Running & Rehab: Peroneal Tendon Injuries

A true runner without a history of pain or injuries is one in a million. The constant pounding on the ground through all of the joints in the body is bound to put stress on some area of weakness and eventually cause discomfort. If you have searched for the most common running related injuries or pain, you have probably come across knee or IT band issues. The ankle and foot are almost, if not just as common as those two. It makes sense why—the feet take on the most pressure during running since they carry our entire body weight throughout the running cycle. Foot structure and deformities are one of the main reasons injuries to this body part occur. Unfortunately once you injure the foot or ankle once, you are prone to getting injured again, especially if you do not take care of the cause.

Besides foot structure, general ankle instability is a problem for runners, causing a large percentage of traumatic injuries such as sprains and tears, as well as overuse injuries and pain like plantar fasciitis and tendonitis. An overlooked and often misdiagnosed issue is peroneal tendon dysfunction. The two peroneal tendons run along the outer side of the lower leg, one connecting to the side of the foot and the other underneath the foot. These tendons are responsible for eversion of the foot, which is the movement of rotating the foot out to the side. It is quite common for peroneal tendon issues to be mistaken for ligament injuries (sprains). Understanding the causes and how to address instability is key to full recovery from and prevention of peroneal tendon dysfunction.

Types of Peroneal Injuries

Tendonitis

This diagnosis presents itself with inflammation in one or both tendons and is usually caused by activities that involve repetitive overuse of the peroneal tendons. Trauma, such as an ankle sprain, can also cause tendonitis since when rolling the ankle the tendons must powerfully try to control from rolling too far. Pain is normally felt behind or underneath the outer ankle bone during activity, and subsides with rest. Treatment involves using anti-inflammatory pain medication, rest, and activity modifications. If the tendonitis is severe, immobilization for four to six weeks in a walking boot may be necessary.

Dislocation

Also called ‘subluxation’, this injury consists of the tendons snapping out of place over the outer ankle bone. There is a sheath that holds the tendons in place at all times that may tear with traumatic events and cause this dislocation. Already present deformities such a shallow or nonexistent groove where the tendons lie or a loose sheath to begin with can also be the cause. After the initial trauma, it may be difficulty to diagnose this issue since there is subsequent inflammation throughout the entire joint. The snapping is felt during forceful dorsiflexion and inversion, or flexing the ankle joint upwards as if raising the toes while rotating the foot inwards. Runners will feel the snapping during the push-off phase of running since it is a forceful movement from heel strike or a neutral position to pointing the toes downward.

Treatment for initial encounter subluxations can and should be treated conservatively with rest, immobilization in a cast or boot, and anti-inflammatory medications. For injuries involving a tear of the sheath, chronic dislocations due to ankle deformities, or failed conservative treatment, surgery will be the only option to repair the cause. After surgical repair, physical therapy will be necessary to manage pain and inflammation and restore motion and strength. Individuals who experience chronic dislocations of the peroneal tendons should seek treatment as soon as possible as this consistent snapping can lead to tears.

Tendon Tears

This peroneal tendon diagnosis can be a result of an acute traumatic injury such as a severe ankle sprain. Chronic issues such as consistent dislocations or weakness and instability in the ankle joint can also cause tears by means of overuse leading to fraying and splitting of the tendon. Individuals with high arches are more prone to this type of overuse and should consider using arch support orthotics in their shoes especially for running and other high impact sports. Surgery is usually required to repair the torn tendon, followed by immobilization and physical therapy.

Ankle and Foot Strengthening

Since instability and weakness are a main cause of most foot and ankle issues in runners, it makes sense to incorporate direct strengthening exercises for these areas. A simple strategy is to perform a few before an easy run about three times per week. Resistance bands can be used to target the main movements of the ankle as shown below. Heel and toe raises will also strengthen the calves and dorsiflexors (muscles along the shins). The smaller muscles of the foot can be strengthened with toe curls using a towel on the floor and trying to pick it up with your toes for up to ten repetitions for two to three sets. More advanced exercises consist of using unstable surfaces such as a balance disc or foam mat to perform exercises.

Ankle pain and instability is often diagnosed as a sprain, especially if there was a trauma. It is important to keep in mind that sprains can also involve tendon injuries. If you are diagnosed with a lateral ankle sprain and have done all treatment correctly but continue to have pain, the next step should be to follow-up with your doctor to check for any peroneal tendon injuries. Most cases with minimal symptoms do well with conservative management. Unfortunately if there is a greater loss of function, especially for athletes who want to continue their demanding sport, surgery may be necessary. As mentioned above, the foot and ankle joints are very important for runners, therefore any instability or weakness should be taken care of to avoid injury. If not taken are of, foot problems tend to lead to issues in higher joints such as the knee, hip and back. It is useful to remember that healthy feet leads to healthy running!

Sources

Kinner Davda, Karan Malhotra, Paul O’Donnell, Dishan Singh, and Nicholas Cullen, Peroneal Tendon Disorders, Journal, Apr 28, 2020.

Race Recap: Miami Marathon 2020

“Dear legs, give me a great race today.” This was exactly what I told myself when my corral was moved up to the start line. This was going to be my 8th marathon attempt and 12th time at the start line of the Miami Marathon & Half Marathon. Even having experienced the Boston and New York City Marathon, Miami is still my favorite race. It has so much to do with the fact that it’s my hometown and I know the streets like the back of my hand, but even the non-locals say it’s great for its amazing scenery, flat and fast course, and pretty comfortable weather. You can’t go wrong with the events surrounding the race either—it truly gets you in the mood to join the running community!

It was 71 degrees, which was probably too warm for everyone else, but it was the perfect racing weather in my book. Although the body has to work harder to keep a proper core temperature and avoid overheating, I have been so used to running in the heat. I had my hydration and fueling plan down-packed and my salt tabs ready. Everyone asks me how I carry these along with an entire 8 gels without a waist belt or armband. I literally stuff 4 in my sports bra with the salt tabs and the others tucked in my running shorts waistband. It’s easy to grab and you get used to just getting chafed and dealing with it for a week or so.

I tried something new this time around—racing with a partner. I actually had two race buddies, Frank, who I had the pleasure of getting in important long runs with throughout my months of training, and Kevin who decided to join in a couple of days before the race. This was the best thing I could have done for myself. To be honest, I had been so nervous to race this time. Well, I am usually a nervous wreck before races, but this time was worse and it was because I stayed away from racing for almost a year because of the miserable bout I had at the end of 2018 and beginning of 2019. This was a mistake. I was fine physically, but without some practice runs leading up to the big day, it messed with me mentally.

My usual self usually throws all of the pacing strategies I spend time creating for myself out the window and goes out way to fast and struggles in that last 10k. The best thing about my partners at this race was that they were so good at pacing so I just stuck with them and I never felt better. Our goal was to start off and run the first 5k around 7:00 min/mile, which is about 10-15 second slower than our goal pace. This first part of the race is the hardest since it includes a pretty long and steep causeway followed by another smaller one, all with a headwind. We averaged the 5k at a 6:59 pace.

 The next goal was to be in the 6:40s by the time we reached 10k. Unfortunately I lost Frank around mile 9 to an upset stomach. Thankfully he felt okay to stick it out and finish the half marathon with a decent time! I was determined to stick with Kevin for the entire race. After all I felt amazing hitting every single mile in the 6:40s, something I felt was going to be impossible to do these days. I was annoyed when my Garmin rang in mile 14 about 200 meters too soon, so from then on my watch was completely off—UGH! 

We made the turn into Key Biscayne during mile 15, and had a strong headwind again. It’s only one mile in and back out, but it feels like forever. For the first half of the mile in I struggled to stay behind Kevin—he could have blocked the wind for me, so I began to separate further and further from him. I ended up speeding up to try to close the gap, but realized halfway that I was going to lose energy so I slowed down and planned on worrying about catching up to him after making the turn to run back with the tailwind. Unfortunately I wasn’t able to catch up, so my plan now was to keep him in sight. I was still averaging 6:49 when I reached mile 18, although my Garmin was inaccurate so I really started to lose track. 

It was right before my watch rang for mile 20 that I felt a sharp pain in the left side of my right hamstring along with a snap. I sort of buckled but kept on trying to run. That lasted for only a few steps and I had to come to a complete stop, pull over on the side of the course and shake out my leg. This must have been at least a 30 second stop. Hoping it was just a cramp or something, I took a deep breath and went out again, to only last about 10 steps before the sharp pain was unbearable. It was at this time that I remembered that around mile 9 or 10 I felt a slight twinge in my hamstring, but it actually felt like my regular piriformis/glute nerve impingement-type pain I get most days. I even felt this in my left glute during my warm up but as always it went away and I was fine. I thought this hamstring issue was related, and I still do, so I ignored it at the time. I kept on feeling a twinge throughout the race once in a while, but it was minor and went away with a little adjustment in my posture and form.

The second time I had to stop was at least for another minute. At this point I had no idea if I was still on track, especially since my watch was completely useless. I eventually got back on the course and my mile 20 rang in at 7:47. From this point on the only way to avoid the unbearable pain was to take the shortest steps possible. I am a major over-strider so this felt so awkward for me but it was the only way to keep a decent pace. Mile 21 rang in at 7:01, so I felt there was hope to speed up again, but once I tried, the sharp pain came to life again. I was so frustrated, and still am, because overall my body felt super strong and able to run fast and the stupid pain just held me back. My endurance and non-existent fatigue felt great to keep with my plan of maintaining my 6:49 pace and speeding it up at the 35k point, but after 2 miles of struggling, I knew this plan was out the window.

Looking back at my paces now, I am impressed I was able to average 7:09 for the last 5 miles of the race, given the pain I was in. I ran well, raced the best I could have, and stayed positive the entire time. As upset as I was at the finish line that I did not reach that long-awaited sub-3 hour goal, I knew that I had it in me. I felt so strong at those paces for the first 19+ miles. It wasn’t a struggle at all to maintain the 6:40s for 2 hours, so that feeling alone has made me proud of the hard work I’ve done.

 I’ve got 7 months until my next attempt, and the goal this time is not just to break 3 hours, but it’s going to be an even bigger goal! Chicago can be tricky with it’s ever-changing weather patterns, but the course is flat and I hear the crowds are super engaging so I believe it’s going to be a good one for me! Bring it on!

Injury Prevention 101

We all know that runners have a higher risk of injury than non-runners, just as do athletes of any other sport. Obviously this is true, as simply being more active means you are on your feet more often with a greater availability to trip over an object and fall, step on uneven surface and roll an ankle, or just overuse weak body parts. In my opinion this risk is better than being inactive and risking developing heart disease, diabetes, and other health issues that come from lack of exercise. Besides being cautious to avoid tripping and bumping into something, runners, and all other endurance athletes, should follow other steps to decrease their injury risk on a daily basis.

SLEEP & Rest

The first and most important method to help prevent injury is to make sure you are getting enough sleep. You may feel like your 4 or 5 hours of sleep every night is just fine to keep you going, but sleep does much more than help us get through our day. Most, if not all, of the muscle damage repair and growth occurs during sleep. Human growth hormone is released during certain stages of sleep that increase blood flow to our muscles so that they can repair from our workouts. Another stage of sleep, REM, is responsible for relaxing our muscles and reducing symptoms of chronic pain. Runners should aim for at least 7 hours of sleep each night, but research shows 9 or more hours gives the most benefit to competitive athletes.

Strength Training

A well-rounded exercise plan is always best when it comes to lowering your risk of overuse injuries. You’ve probably read that triathletes, even those who participate in Iron Man competitions, have a lower risk of injury than marathoners. That’s because triathletes train with a balanced mix of running, cycling, and swimming. As a distance runner, if all you are doing is running, then you are inching your way closer and closer to an injury every day. The best formula for runners is to incorporate a mix of running, weight lifting, and other cross training cardio exercises. Lack of time may be the reason most runners skip strength training, but you can highly benefit from a quick 20 to 30 minute session a few days per week. This should be a priority if your goal is to improve your performance and not get injured.

Pack on the Miles GRADUALLY

One of the quickest ways to get injured as a runner is to increase weekly mileage by a substantial amount—even if you’re feeling great. The rule of thumb is to never increase by more than 10% each week. This may even be too much for some runners. A safe method is to increase by a handful of miles each week for 3 to 4 weeks and then have one week as “recovery” where you drop your mileage by 20% to let your body rest. After this recovery week, you can safely start back from where you left off.

Rotate Your Shoes

Since the feet carry your entire body weight during all activities, it is beneficial to give this part of the body a break. One way to do this is to switch your shoes throughout the week. Most brands make running shoes for different types of workouts. Save your well-cushioned shoes for long runs and recovery runs, and your lighter pairs for speed and track sessions. The style of each shoe is different which means your foot muscles will work differently in each pair. Everything that happens down in the feet has an effect on the rest of the body—so shoe rotation lets different muscles all over the body work and rest all at different times. 

Focus on Good Form

The constant pounding on the ground from running has an impact on the entire body. The ideal running form is one that lessens this impact and keeps all parts in sync and balanced. It is beneficial to add strides once or twice a week to focus on this. Run 5 sets of 20 to 30 seconds at a hard pace where you practice holding an upright posture with relaxed shoulders, taking quick steps, landing on the mid-foot, and a having a slightly forward lean—all aspects of proper form. Once you master good running mechanics, you will lower your risk of overusing any part of your body.

Stretch & Foam Roll

Just like weak muscles are prone to overuse injuries, tight muscles are more prone to tearing—which is an injury that can put you out for months! Runners can get tight all over, but hamstrings and calves/Achilles are the common areas that get torn. My advice is to make it a habit to stretch after EVERY SINGLE RUN for 10 minutes. A few sets of 20 second holds for the glutes, hamstrings, quads, and calves is enough. Foam rolling can be more tedious but is useful to tackle much deeper muscular tightness. It may also help improve range of motion that is limited by chronic muscle inflammation.

These steps may seem like a large load added onto your regular running routine, but they are necessary if you want to run for years without worrying about easily getting injured. These components will also help you become a more efficient and faster runner over time, so it’s a win-win if you ask me!

Sources

How Sleep Adds Muscle. The National Sleep Foundation. www.sleep.org. Nov 15, 2019.

Got Shin Splints? Learn How to Treat & Prevent This Annoying Injury

One of the most annoying, but significantly common, running injuries is shin splints. Well, this is the usual diagnosis from a doctor or other medical professional when you tell them you have pain in the front part of your lower leg, even without examining you first. Besides learning how to treat and prevent this issue, it is important for athletes to understand the symptoms and different diagnoses that are associated with shin splints in the first place, since there are other similar injuries that can be career (and life!) threatening.

“Shin Pain” Causes

The number one cause of pain in the shins is overuse. You will hear from many doctors and physical therapists that biomechanical factors—think: flat feet, heel striking and overpronating, are the main cause, but it actually has more to do with overloading in general. Yes, these factors contribute to pain and other problems, but without the “overuse” part, most injuries wouldn’t occur. When it comes to runners, those who skip strength training and run excessively are more prone to any overuse injuries. It can be difficult to keep up with other exercises when your mileage builds up and you have a life outside of running, but this is when it is most important.

Differential Diagnosis

A specific condition that often times gets overlooked when diagnosing shin splints is compartment syndrome. Although distance runners will have the less dangerous type—chronic compartment syndrome, it is important to note the symptoms of the acute version, which can be life threatening. This condition consists of increased pressure in the lower limbs from “trapped” fluid. It mimics shin splints in the sense that there is achiness in the shin bone and surrounding areas during activity. With compartment syndrome, this pain rapidly worsens during activity and almost feels like “congestion” in the lower limbs. If you are experiencing similar symptoms, DO NOT continue running and seek medical care as soon as possible!

Stress fractures are often times caused by prolonged shin splints due to the increased use of already inflamed muscles and weakening of the tibia (shin bone). This weakening is the result of degeneration of the bone from overuse. Proper treatment of shin splints can lead to a fast recovery, but it is not the case with a stress fracture. Training through shin pain to the point that it leads to a stress fracture will only delay your progress and cause you to sit out of running for months.

Treating Shin Splints

The first step to recovery is rest (as it is with almost every injury). Start by taking a few days off and icing the area of pain three times per day if you can. Initially it is best to figure out what caused your shin splits to begin with, which is usually a combination of tight calf muscles, weak lower leg and ankle muscles, and inefficient strength of muscles higher up in the body such as the knees, hips, and core. Once the pain is under control and any swelling has relieved, then a gradual progression of strengthening and flexibility exercises should be incorporated. Below are simple ankle exercises used to strengthen the muscles that run down the entire lower leg, as well as stretching techniques for both groups of calf muscles.

When easing back into running, it is a good idea to rotate between different types of shoes throughout the week. Alternating surfaces is also helpful. Try switching between the road, grass, treadmill, and track to relieve pressure in different areas of the feet and legs. For runners who overpronate, choose shoes that help correct your foot strike, or wean into a pair of orthotics that help align your feet. Of course, if any pain starts to trickle back into the picture, take a few days off, ice, and keep working on the exercises. You should always continue strengthening and stretching a few times per week, even if your treatment is successful, in order to prevent shin splints and many other problems in the future. 

Plantar Fasciitis: The Best Treatment Approach

Does foot pain have you limping every time you get out of bed? Do you find yourself constantly rolling your arch with a water bottle every day with zero relief? If you are dealing with plantar fasciitis, as I have for years, it can be an extremely frustrating condition. Unfortunately this particular foot condition can take a while to get under control, but if you are diligent about management techniques, you can limit the effects plantar fasciitis has on your training program and daily life. What has worked for me may not work for everyone, but there are several tried and true methods that are worth the investment in money and time.

Treat the Cause

To understand how to treat your plantar fasciitis, it is important to know the cause, since treating symptoms will only lead to temporary results. This condition can arise from many different problems, and many are issues that are easily corrected.

Improper shoes: Since foot form and landing style can vary from person to person, the style of shoes you wear for every day use and running will largely impact the wear and tear on your feet. Runners who consistently train in low drop shoes are constantly stretching out the Achilles tendon. This undue strain leads to heel pain since the Achilles attaches to the area where the plantar fascia attaches. Since runners also use the calf muscles with every push-off in the running cycle, the calves tend to get overused and tight. Wearing shoes with a higher heel drop decreases the stress to the Achilles, therefore less strain on the bottom of the foot. All of my running shoes have an 8mm or larger drop, and I always rotate between several different pairs at once to give the different muscles of the foot a break at times.

Muscle Tightness: As explained above, tight calves can lead to heel pain. The lack of flexibility causes tugging on the attachment point at the heel where the plantar fascia attaches. Those who suffer from pain right at the base of the heel versus the arch can have success at relieving their issue by simply adding in more flexibility exercises to their program. Stretching the calves in standing both with the knee straight and bent is necessary in order to stretch all of the muscles that attach to the Achilles tendon. Daily post-run foam rolling is also beneficial for breaking up adhesions in the muscles that are causing the lack of flexibility.

Weakness: There are 26 bones in the foot, which means that many muscle attachments and more. The foot is commonly ignored when strength training, but it is the most important body part for runners since the feet carry our entire body weight through miles and miles. The small intrinsic muscles that control toe strength, stability, and range of motion for the feet and lower legs are constantly contracting and if there is any weakness, you can guarantee that much of the pressure gets applied to the fascia at the insertion points of the balls of the feet and heel, as well as in the center at the arch. Exercises such as the well-known “calf raises” (which is better referred to as ‘heel raises’) strengthen the push-off muscles, but it is important for runners to be incorporating toe raises as well in order to strengthen the shin muscles. To work the tiny muscles of the toes, a great exercise can be done in the sitting position: Place a small towel on the floor under the foot and curl the toes as if trying to pick up the towel. Repeat this motion for 2-3 sets of 10 repetitions a few times per week and you’ve hit the toe flexor muscles and stabilizers of the foot. Stabilizing the foot also involves strength from the inverter and everter muscles, which are basically in charge of controlling lateral movements (think rolling your ankle).

Foot Type:Any foot deformity such as bunions, hammertoe, low arches, or flat feet can greatly impact the pressure through the plantar fascia. Particularly having low arches or flat feet is the most concerning as this causes the fascia to be on a stretch at all times. The best relief for this cause is to make sure to wear the proper running shoes, which help supinate the foot, or lift the inner part of the foot to mimic having an arch. There are many insoles created for this purpose. My favorites are by Profoot, which you can find here. Runners with flat feet should also incorporate more hip external rotation and abduction exercises to help keep the hip, knee, and ankle aligned. Good choices to add into your routine are clamshells, banded lateral leg lifts, and hip hiking off of a step.

Personal Relief Strategies

I have dealt with plantar fasciitis for at least 8 years. I used to try to ignore it as much as possible and I got used to always waking up with heel pain and stiffness and it relieving after a few steps. When it would get bad to the point that it would bother me several times a day I would just stretch my toes sometimes and ice my feet when I wasn’t too lazy. All I was doing was controlling the symptoms at the time. Over the years I have developed a routine of different treatment tactics that have gotten me to the point of being pain-free at least 95% of the time. Here’s what has worked for me:

• Using Normatec Compression boots for 45-60 minutes at least 4 times per week—this has helped with my lower leg circulation and relieves general tightness and soreness.

• Rolling my foot with a spike ball every night for a few minutes—breaks up tightness and adhesions in the fascia.

• Wearing insoles for both running and walking most days—Profoot Plantar Fasciitis have been the best! I also use the toe separators every night for just 5 minutes, which helps stretch all of those intrinsic muscles I was referring to.

• Rotating between 5 pairs of shoes for running—currently I use Nike Pegasus Turbo for long runs, Nike Zoom Fly for speed and track sessions, and Saucony Guide Iso 2, Nike Epic React, and Adidas Ultraboost 19 for easy runs.

• Leg strengthening: from the hips all the way down to those small toe muscles—I work them all twice per week!

This is a combination of strategies that has helped me personally, which all have treated different sources of my pain. These may not work for everyone, but I will emphasize that you MUST first figure out what is causing your plantar fasciitis in order to find the right treatment for you! Get advice from an orthopedic specialist or physical therapist to evaluate your issue. Not taking care of plantar fasciitis can lead to many problems from ankle injuries to hip and low back pain, which will only keep you from running you best.

Achilles Issues & How to Fix Them

Some muscles work harder than others during running. One of these star players is the calves. Well, they pretty much work during every movement we do. Crossing both the ankle joint and knee joint, the calf is involved with any activity that requires us to push off of our toes. Not only that but they are also highly active when trying to control our descent during downhill running or walking. Since they play key roles during every part of running, we should be taking very good care of them every day. Strengthening and stretching the calves on a regular basis is an important part of training.

Having limited strength and flexibility in the calves leads to numerous injuries and pain including shin splints, plantar fasciitis, tendonitis, knee issues, and even hip and back issues over time. One common injury experienced by runners and many other athletes is Achilles’ tendinitis. The Achilles tendon is a thick band that connects the calf muscles to the heel of the foot. It is a prominent tendon in most people. All of the forces generated during running, especially during the push-off phase, are transmitted to the Achilles’ tendon. Faster running usually transmits more forces leading to injuries in the area.

What is Achilles’ Tendinitis?

When there is increased strain to the Achilles’ tendon, inflammation, irritation, and degeneration occur. The overworking of the tendon creates tiny microtears that weaken over time and can eventually lead to larger tears and ruptures. The most notable symptoms of Achilles’ tendinitis is visible swelling in the tendon, tenderness, and pain when first getting in up in the morning and when trying to stand on toes. Once it is warmed up the pain will usually subside and runners are able to run through it. As the condition worsens, the pain will gradually reappear and eventually limit the volume and speed of running. Tendon tears and ruptures will either have a visible bump over the area and commonly a gap where the tendon is ruptured.

Biomechanics

Although high volume training, speed training, and lack of strength are all causes of Achilles’ tendon issues, many physiological and biomechanical factors can increase the strain on the tendon and risk developing these problems.

Foot Strike

You have probably heard about how terrible heel striking is for runners. Well, the truth is that the research is inconclusive and heel striking actually works for some people. The reason this type of foot strike is related to Achilles’ tendon pain is that it involves increased stretching of the tendon. So if you already have tight calves to begin with, then the constant pulling during heel striking can lead to overstretching. The opposite type of foot strike, forefoot striking, actually creates a worse strain on the Achilles’ tendon. With this motion, you are basically landing on the toes and pushing off for the next stride all without giving the calves a break.

Pronation

Foot form is different for everyone. Flat-footed people or those with pronated feet (foot is turned inward when standing) will have a more strained Achilles’ tendon, as well as impeded blood flow to the area. There is already an area with limited blood supply, termed the “watershed area”, where the majority of tendon ruptures occur. This area is located about 4cm above the end point of the tendon on the heel. Limiting blood flow further as in the case of pronation will increase the risk of damage and slow healing on the tendon. Using supinated running shoes or inserts to decrease the amount of pronation is a treatment strategy.

Treatment & Prevention

Runners should focus on incorporating calf strengthening a couple of times every week, especially during their training seasons. Heel raises in all planes—toes pointed straight, toes pointed inward, and toes pointed outward are the main exercise for the calves. Seated heel raises or while in a squat position will help strengthen the soleus muscle, which is a muscle found deep under the gastrocs, the main calf muscles, that also connects to the Achilles’ tendon. Eccentric heel raises are the best way to strengthen the calf muscles as this will prepare the tendon for activities in which it is required to control the descent from extreme positions. To perform eccentric heel raises follow these steps:

1. Stand on a step with both heels hanging off.

2.  Lift both heels together.

3. Once completely on toes, shift all weight to only one leg and slowly lower the heel to just below the edge of the step.

4. Repeat 10-20 times on one leg, then repeat the same with the other leg.

Essentially this exercise will create a type of damage in the tendon, which strips away the previously damaged fibers and encourages the development of new fibers as a form of healing.

Runners should also incorporate stretching after every run and activity that highly involves the Achilles’ tendon such as hiking and climbing stairs. Stretching with both the knee straight and bent is important in order to include both the gastric and soleus muscles. Foam rolling is also helpful to break up any adhesions and extreme tightness in the muscles. Although strength training is time-consuming during training season, it is very important in order to prevent injuries. Achilles’ tendon injuries can be frustrating as they are frequently overlooked since the initial stages involve pain-free running. Taking care of Achilles’ issues from the start will involve a short rehab time while waiting until the pain is unbearable and affecting your running can leave you out of the sport for several months.

Sources:

Răzvan Aniţaş And Dan Lucaciu, A Study Of The Achilles Tendon While Running, Journal, Sep 07, 2018