Physical
Training Jan 2005
Water Works: Running Injuries III
Copyright Michael Moon © 2005 all rights reserved
Sport Medicine and Injury Rehabilitation: Running Injuries
Two issues ago we introduced this series of articles with an overview
of the stresses that result from running on land and the injuries that
very often result. Last issue we looked at stress reactions
and/or fractures. This article will focus on an injury common to
many athletes, Achilles Tendinitis.
Achilles Tendinitis
Achilles tendinitis is “characterized by pain and
stiffness, with tenderness, swelling, and nodularity in the substance
of the Achilles tendon or at the site of its insertion into the
calcaneus”(1). This injury often presents in runners in a
progressive and ordered fashion over an extended period of time.
There are in fact three distinct stages that differentiate the extent
of the injury. It is possible though for a runner to develop a
more advanced stage of the injury in a short period of time from one or
more excessively intense training sessions. The first stage is
characterized by an inflammation of the peritendinous tissue
surrounding the tendon. This progresses to tendinosis where the
tendon itself begins to show degenerative changes. Finally if the
excessive stress continues, macroscopic tears and partial disruption
will result (2). There are many factors that can play a role in
the development of Achilles tendinitis but the main initiation of the
problem is again a result of over-stress through increasing the
intensity or quantity of training too rapidly. Consideration must
also be given to biomechanics, which could partly be due to muscular
imbalances/weaknesses in and around the lower leg as well as structural
deficiencies. A tightness or lack of flexibility in the calf
muscles could precipitate this injury as well.
Prevention
A gradual appropriately structured increase in
training loads will usually prevent this problem occurring. This
assumption does however presuppose that any bio-mechanic, muscular
weakness and range of motion issues have been addressed.
Biomechanical issues in this case usually come down to a problem with
over pronation. “If the foot remains pronated excessively as
normal knee extension occurs, the Achilles experiences unusually high
forces”(2). These bio-mechanic problems may be alleviated with a
proper motion control shoe or in severe cases with the insertion of an
in shoe orthotic.
Strengthening and stretching of the musculature of
the lower leg, which goes into and around the Achilles tendon, should
be a part of any well-planned running program. These exercises
will act to support the Achilles in its role and prevent the possible
onset of tendinitis
Treatment and Rehabilitation
If Achilles tendinitis is caught in its earliest
stage than a simple reduction in the training load in conjunction with
standard inflammation treatment may be all that is required. As
this injury advances more extensive steps must be taken. A
complete period of non-running is often required to allow healing of
the damaged tendon to take place. In one study 56% of track and
field athletes with Achilles tendinitis had to take at least four weeks
off to promote healing (1).
After the initial acute stage of treatment the
athlete should begin working on strengthening and range of motion
exercises. It is especially important to strengthen the Achilles
eccentrically, as this is the manner in which it functions on impact
while running. This eccentric strengthening can be done by
performing calf raises and then drops on the edge of a stair, again,
focusing on the drop aspect of the exercise. This exercise should
be introduced slowly and only after healing is well underway and the
athlete is pain free. Another modality that may be introduced in
the latter stages of rehabilitation would be cross-friction
massage. This treatment will help to break up any adhesions that
may have formed and help to insure a complete pain free range of
motion.
Maintaining Fitness
In the most severe cases complete rest may be needed
for a short period. In the majority of situations however the
runner can begin cross-training activities almost immediately.
The activity of first choice should be deep water running. This
activity would present the least amount of stress on the Achilles while
allowing the athlete to maintain their cardio-vascular
conditioning. Deep water running will also provide the greatest
crossover effect for running athletes. A complete description of
deep water running procedures will be the focus of the last article in
this series. The reader can also visit the website
deepwaterexercise.com for further information.
Next Issue: Illiotibial Band Friction Syndrome
References:
8. Shrier I., Matheson G.O., Kohl H.W. Achilles Tendinitis: Are
Corticosteriod Injections Useful or Harmful? Clinical Journal of
Sport Medicine 1996:6:245-250.
2. Fredericson M. Common Injuries in Runners. Sports Medicine
1996:Jan.;21(1):49-72.
Mike Moon has a M.Ed in
Coaching (UVIC) B.PHED, BA,
B.ED (UBC) and
has been Assistant Coach of UBC Track and Cross Country for 15 years.
He
is also Head Coach, St. Georges Junior School Track and Field Program.
He has developed the Deep Water Exercise
program
which is used by elite level and professional athletes for
rehabilitation
and training. Mike continues to compete at the Masters level (in
distances
from 5000m to the marathon).
His website is: http://www.deepwaterexercise.com/
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