles and can soon run into trouble. Imagine an article in a national magazine being followed by 1000 novice runners. A problem can occur when the programme advises you increase the distance of your training at a certain point. Firstly not all runners will have begun the training with the same ability or fitness levels and when asked to step up the distance may not be ready for it. This can result in injuries and is a common cause of frustration in novice runners.
Distance running advice will normally state that a certain training regime is a guideline and will be suitable for many runners but solid advice is to listen to your body. If you try and rush things during your marathon preparation then you may suffer the consequences.
Beware of running continually on the same road camber as this can lead to undue stress on the lower limbs and result in tendonitis, shinsplints and iliotibial band soreness. Change sides of the road if possible to ensure a balance is maintained.
Blisters can be a nightmare for some runners and are very painful. They can prevent you finishing or at least slow you down significantly. Blisters are simple to avoid as they are a problem of friction. Basically something is rubbing and you need to prevent the friction. An easy way to solve it is to apply Vaseline over the affected area which will stop the friction and allow the two offending structures to slip over each other thus preventing the friction burn and ultimate blister.
Many runners rub Vaseline over their nipples to prevent them from rubbing on the running vest which really helps. Where you are likely to get something rubbing against your skin then smear a little Vaseline and you will make it all the way without discomfort.
For those of you that pick up injuries during your training, please seek help before it gets too chronic.
The rule of thumb is, the longer you have had the problem, the longer it takes to fix.!
Atlas Pain Relief Centre have Sports Injury Clinics in both Tamworth, Staffordshire and Solihull, Birmingham, West Midlands and host experienced sports physiotherapists who actually run distance races themselves.
Sports Injury advice and training advice is available with swift sports injury treatment if you need it.
Use the experts who understand biomechanics and soft tissue injuries and get advice on orthotics if you are a pronator and have over pronated feet resulting in dropped arches. This can lead to many injuries for the distance runner.
Running injury help can be obtained by contacting John Williams at Atlas Pain Relief Centre on 01827 59943 or visiting the website www.solihullsportsinjuryclinic.co.uk
Runners Knee
This is a knee pain condition which presents as pain on the outside of the knee joint. It is commonly seen in distance runners or winter training where increase in distance is involved.
The knee pain is generally eased with rest, but as you run further the pain will return and get progressively worse. You may be aware of a clicking sensation as the knee bends and straightens which could indicate a tight IT Band.
The Ilio-Tibial Band (ITB) is a straplike band of tissue that runs down the outside of the upper thigh and attaches to the outside of the lower leg just below the knee. The ITB is a lateral stabilizer of the knee joint and protects the knee from unwanted sidewards movement.
If the runner runs off road, runs on a camber for long periods or is an over pronator, then this can lead to a tightening of this band via contraction of the tensor fasciae latae. Once this band tightens, the act of bending and straightening the knee will force the tight ITB to flick over the lateral femoral condyle.
Repetitive movements such as running long distances will eventually irritate the tight band and create an inflammation and tenderness which will be very painful.
The ITB is very difficult to stretch due to its location, but icing the inflamed area, reducing mileage and addressing the cause of the irritation will assist the recovery of the condition. Manual Fascial stretching may be needed to stretch the ITB in order to gain a faster recovery time but ultimately a reduction in mileage is necessary to allow the inflammation to be treated.
Careful management during the treatment phase will get fast results and make sure you enlist the help of sports injury specialist with knowledge of running injuries. Solihull Sports Injury Clinic in Hockley Heath, Solihull between Stratford on Avon and Birmingham have such expertise and also have a clinic in Tamworth, Staffordshire. Headed by Sports Physiotherapist and Osteopath John Williams, Solihull Sports Injury Clinic will get runners back running again. More information on Running injuries can be found by visiting their website www.solihullsportsinjuryclinic.co.uk
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