Increasing Achilles Load Tolerance – part 1 – The Reset
This article speaks to those who’ve already got an Achilles tendon problem but are trying to push on with running.
First up – your Achilles tendon problem is like many others, but it’s unique to you, so it’s specific. It’s not cool to bring a general problem to a specific person, but there are common solutions. Also, there are different reasons and locations for Achilles pain – from the sore nodules in the middle of the tendon, to the creaky, mushy tendons that feel yuck when you simple move your ankle, to the ones that hurt right where the tendon attaches to your heel. Since they’re different, they have different approaches. Let’s talk about what I’ve seen most in Australian Footballers and runners – the sore nodule in the mid-tendon.
You might be able to keep going, but take the verbal medicine I’m giving you – you may absolutely need to stop running right now – at least for a short period, and quite possibly for many weeks. Coaches hate to hear you’re out of running, but they are grown ups, and you’re a grown up, so treat it right and do what’s required. Many times, the pain settles spontaneously, only to come back later.
Often, the tendon pain occurs after a temporary increase in tendon loading, for example – increase in speed, volume, frequency of running, or even something as sneaky as running on a cambered surface, like road running where the road slopes a little to drain water, then when you run back home, you cross the road only to end up having the same camber. Be careful also of the “usual run” that has no change in any of those parameters, but follows on from a period of stress in other ways, eg. when you’ve not fully recovered from a fatiguing event. Here’s the responsible advice – don’t be the person whose Achilles tendon pain comes from a medical problem where a fitness solution isn’t right. A quick check with your responsible health practitioner is the first step.
The good news is that tendons don’t like to be rested, so you’re not going to be expected to simply not do anything. They don’t get better with rest, they get better with modified load. They get better with better movement and better load tolerance in other parts of the body. They will, however, benefit from direct treatment, so get ready to step up and help your little buddy.
In the Functional Movement Systems, one of the principles that guide clinicians and coaches through injury and movement problems is the three steps paradigm of Reset, Reinforce and Reload. This applies to Achilles pain too. The Reset means when someone does something to you that removes pain or restores movement you couldn’t do yourself. With advances in self-help, we can use many tools to reset ourselves.
When it comes to pain in the tendon, for mine, it comes down to whether you have just had pain in the last 24 hours, or whether it’s been hurting beyond 2 days.
If it’s a fresh Achilles pain, within a day, the active ingredient in simple over-the-counter medicine Ibuprofen has been shown to quieten down the tendon cells that spew out a different water-attracting-protein – the reason for the swelling. You’ve got to block these cells right away – if you miss using ibuprofen straight away, you’ll have missed the opportunity to minimise the tendon swelling in the short term.
If it isn’t a fresh Achilles tendon pain, the biggest bang-for-buck thing you can do is consider, with your local doctor who’s experienced in sports injuries, the use of GTN patches. GTN, or Glycerol Tri-Nitrate, is usually used to treat angina, as it releases nitric oxide which opens blood vessels. It’s not clear why opening blood vessels helps Achilles tendon pain, but it certainly does. So many of my Australian Football player athletes with Achilles tendon pain have had their pain abolished within a couple of weeks – if you think that’s a long time, it’s not – these tendons can be painful for weeks to months. You’ll need a prescription from your doctor, who should be familiar with its use in Achilles tendon injuries. If your doctor doesn’t know about it, go to one who does, or provide them with this article to study, followed by this article about long term results.
The second best value input you can deliver is to check on the tissue quality above and below the painful part of the tendon. In simple terms, that means poke and push around the calf muscles, shin muscles and soft tissues on the sole of the foot. It’s no joke to hear that painful spots in any of these places can actually send pain to the Achilles tendon. There’s a small proportion of athletes who do some self myofascial resets, via a massage stick, a foam roller, or another self-treatment device on a sore spot nearby only to find that the movement that hurt their Achilles was now not sore, or at least less sore. For the stubborn painful spots, some western style dry needle therapy, with acupuncture needles, can enhance the treatment to these sore areas.
Alongside tissue quality, ankle joint, big toe joint, knee and hip joint mobility drills, with belts/straps/bands are not to be underestimated when it comes to altering both Achilles tendon pain and the sticky movement that is associated with it. One of the really positive benefits of the Crossfit explosion in popularity is the countless WOD (Workout Of the Day) sites that display band/strap/belt-assisted joint mobility drills – here’s one example.
The resets mentioned above are clearing the pain and resetting tissue mobility. After these passive resets, there are countless specific and general movement strategies available to clean up the limp you developed when you started with Achilles pain. That’s for part two.