In early season training we incorporate anatomical adaptation and Prep periods to prepare the body's muscles and connective tissues for the long miles we will do in the Base Periods. We are also preparing for the intensity of LTHR testing and Build Periods. One of our main objectives is to strengthen muscle and connective tissue so that we avoid injury. A tendon is a fibrous cord of connective tissue continuous with the fibers of a muscle and attaching the muscle to bone or cartilage. Muscle strengthens three times faster than tendon. In other words, muscles prepare faster for hard work than tendon. Because of this fact, tendonitis is common in those of us who initially do too much volume or too much intensity too fast. Tendonitis is the inflammation of a tendon. A rupture is the complete tearing of a tendon. Partial tears may also occur.
Achilles tendonitis is common among runners and cyclists and may even show up when swimming as we push off walls. Sometimes irritation begins in the weight room with increased loads. Achilles tendonitis and partial tears can be confused. Ignoring a partial tear could lead to a rupture. A rupture may be career threatening and at the very least is a one to two year rehabilitation.
I would approach an Achilles tendon injury with three things in mind: understanding the anatomy, determining how the injury occurred, and deciding a course of recovery. Failing to do any of the three may invite the problem to become more acute or chronic.
The Achilles is the common tendon of the triceps surae. The triceps surae (triceps meaning three heads) is the name applied collectively to the gastrocnemius and soleus muscles. The gastrocnemius starts at the distal (far) portion of the femur, or above the knee, and the soleus originates at the top of the tibia. The gastrocnemius is the outer calf muscle and the soleus is a bit deeper and more medial. They eventually join to form the powerful Achilles tendon. This tendon is under extreme loads and warrants attention when painful. There is also a bursa (a fluid filled sac that prevents friction on bone) that can become inflamed under the tendon.
Symptoms: Lower calf pain or back of the heel discomfort. Pain is worsened by running or other use of the lower leg, especially on hills where loads are increased. This injury is more prevalent in women who wear high heels as this seems to shorten the tendon. Flat shoes may then stretch the tendon to a point of injury.
Irritation of the tendon can stem from many different directions. Some of these are poor or ill fitting equipment, problems with technique, too much volume, duration or intensity too quickly, poor recovery practices, a brittle tendon belonging to a past couch potato, bad luck, leg length problems and more. Most often it results from over use or sudden load increases.
Treatment for a rupture is normally surgical intervention. Treatment for strain or partial tear is more conservative. Both of the latter can be very painful and may disappear once you are warmed and moving. This phenomenon causes many to keep training long after rest and treatment should have started. Dont be fooled. The absence of pain when training followed by limping the next morning can be a sign of serious irritation or tear.
For mild to moderate strain, immediate rest from stressful training should be your first option. However, rehabilitation can start immediately. Use the following link to find some excellent eccentric exercises that my athletes and I have had great success with: http://www.nismat.org/ptcor/eccentric_achilles/ *
Some or all of the following may be helpful: ice, heat, ultrasound, micro current, massage, meds, a small heel lift and/or other forms of health care if appropriate. A doctor or health care provider with experience in diagnosing sports injuries should differentially diagnose the severity of the strain or tear. A walking boot may be necessary for 10-14 days to rest the tendon. In some cases only a boot used while sleeping is called for. This keeps the foot and toes from pointing downward through the night. The downward position of the foot shortens the fibers of the tendon as they heal. The moment you bear weight the next morning any healing that took place in the shortened position may be torn lose as the tendon stretches and carries a load.
By feeling the large cord like tendon you may be able to locate a partial tear. It may show up as a bump or knot about the size of an apricot seed. This is a clear sign for greater concern and rest.
As an athlete begins to return to training they should avoid hills, intensity and any hard surfaces or sudden increases in loads on the tendon. Be wary of low back discomfort as a result of a heel lift if one is worn. Four to five millimeters in lift is enough to begin with. Keep the muscles of the calf stretched and relaxed as muscular tightness increases the chance of injury. An Achilles tendonitis should be rested from the start. Any lost time training is better than what may lie ahead if this problem is ignored.
* © 1996-2002 The Nicholas Institute of Sports Medicine and Athletic Trauma. All rights reserved.
Kevin Purcell, D.C., is a USAT Level 1 certified coach for Elite and Age Group triathletes who compete at both Ironman and short course distances. Coach KP has completed 10 Ironmans and qualified for the 2003 Hawaii Ironman Triathlon World Championships. Dr. Purcell practices Chiropractic with an emphasis on sports medicine in San Diego, California and can be reached at firstname.lastname@example.org.