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ASSESS, THEN ADDRESS: How I went from severe achilles flare up, to pain-free running in <20 days

GABRIEL JONES PERFORMANCE

13 NOV 2023


18 months ago I had developed some achilles discomfort as I begun training for the Royal Parks half-marathon in 2022 - an opportunity for a beautiful run around central London with my best mate and one I really didn’t want to miss. It was the kind of injury you’d be tempted to use as an excuse to stop your training and give up your place in the race. But you know that ain’t me. My challenge at that time was not only to continue with the necessary running training, but also to manage my impact load on the tendon, and aggressively rehabilitate it so that I could come out of the half-marathon stronger for all my training, rather than broken man with a ruptured achilles. I didn’t want to just suffer through the training.


Achilles pain and inflammation is also a ridiculously common problem I encounter with clients on a regular basis. At best, it’s just this annoying thing which is going to keep you from running, jumping, and almost any other explosive or dynamic exercise. At worst, it is a crippling and unrelenting pain which persists from the moment you set foot out of bed, until the minute you go back to bed the next day - never mind the long list of activities it prevents you from doing.

So following a successful half-marathon, I had no further complaints with the injury and I was able to essentially put it behind me, until in early October this year (almost exactly 1 year later), I felt that familiar feeling - like somebody taking a hot poker and sticking it into your ankle, turning any attempt to run into a ridiculous hobble. The 5-a-side game I tried to play through that night led to the alarm bells ringing in my head and body. Whispering to me that one of the injuries I have always feared the most (one of those full achilles ruptures where your calf shoots up into your knee) could be 1 miscalculated action away if I was not careful.

So that was it - it was time to go into beast repair mode, and I knew with the right approach and the strategies I had used in 2022, I could be back on the pitch and feeling normal again sooner rather than later.

So here’s what I did to shake it off in less than 3 weeks…


ASSESS:

The first thing to establish is what is causing the inflammation? You don’t get achilles pain because ‘you’re doing it wrong’ with your achilles tendon. The same way you don’t get knee pain because your knee isn’t ‘activating properly’, or back pain because of the back. The culprit can always be found in the behaviour of the muscles near and far from that joint.

What I immediately identified was that my right calf was insanely tight. I performed a gastrocnemius stretch on my left side with no problems, but on my right side, quickly found that I could not straighten my knee and continue to keep my heel pressed into the floor for this stretch. I know from a historical knee injury my right quadricep is problematic and doesn’t fire particularly well, so I know that my hamstring and calf are particularly overactive on that side anyway. So problem #1 became apparent - Lack of right calf flexibility and mobility.

The next thing I assessed was the strength around my ankle joint. This is easy to do on any step you can find nearby. I carried out a single leg calf raise test on my left leg, staying locked at the knee and seeing how many SL calf raises I could carry out (14), then compared this to my right (8) - a huge strength deficiency revealing problem #2 - Lack of right calf muscular endurance.

The next day, I focused on the qualities of the connective tissue - the tendon itself. A thick and stiff tendon can be a very useful thing for an athlete, not least because a thicker tendon can tolerate more force, create a quicker stretch-shortening cycle and is harder to snap. A way that we can develop tendon thickness and stiffness is through eccentric strength training, and we can use a single leg eccentric test to get an idea about the qualities of the tendon on each side.

Using the same step scenario as the calf raise before, I took my heel below step level into a stretch, and held this for 3 seconds. Then slowly, I raised my heel as high as possible, going up onto tip toes, raising for the duration of 3 seconds. Once at the top, I held this position for 3 seconds, concentrically contracting and trying to sustain it. Then finally, I lowered myself slowly for 3 seconds back to the beginning stretched position.

This is a lot harder than it sounds! 12 seconds per repetition, trying to carry out as many reps as possible (it may well reveal something psychological as well as physical to you). My left side managed 11 reps, my right side - only 6. And there we found problem #3 - a total lack of eccentric strength.


ADDRESS:

Now that I had identified my 3 key problems which (I’m guessing) had been causing my achilles pain, I could now get to work on rectifying these issues.

Problem #1 -Flexibility & Mobility

How do we rectify problem 1, which is a lack of flexibility in the calf/mobility at the ankle joint? Well, my flexibility was simply fixed with a lot of foam rolling and a lot of stretching. Not to a ridiculous degree, but just consistently, and every day if possible. I specifically aimed to foam roll (or use my massage gun) twice per day, for 1-2 minutes per calf, once in the early part of the day, and once in the later part of the day. So that’s foam rolling roughly 5 mins per day. For stretches I carried out the gastrocnemius stretch for 2 x 30 sec each leg, aiming for twice per day, so this is 4 mins of stretching per day. For mobility I did this ankle mobility drill 👇🏽 twice per day, which takes 30 seconds.

I can only speak for myself, but it felt so reassuring to know that for just 10 minutes of my time per day, I could be 1/3 of the way to eradicating a crippling problem that usually keeps people out of action for MONTHS at a time.

Problem #2 - Strength and Endurance

To rectify problem 2, which was a lack of a combination of strength, hypertrophy and muscular endurance of the right calf (gastroc and soleus), I committed to addressing this twice weekly with single leg calf raises - once with sets of heavy weight and low reps (5-8), and once with lighter weight and higher reps (12+). I tried to target one of these near the start of the week and one near the end (eg. Tues & Fri), giving the muscle a bit of recovery time and encouraging the strength and endurance adaptations to set in.

Problem #3 - Eccentric Strength / Tendon Qualities

To complete the jigsaw, I sought out improved eccentric strength, to hopefully improve the quality and function of my right Achilles tendon, and allow it to tolerate the forces I was putting it through with my weekly training load. Twice per week I would carry out the eccentric hold routine (3 stretch, 3 up, 3 hold, 3 down) on any step I could find, and do 2 sets of as many reps as possible, aiming to get my right leg to an equal degree of strength as my left.

What I found is that once I had been consistent with this process for a couple of weeks, certain symptoms of the injury began to go away. I was no longer hobbling after getting out of bed, not noticing the pain during my journey to work or day-to-day activities. It would only remind me it wasn’t entirely gone if I began an activity like running or jumping, which served to let me know I needed to continue what I am doing to ensure it is completely gone.

Gradually I was able to reintroduce running (everything must be pain free) in small doses. I used hops and jumps in my warm ups, and progressed these plyometrics slowly, before returning to a short 5-a-side football match to reintroduce myself to my sport, then 45 minutes of a full 11-a-side match, coming though it unscathed.

Although I now feel happy and ready to properly return to play, one thing I can’t afford to do is forget about all of the things I did to get my ankles functioning in a healthy way again - I continue with all of these activities, not as aggressively, but as a form of maintenance in my warm ups and activities at home.

So if you’ve got yourself some Achilles problems, give these steps a try, and if you’re still not having any joy? Get in touch and tell me about your problem!

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