Sports Medicine Services - Injury of the Month

It is common to get problems with the Achilles tendon when running and playing sport. It can be very difficult to cure the problem but here are a few tips.

Prevention
Warming up and stretching before running can reduce the risk. Make sure you run in good shoes or boots (even football boots should support the arch of the foot). The shoes should not collapse in the inner side when you lean forward over the toes. Most important of all when you start exercising or change the amount you do, you need to give the body time to adapt. So increase the miles you run slowly (10% increase in total each week) and if you are hill running (especially hard on the Achilles) start slowly and don't run too far. At the beginning of the football season don't go from nothing to 4 hard sessions per week at once. A gradual increase in work load will avoid many so-called "overuse" injuries.

Sudden onset
If the tendon suddenly becomes painful you have probably torn something. It may be necessary to see a doctor to check you have not completely torn the tendon. Ice applied for 10 minutes every hour will prevent some of the swelling, along with elevation. If the pain goes quickly, rest for a few days while still stretching the calf (remember there are 2 calf muscles and you need to stretch the calf with the knee straight and slightly bent), then start again slowly.

Insidious onset
More often the pain comes on slowly, at first at the start of a run, and afterwards, getting slowly more persistent. The earlier you get advice the quicker it will resolve. Stop running or reduce the distance (training if you are playing football or hockey for example).

Don't do nothing - few tissues of the body get better with complete rest, So cycle, swim, row etc. and increase the stretching. The best regime to cure an Achilles tendon problem involves eccentric loading (loading while the muscle and tendon are lengthening not shortening) such as standing on your toes on a step and lowering the heel, holding for a few seconds then coming up with the weight on the other leg. This will slowly stimulate the tendon to heel over 2-3 months if repeated twice daily, but caution is needed at first to ensure that more damage is not caused. Sometimes the tendon is too weak to stand the strain and needs careful supervision. Go to a clinic where there is at least a doctor and physiotherapist (sports injuries need team work rather than just one therapist!) and ask about eccentric loading exercises.

But be patient! Local massage can stimulate the blood supply and aid healing. Injections can help a bit but only alongside appropriate exercises, and surgery is very much the last resort. Physiotherapist's electrotherapy (ultrasound, laser etc.) can make a little difference but the main part of treatment is what you do yourself to stimulate the tendon - there are no short cuts!

Point to remember : Increase the load on tendons slowly. Don't go mad when starting any exercise regime!