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How I Dealt With an Achilles Problem: A Case Study

By: Mike Kiely BA (hons) - Updated: 26 May 2010 | comments*Discuss
Achilles Tendonitis Overuse Pain

There is nothing more frustrating for a runner than to settle into an exercise regime only for a nagging injury to develop. Not only does the pain physically impair their performance, but it results in the development of a mental barrier: instead of being relaxed, the runner is anxious, waiting for the pain to begin as they follow their designated course.

In the case of Maria, she succumbed to one of the most common running injuries – inflammation of the Achilles, the tendon which links the heel of the foot with the calf muscle. Rookie runners are always advised to include exercises during their warm-up to stretch the tendon as a preventative measure against damage. Unfortunately, a proportion of individuals tend to skip such preparation in their eagerness to get on the move. However, even those runners who religiously follow their regime of pre- and post-run stretches can succumb to pain in the Achilles, most commonly through what is known as an overuse injury.

“I was running between 5km to 10 km, three times a week on road surfaces and on treadmills, each session lasting a maximum of one hour depending on the distance,” says Maria. “The problem first manifested itself as an aching, not though the middle of the Achilles but on the outside of the foot. At first I thought it was my running shoes.

Pressing on the Achilles

“Some shoes have a lip and then a dip where the back of the heel is. This was pressing on the Achilles. So I changed the shoes to ones that had slightly lower backs, but this made no difference.”

Did the pain occur during running or after? “Both. When it got really bad was when I woke up the next morning and I couldn’t put my foot flat on the floor without it being painful, so I would tend to keep the heel of my foot raised off the floor.”It was a period of six months from when the pain first manifested itself to the point where Maria decided to visit a physio. In hindsight, she should have sought help sooner because a diagnosis – in this case, tendonitis - and preventative measures could have been taken while the condition was at a relatively minor stage.

Friction Massage

Maria invested in a course of sessions over a four-week period, each weekly session lasting half an hour “I was treated using friction massage and ultrasound. Massage is used because, apparently, if there is inflation in the sheath [of the Achilles] they try to dissipate the inflammation and increase the blood flow to the area.”

She responded well to the treatment and, buoyed by the absence of pain, couldn’t wait to get back on the road. “I went back to running, in fact more than I was before, probably too much, and about a year later it started again. I went back to the physio and this time he also did acupuncture and it alleviated it. However, every time I went back to running the pain came back. At the time he said, ‘don’t stop exercise altogether, you can run but don’t do more than two kilometres’. I found it was still painful so I decided to lay off it, and he agreed. Now I don’t need to see him because it is not aching.”

Maria decided to try alternative forms of exercise. However, it was still a case of trial and error. “The thing that aggravates the Achilles is pounding, and jumping up and down. For a while I was doing circuit training because I thought it would be easier because there was less running, but actually it was more painful because you are doing a lot of jumping – a lot of impact such as star jumps.”

Her exercise regime is now dominated by spinning sessions in the gym, supplemented by use of the rowing machine, as well as cycling outdoors. This may not make up for the lost enjoyment of clocking up the miles in her running shoes, but she is still reaping the benefits of intensive workouts but without the stress on her lower body. Most importantly she is pain-free.

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