Achilles trouble with less than a week to go before the London Marathon?

I have a question from one of my Twitter followers; what to do when you have Achilles Tendon issues with such a short time before the London Marathon? Not much fun. So here goes.

Achilles tendon problems account for around 11% of the injuries experienced by runners. The Achilles tendon attaches the two calf muscles Gastrocnemius and Soleus, the most powerful muscle group in the body, to the heel. It carries the force generated by these muscles to propel the body upwards and forwards and also functions as a shock-absorber. During the course of a run it works very, very hard! The most common Achilles problem is a Tendinopathy (or Tendinosis) characterised by degeneration or ‘wear and tear’ of the tendon. This is, contrary to popular belief, a non-inflammatory problem.

At this late stage, ice (still currently advised despite the non-inflammatory nature- more about this another day!) and rest can help. Ice for about 20 mins at a time and up to once an hour.

You want to try and stretch the calf muscles but need to take care not to overstretch the tendon itself. Putting a small heel raise under the heel of the foot/leg that you are stretching will help to off-load the tendon whilst still allowing you to stretch the calf. Use straight leg stretches- anything with a bent knee will target the Achilles more specifically, which for the moment you want to avoid. Hold for 20 seconds at a time and repeat several times a day. Stretch the Hamstrings too.

Book yourself a Sports massage focusing on your Calves and Hamstrings. Tight Hamstrings massively influence the tension forces within the calf and Achilles complex. A daily treatment up until Marathon day would be optimal but otherwise have one as soon as you can, and then a day or two before (providing you do not suffer with treatment soreness from the first one). You can even get a massage at the Virgin London Marathon Expo!

If you’ve not already implemented the use of a heel raise in your trainers, carry a pair and pop them in if you are struggling during the race. These will off-load the tendon a little if it is getting sore. Put them in both shoes (to keep you level) and only do this if you need to- it’s best not to introduce anything different on race day unless you have to.  You can get these from online sports medicals suppliers.

As discussed previously, Warm-up with a dynamic-warm up pre-race. Keep warm on the start-line.

Finally- your trainers should be new-ish, you should have done a couple of long runs in them but not beaten them into the ground! It’s not the best advice to get new trainers for the race, but if yours have done over 300 miles and you can get the exact same pair to replace them then it is worth considering.  Be aware that from season to season changes are often made to a model of the trainer so just because it has the same name doesn’t mean it is the same. Check very carefully before you buy. In general, people that suffer from Achilles problems are better to choose shoes without air filled heels since these increase the stretch on the tendon when the heel contacts with the ground. This is especially true if you have a heel-strike running style.

Post marathon you need to rest from your running. Wear your heel raises to off-load the tendon and optimise the rest period. Consider implementing eccentric stretching (sometimes called eccentric strengthening, more about this in future posts), plus a strength and conditioning programme. You can resume light running  (avoid speed work and hills) whilst you work on these, providing your problem is not worsening. This condition can become really troublesome if you don’t give it adequate rest and treatment.

I would say this but… it would also be wise to get an assessment from a Sports Physiotherapist in order to identify personal risk factors including faulty biomechanics and inadequate recovery from old foot and ankle injuries. The findings are then used to implement training techniques to reduce abnormal and excessive load on the tendon and mobilise stiff elements in the foot, ankle and pelvis to regain freedom within the joint system. The advantage of such a programme is that the runner’s performance will also improve, since a flexible yet stable system, as well as being less prone to injury is also more efficient.

There is currently lots of interesting research regarding tendon pathology and optimal treatment approaches. The advice here is mainly based on a last minute ‘get me through the race’ approach. Hope it helps- keep me posted!