Keep it moving

COVID-19 and lockdown has forced a huge number of businesses to shut up shop, and with the reliance now on employees to work a normal 9-5 whilst sitting crumpled up at their dining room tables it is hardly surprising that people are starting to get sore necks and backs.

Add into the mix those slumped on the sofa self-isolating or living the furlough life churning out episode after episode on Netflix and the result is a lot of painful necks, stiff backs, tight chests and crackly coughs – for those recovering from illness.

One way Witty, Pask & Buckingham have adapted is by offering video consultations for those who are in need of expert advice. One particular service is a Zoom consultation around your posture and working from home set-up.

Leaving athletes more vulnerable

Simply put, the body does not like static postures, especially sitting. Movement is the key to keeping joints, especially those in the back, well oiled.

Prolonged postures will lead to one of two things; stiffness or weakness, or both, which will subsequently cause you pain, dysfunction and leave you vulnerable to strains and sprains.

Not only this, but in the case of the upper back, chest, and ribs it will make keeping your lungs and airways clear much, much harder…..which might be why you are still feeling a bit out of breath.

Here are out top tips to avoiding the lockdown aches and pains.

The Sofa Slumper

• Every 20-30 minutes get up, go to the loo, drink some water, walk up and down the stairs a few times. 
• Reach your arms above your head and lean back over your chair (avoiding falling off ideally) and reverse the position you have been in.
• Front of the hip – it is essential to stretch this out. Tightness here leads to you tipping your pelvis forward and your lower back becoming stiff, 
  • Stand up. Take a step forwards so you are in a stride position.
    Tighten in the tummy muscles and lean into the front leg to feel the stretch through the front of the hip (back leg). If balance allows you reach up above your head.
    Hold for 30 seconds, swap legs.
    Perform 3x

Working From Home 

Setup is key. Good posture is not about forcing yourself to sit bolt upright and hold yourself tense.

• Make sure you are close to the keyboard, so that you are not overreaching
• Get a chair which can go under the table/desk, so your tummy is touching the desk. This allows you to sit back against the back of the chair and relax.
• If using a laptop bring it near you so that you don’t have to lean or reach for the keys and use books to raise the level of the screen to eye level.
• Similarly, if using a desktop PC ensure the keyboard is close to you and monitor at eye level so you are not forced to slump forward to look at the screen.

Why is this important?

Upper back and rib cage pain is tough and slumping for hours while holding yourself up with those muscles is painful. It can also lead to the classic ‘chin poke’ posture which compresses your neck and will give you neck and shoulder pain, as well as headaches.

We all just have to ensure we are all doing the small things right to prevent the NHS becoming overwhelmed with really sick people.

Just do as you are asked. Follow the guidelines, stay safe, look after the vulnerable, and don’t think it doesn’t apply to you….it does. Don’t be that idiot.

Together we will beat this.

Matt Bergin and Mark Buckingham are both chartered physiotherapists at Witty, Pask and Buckingham. For more information on both, or the clinic as a whole, click here. They are still able to offer video consultations within the current situation. 

The post Are you sitting properly? appeared first on Fast Running.

Whilst this isn’t specific for running I’ve had a few runners recovering from COVID-19 that have actually found it helpful. As well as this athletes slumped around the house all day in general might benefit from thinking about their breathing too.

If you are recovering from illness or struggling with breathlessness, or even fear, anxiety or panic, learning some simple breathing techniques can really help.

It is essential to keep good lung function and breathing patterns to ventilate all the lung to reduce infection by mobilising and clearing the whole of the lung of fluids.

Your lungs sit within the protective cage of your ribs, with the diaphragm – the dome-shaped muscle, at the bottom. It is the diaphragm that plays a major role in breathing. 

Breathe it all in

As you take a breath in the diaphragm contracts and flattens, increasing the space in the chest, allowing air to rush into your lungs. The opposite then happens when you breathe out. 

Good diaphragm strength improves cough effectiveness and makes it harder for bugs to take hold – which is the difficulty people have with this virus.

When we get breathless or spend hours slumped on the sofa or over your laptop, we do not effectively use the diaphragm and we revert to breathing only with the top of the lungs, and the lower parts become stagnant. This then in turns reduces the oxygen uptake in the blood and leads to more feelings of breathlessness…..a vicious cycle.

You can get control of this as well as exercise the lungs and clear the tubes more effectively by working on your breathing pattern.

Posture can be key

To start with think about sitting back in a chair and taking pressure off your tummy. This allows space for the diaphragm to move. If you can’t sit back, then lean forwards with your elbows on your knees to let your tummy space to expand.

Breathing Exercises

The active cycle of breathing techniques (ACBT) is an effective way to help clear sputum from your chest. ACBT is simply a set of exercises that helps loosen and remove secretions from deep in your lungs and airways. 

Breathing Control

Breathing control is slow, controlled breathing, using as little effort as possible.

• Check your posture (as above).
  Relax your shoulders and think about breathing in with your tummy. 
  • Place one hand on your tummy and one on the chest, feel the movement.
• Take a slow breath in through your nose, using your tummy
• As you breathe out purse your lips – this helps to open up the airways
• Gradually make the breaths slower and deeper

Deep Breathing 

Deep breathing allows the lungs to fully expand, especially the lower parts.

• Take a long deep breath in through the nose, using your tummy to fully expand your lungs. 
  • At the end of the breath in you might feel the ribs lifting, this is good. It should NOT be the first movement though.
  • What you DON’T want is your shoulders lifting up. Doing this leads to issues elsewhere – neck/shoulder tightness predominantly.
  • It can also be helpful to hold your breath for a couple of seconds at the end of the breath in, to really allow the air to get to the depths of your lungs. 
• Breathe out gently and relaxed, as if you’re sighing. 
• Repeat 3-5x

Huffing or Coughing 

Huffing is brilliant at shifting reluctant materials from the depths of the lungs to the central tubes ready to be coughed out. Better than coughing and nicer on the throat. If when performing you hear a rattling sound, you are doing it right. 

• Perform the huff on the breath out. You should have an open mouth, and imagine you are trying to steam up a mirror, rather than coughing. Use your tummy muscles to help you squeeze the air out.
  • This can either be a gentle, long huff or shorter, sharper huff.
• Repeat 3x
• Each cycle of huffing should be followed by breathing control.

If you have found this sequence of exercises has not completely cleared the chest it may then be worth performing a couple of coughs.

• At the end of the huffing, perform 1-2 short coughs, with chin to chest.
• The temptation is often to continuously and aggressively cough in the attempt to remove fluid, avoid this. It will cause irritation in the throat and will make you more breathless.

Working on these exercises several times a day will help enormously to ventilate the lungs and prepare you to better fight the worst effects of this virus.

Matt Bergin and Mark Buckingham are both chartered physiotherapists at Witty, Pask and Buckingham. For more information on both, or the clinic as a whole, click here. They are still able to offer video consultations within the current situation. 

The post Time to breathe appeared first on Fast Running.

A week rarely goes by where I don’t get someone telling me they have shin splints. It is one of the most common injury related phrases heard in the running world, so you would think it is fairly well understood, but often this isn’t the case.

This isn’t just something I see in those new to running either. I see it across the board. From people just starting out at parkrun all the way through to the elites. So what actually is shin splints?

The term ‘shin splints’ isn’t so much a diagnosis, rather a part of one of four conditions affecting the medial shin area, most commonly. Shin pain can be broken down into four general categories; muscular, bony, neural and vascular.

Often muscular shin pain can be caused by strain or excessive tightness to a number of muscles occupying the medial shin area. Their attachment to the bone via a structure called the periosteum can become irritated and inflamed (periostitis). If these structures continue to be overworked and overloaded bony stress injuries can occur (reaction/fracture).

There are also several other conditions which can manifest themselves as lower leg/shin pain. None of which should be overlooked. These include types of compartment syndrome and nerve related issues such as nerve entrapments in the lower leg, or referred neural issues from the lower back. To make our lives more difficult you can have combinations of these.

Muscular

First we will focus on the most common, the muscular type injury.

Differentiating between these conditions can often be difficult, no less because they often co-exist. However, there are subtle distinctions in the presentation and behaviour of each. This helps to guide the treatment and rehab.

The most common type of shin pain I see is caused by excessive tightness or strain to the muscles occupying the medial shin area. Namely the tibialis posterior and soles muscles. As well as occasionally several other muscles in the area responsible for flexing of the toes. You can also develop inflammation to these muscles points of attachment to the bone via a structure called the periosteum (periostitis).

Tibialis posterior/soleus pain is felt as a dull pain or real tightness typically along the distal 1/3 of the inner shin, into the soft tissues behind the bone. A soft tissue problem generally won’t be painful at rest. But will be most sore at the beginning of a run and will often get easier as you get moving. 

Bony

You then have the bony type injuries, the two words that put fear into ever runners minds… stress fracture (or reaction).

To briefly explain the process, our bones are constantly being remodelled to adapt to the stresses and loads placed upon them. If the level of stress being placed through them is greater than the rate at which the structures adapt, an area of bone weakness will develop.

When the excessive stress continues the bone may fracture microscopically – this is when you experience pain. Ignore the pain and continue to stress the area then it can develop into a larger crack. Eventually, a stress fracture will happen.

Similar to the muscular type pain the most common location for stress reaction/fracture is the lower part of the inner shin. There will be a specific point of tenderness on the bone and in contrast to the muscular type injury this will be felt over a much smaller area – maybe 1-2cm. Another give away is the behaviour of the pain.

With a stress reaction, the issue will worsen as you run and will feel worse after, and you may even experience a deep ache, or throbbing type pain at rest or at night in the more developed (stress fracture) types.

‘Medial Tibial Stress Syndrome’

Where things can get confusing is the involvement of the periosteum (periostitis) – which is often understood to be part of a process called ‘Medial Tibial Stress Syndrome’ (MTSS) the term now more commonly used in place of ‘shin splints’.

Due to the rich nerve supply of the periosteum the bone will be exquisitely tender to touch, however, this will generally be felt over a larger area. There will not be the one to two centimetre focal point of tenderness as in a stress fracture. Some view this as a part of the stress reaction/fracture pathway, while others view it separately.

The Causes of shin pain

Shin pain of bone, muscle or inflammation of the periosteum often have similar causes. As a physiotherapist the aim is to figure out what factor(s) have contributed to an excessive amount of stress being placed through the medial shin.

The simple things should not be overlooked. “Too much too soon” or footwear that should have been changed months ago. But also things like changes in running surface, e.g. more running on concrete, running on a camber, more track running. All such things will impact the way we run and the stresses and strains placed through the body, especially the medial shin.

There are however some common biomechanical issues that can cause medial shin pain. The most common is over-pronation, the rolling in of the foot. This pattern of over-pronation can happen higher up the chain as well, with excessive internal rotation of the leg as whole.

This lack of control on impact places a torsional (twisting) stress through the inner part of the shin as the foot collapses and the knee drifts inwards. It’s overloading the inner shin muscles – namely the tibialis posterior – which coincidently controls pronation. Weakness in this muscle, along with the lateral glutes (you’ll hear this a lot) will often leave you with this pattern of movement.

Self testing

There are a few simple tests you can do yourself, which may be revealing….

Standing in front a mirror or recording on your phone, perform a few single leg knee bends. Watch what happens to the foot and knee. Then do the same but hopping this time, what happens.

What you are looking for is the foot to maintain a strong arch, the knee to travel over the middle of the foot and also for the pelvis to remain level.

It is then worth looking at the strength of these specific muscles…

Tibialis posterior

With the outward force being applied by the tester, the foot should hold strong. If the tester is able to easily move the foot it simply isn’t strong enough. When we run we put somewhere around there to four times our body weight through the legs. If you cannot resist a friend pushing your ankle out, imagine what is happening when you run?

 Glute strength 

The more lateral gluteal muscles are of particular importance. They are holding the knee over the middle of the foot on impact. Side-lying, lifting the test leg up and backwards (behind the line of the body), you should hold strong to a downward applied force. There must be no rocking back of the pelvis/trunk or bringing forwards of the leg – these are all cheating mechanisms to overcome the weak lateral gluteal muscles.

As well as having the strength in these muscles we also need to have adequate flexibility, particularly through the calf, foot and ankle to allow for load absorption on impact.

If there is a restriction in ankle range, either due to calf tightness or ankle stiffness the foot will often over-pronate, or externally rotation (turn outwards) to overcome the lack of range. This will cause a much greater torsional stress through the medial shin.

If you have been working on these areas and you still feel you aren’t getting anywhere it is worth looking at several other areas. I would recommend routine assessment by any qualified physiotherapist you may visit. Restrictions through the hip, issues in the sacroiliac joint (SIJ) and lower back can all also be contributing factors.

Treatment

The often co-existing and overlapping nature of medial shin pain is what makes it so difficult to treat. It’s why people so often find themselves suffering with it time and time again. Even when doing what they think (or have been told by Dr Google) are the right things.

If there is any concern that you may have sustained more of a bony type injury my advice would be to get it properly checked out. Despite the fact I have just written heavily about the issue,  do not solely rely on the internet for help.

Once the underlying cause of your shin pain has been determined, the rehabilitation can take a number of routes.

Bony

If the issue is bony in nature (i.e. stress reaction or fracture) you will require rest, somewhere between four-eight weeks depending on the severity of the injury. More detail of stress fracture management and rehabilitation will be discussed in later pieces.

Muscular

If the issue is muscular in nature, or irritation to the periosteum, you still need to be sensible. Symptoms are often ignored in the early stages. It might just be that the pain is felt as an occasional tightness and soon disappears once you get running. But the sooner you take action the better.

If these early signs are ignored and the feeling of tightness becomes more consistent you will likely require some rest. This is simply overloading the tissues and a more serious injury will develop if ignored.

In order to address the issue, treatment will be focussed on correcting all the weaknesses, areas of tightness, and biomechanical faults that have been identified.

Tibialis posterior strength

The tibialis posterior muscle is largely responsible for controlling pronation of the foot on impact, so it is essential this muscle is strong.

I would aim for three sets of around 15 repetitions. Alternatively, you can perform the same exercise in the gym using a pulley machine. 

Lateral glute strength

When running the lateral glute muscles are responsible for controlling the internal rotation of the hip on impact. Weakness here will often leave you with the movement pattern shown above.

There are many many ways of building strength through these muscles, but the more functional you can make it to running, the better.

Standing on the affected leg, with the opposite leg against the wall. Keeping the foot pointing forwards, slightly bend the standing knee and turn it out over the foot so that you can see several toes inside the knee, as you look down.

Push the leg into the wall and hold strong through the standing leg. Initially, I would aim to hold for at least 30 seconds, but quickly working up to two-three minutes.

Progressing on

Once the initial strength through these muscles has been well developed you should then look at building to more running specific exercises. These can include single leg control drills such as hops, bounds, lunges etc. It is this initial strength, coupled with the running specific drills that, over time, will transfer into your running. This then reduces the chances of developing such injuries.

It is also worth assessing the range through the calf muscle as tightness here will force the ankle into a more overpronated position on impact, as the knee moves over the foot, again stressing the medial shin area.

In terms of self treatments, it is worthwhile getting fingers and thumbs through the inner, muscular part of the shin. Just a few minutes, every day or so, to free off any of the tightness can help.

The strengthening exercises will take a few weeks to show initial improvement. Thus some deep tissue work is a good place to start in the meantime.

RELATED: The causes of Achilles pain by Matt Bergin

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk.

Are you a fan of Fast Running? Then please support us and become a patron. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Runner’s shin pain: What, why and how to treat appeared first on Fast Running.

After the first article addressed identifying and treating an Achilles injury, this time we look at the causes of this type of injury.

There are a number of common causes that can predispose one to developing an Achilles injury, and it often requires looking deeper than just the normal ‘too much too soon’.

Biomechanical faults, lower limb weakness, poor muscle flexibility or joint range, limb control, as well as training and footwear errors can all impact the way you run. Change the loads being placed through the Achilles and over time you have the potential to cause tissue damage.

If you are experiencing Achilles pain then start by looking at the possible causes below.

The most common causes

1) Strength

For any runner you should be able to achieve around 3 sets of 25 single leg heel raises, with weight (up to 20kg). If you are only able to complete 10 before you feel fatigue more strain may be placed upon the Achilles tendon than it can manage. Specific to the Achilles tendon, eccentric heel raises should be completed.

Eccentric Heel Raises are shown in my first article.

For a mid-tendon Achilles issue that is a few weeks old, begin the eccentric heel raises. Rise up on two feet, and lower down on one. Initially perform 3 sets of 15 reps, 2 times daily and then working up to 3 sets of 25 reps as able, plus working up to some resistance (up to 20kg).

For the more acute issues, rest, ice, load management, plus some isometric strengthening are your best options until things settle.

It is also worthwhile looking at the strength of several other areas, which have a stabilising and movement control role during running:

2) Foot invertor strength – tibialis posterior

3) Gluteal strength – especially gluteus medius

4) Movement control – assesses both pelvic control (especially glute) and ankle control also

5) Flexibility

This can either be from stiffness in the ankle joint itself, or from tightness in the calf muscle. You can test the calf length yourself. With the help from a friend, keeping the knee straight the ankle should be able to passively bend up 20 degrees past 90.

6) Excessive pronation

Does your foot collapse in as you run?

This could be a result of weakness in the tibialis posterior muscle, which should be strengthened (as per picture of ankle inversion strength above)

7) Training errors

Injury to the Achilles tendon can often occur as a result of a rapid increase in training volume. You should aim to increase training volume by 10-15% over time.

You may also have just incorporated a lot of hill training into your schedule, or have started running on a surface harder that you are used to, for example concrete. Even a track that is harder than you are used to could have an impact.

8) Footwear

Do I need new or more supportive running shoes? What about orthotics due to a long history of flat feet?

These are all questions you will have on your mind and, as runners; our footwear is our most vital piece of equipment. I advise footwear to be changed every 500 miles and plenty of training apps allow you to count the miles in each pair of shoes.

We must also consider the terrain we run on. Minimalist or barefoot running is becoming increasingly popular, and we are seeing more and more foot issues as a result. Wearing these shoes is not always a bad thing, but it must be done with caution and introduced over time. It’s no good suddenly doing all your runs in minimalist shoes on concrete, you will get hurt.

Remember everyone is different

Everything discussed in these Achilles articles is a guide. Everyone’s Achilles issue is different and everyone will respond differently to the exercises and progress at different rates. So it is vital that you listen to your body. If things settle sooner, then you can accelerate things, and progress the rehab accordingly, and similarly if you feel soreness don’t be afraid to take a day or too longer.

If you wish to have more individual guidance then please consult a chartered Physiotherapist with specialist knowledge of Achilles issues. Here, the lower back and pelvis can also carefully be assessed, as many imbalances stem from issues in the spine and pelvic girdle

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk

In his next article, Bergin will take a closer look at the causes of an Achilles injury.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post The causes of Achilles pain appeared first on Fast Running.

If you’re reading this, there’s a good chance you’ve had a run-in with the dreaded Achilles tendon pain, and you’re wondering ‘is it finally time to have a few days rest’.

You wake up every morning tentative to take those first few steps out of bed. You know the pain and stiffness is ready to greet you. The first 10 minutes of your run is a hobble until finally, it eases out and you feel you can run normally. Then you wake up the next morning, and it all begins again…

Background

The Achilles tendon is the strongest tendon in the body, but one of the most problematic for runners and also one of the most difficult to treat.

Its role is to absorb shock and, through elastic recoil, allow us to push off through our toes. During this movement, the Achilles is subjected to around three to four times our body weight. It’s hardly surprising it’s such a common injury!

Our bodies are constantly building and breaking down tissue. This balancing act is guided by the stresses and loads we place on them. This constant dynamism is what allows our tissues to adapt to the demands placed upon them.

Unlike with muscle the Achilles tendon has very little blood flow of its own, so relies on the supply that exists in the sheath surrounding the tendon.

If we place too much load through a tendon, without adequate recovery tissue breakdown begins to exceed production and we are left with a painful Achilles tendon. The addition of poor biomechanics further overloading the area can exacerbate this even further.

Treating an Achilles injury

In order to effectively treat an Achilles issue, you must look at two aspects.

1) The tendon itself. It needs time to heal. If the problem has become chronic (six weeks plus) it needs to be prompted to heal through a number of techniques.

2) The underpinning cause(s) of the injury. Typically a combination of poor biomechanics, strength deficits, and reduced flexibility. These must all be addressed in patient and activity specific ways. One must allow the tendon to adapt to the demands that will be asked of it.

Symptoms

1) The onset of pain is rarely sudden, but a stiffness that builds. This can be especially in the mornings and at the beginning of a run.

2) If the stiffness eases throughout the morning (less than 10 minutes) and eases as you get into training, then it can be trained on at a level that does not make things worse.

3) If the pain is sharp there is likely to be significant tissue damage and running will cause more problems. Please stop.

4) If the tightness and stiffness does not lessen when running and gets worse throughout the day, you are asking too much of an already damaged tendon. You need to reduce the frequency, duration and intensity of your training.

Some patients complain that their Achilles swells or seems constantly swollen. If the Achilles blows up with swelling after a run please reduce the amount you are doing. You are continuing to damage an already damaged tendon.

If it appears swollen, but it is a thick, solid type swelling that does not fluctuate then this is more likely the result of scar tissue and thickening of the tendon sheath. If the pain is not worsening you can still run on it.

Where does it hurt?

The exact location of your Achilles pain will help guide you to the type of rehabilitation exercises you should undertake. Tendons are inherently tender to poke, so compare with the other leg to see if you have found the right part, there may be an area of lumpiness or it may feel like it’s creaking.

Mid-tendon

This is felt a few inches above the heel, often more to the inside of the tendon. If it is only a few days old and particularly tender, please rest and ice until symptoms have eased.

If the issue is a few weeks old begin loading the tendon through eccentric heel raises. This is where you rise up on two feet on the edge of a step and lower fully down on the affected leg in a controlled manner. Three sets of 15 reps, two times daily then building up to around 20kg as able.

Insertional

This is felt within an inch of the heel bone. When the foot is pulled up the heel bone is pushed into the Achilles. Do NOT pursue eccentric exercises with the heel below the toes as this will potentially irritate things further.

If a few weeks old you may do the eccentric lowers but on the flat.

Retrocalcaneal Bursa

The retrocalcaneal bursa, which is a fluid-filled sack, sits between the Achilles insertion (as above) and the heel bone, and is there to reduce friction. However, it can often become irritated in someone with an insertional Achilles issue.

– With the bursa, the pain will be felt more to the sides of the heel.
– If you suspect a bursa, stick with ice and rest to start with as often any heel raises will irritate it.

Haglund’s Deformity

This is an extra bit of bone that sits on the outer edge of your heel bone. They can be in response to loading or just genetics.

Some people can have no Achilles problems even with a Haglund’s deformity, however, having one predisposes you to Achilles issues as the bone compresses into the tendon more than a ‘normal’ heel would. For these please seek advice and do not continue exercising while in pain.

What can I do about it?

The history of your Achilles issue will help determine what type of rehabilitation exercises and treatments you should undertake. Is it an acute problem that has developed in the last few days? Or are you suffering from an Achilles that has been giving you issues for weeks, if not months now?

In an acute Achilles issue, the first step is to address the pain.

Running through this might not be the answer. You are obviously operating at a level which the Achilles simply cannot cope with. Tissue breakdown is exceeding tissue generation.

We must reduce the loads being placed through the tendon. This is done by reducing the volume/intensity of runs, avoiding hills, harsher running surfaces, and anything else that aggravated your Achilles which may be specific to you. If you do this early, your tendon may settle in as little as one week.

A general guide in helping to decide whether you need to stop entirely is your level of pain the following day(s) after running. Tendons often ease throughout the course of a run so may feel quite good during your run, however, the following morning, or even up to 48 hours after, is a more realistic time to judge things.

Other treatments to help an acute Achilles issue

– Anti-inflammatory medication – ibuprofen is often recommended for acute tendon issues. Please consult your GP or pharmacist first.
– Ice – 10-15 minutes several times throughout the day.
– Foam rolling – avoiding the tendon itself, massaging or rolling the calf muscle can help to reduce strain on the Achilles.
– Isometric calf raises (should be pain-free).

In standing slowly push up onto your toes on both feet, use support if required. Hold this position for 5-10 seconds, and then slowly lower again. Work up to 10 reps. If you have no problems and find this easy progress to rising up on two feet, transfer the weight onto one leg and then hold. Then slowly lower on two.

Weeks or months of pain

If you have been struggling with your Achilles for a few weeks now, or you’ve had issues for a few months with intermittent flare-ups the approach will be slightly different.

You may find that your Achilles is visibly thicker than the other one or there may be palpable ‘nodules’ and areas of thickening within the tendon. These changes will often not resolve but it does not mean the tendon cannot function well.

As with an acute tendon issue, the load being placed through the Achilles must first be addressed.

If you continue to run on an already weakened tendon it may soon lead to severe degeneration or worst case, tendon rupture. Again be guided by the pain and symptoms (stiffness/creaking etc.) you are experiencing the following morning.

Specific to the Achilles tendon, we can enhance the tissues ability to handle load through an eccentric loading program, which have been shown to produce great results.

Over the edge of a step (mid-tendon) rise up on two feet and slowly lower down on one, coming past the level of the step.

You should aim to initially complete 3 sets of 15 reps, two to three times daily. Work up to 25 reps and building in weight (up to 25kg) using either a Smith Machine in the gym or by popping on a backpack and filling with household objects.

Mobilization

The Achilles needs to be elastic and not stiff, as often happens in a damaged tendon. So mobilization of the whole tendon is essential. All it takes is two minutes several times a day.

As discussed above the Achilles tendon is surrounded by a sheath. This can become stuck down to the tendon, even after the tendon has repaired, and this is often the ‘creaking’ feeling you may experience in the mornings.

Freeing this up can be very beneficial, but can be a little painful during. Pinch the sides of the tendon, and move the foot up and down. This slides the tendon within the sheath and helps loosen these adhesions. Two minutes, a couple times a day.

These exercises will take around two to three weeks to have an initial effect and then a further two to three weeks to get really good. So stick with it!

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk

In his next article, Bergin will take a closer look at the causes of an Achilles injury.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post How to identify and treat an Achilles injury appeared first on Fast Running.