The #1 Achilles Mistake That Keeps Runners Injured

[00:00:00] You train hard. You’ve been doing VO two max sessions, sprints, et cetera, for years. But now your heel and below your calf has this sharp stinging sensation every time you wake up. And when you start walking after sitting for a while, and even at the beginning of some of your runs, you just chalk it up and say, I got tight calfs until one day.

[00:00:19] Boom. Feels like something got strained and kind of like punched you in the bottom of your calf, and it’s hard to push off normally when you run. Here’s what’s happening with your Achilles issues and why it’s not going away, and how to finally fix it for good. In this episode, you’re gonna find out the difference between certain Achilles injuries and how you need to rehab.

[00:00:40] Each one differently. The exact rehab protocol a pro running physical therapist uses for myself and other elite runners. Why some exercises make it worse and what to do instead, and how to avoid getting sidelined even if you’re running. 100 K, 60, 70 mile weeks. I’ll be joined for all the science backed stuff by Sam Shearman Pro Running Physiotherapist here at Sydney, Australia, and founder of 10 Weeks to Strength Running app.

[00:01:05] I’m Daren DLake Sub three hour Marathon, a 10 hour Ironman finisher, run coach, and human Guinea pig of the last 30 years trying to figure out how to get 1% better each day and tell all the self-coach runners of the world out there how to do it. Let’s get into the episode. Lisa, we have Lisa. She’s a 30-year-old hardcore endurance athlete who trains and competes in various endurance events, including marathons, triathlons, and ultra marathons.

[00:01:32] She typically trains two to three times a day, including running, cycling, and swimming and strength training, and has been doing so for, uh. The past five, six years. However, she has been recently experiencing pain and stiffness in her achilles tendon, especially in the morning or after prolonged periods of sitting.

[00:01:51] The pain is localized to the back of her heel, at the bottom of the heel, and rates as a four outta 10 at worst asterisk. Uh, she actually had one of the worst issues with it. About four weeks ago, she decided to wear her zero millimeter. Uh, flats on concrete and do a one mile time trial, um, and then do sprints uphill right after that.

[00:02:18] Oh, dear. Uh, and that spiked it up to about an eight, outta 10, and she was in extreme, extreme pain. I know Lisa very, very closely. She’s a, a dear friend of mine. That’s a joke. So what do you think she has? It sounds like an insertional achilles tendinopathy and the difference between a, I guess a mid portion and an insertional achilles tendinopathy.

[00:02:38] It just depends on where the area of pathology or tendinopathy is. The insertional one is where the tendon wraps kind of under onto the calcaneus as opposed to the mid part of the tendon, and it affects how we manage them. All right. I, I have had this before, uh, so I know a lot about this, but you’re the expert.

[00:02:58] So what’s the immediate treatment? I, she comes into your office? Yeah. What are you gonna do? Yeah, she’s still high at that high, sort of eight, outta 10, or she dropped that, dropped back down below. Where is she at with her pain at this stage? Sorry. Uh, so she was eight outta 10, four weeks ago. She thought it would go away and it’s really hovering between that four out five.

[00:03:12] Four, sorry. 4, 2, 5 out of 10. Okay. Um, so what would you do? So first of all, I think I would test what she’s like doing her single leg calf raise raises and how painful does it get if it’s getting quite, you know, almost up at that eight, outta 10 while we’re just doing, you know, body weight calf raises or even weighted calf raises.

[00:03:30] I’d be starting with an isometric exercise. And that’s the holding. That’s the holding, yeah. So an isometric exercise, once again, it’s when you are holding a muscle contraction, but you’re not moving the joint through range. So for her, if again, if she’s got higher irritability, I’m getting her to do a, either a double leg.

[00:03:45] Or a single leg calf raise, hold it for 45 seconds and then repeat four sets. Now with this kind of injury, you can do this up to four times a day. It is actually relieving for tendon pain. If she’s less irritable, I would get her straight onto, well, she’s already in the gym, so I’ll probably get her onto a heavy slow resistance strength training program.

[00:04:06] And the exercises would look like. We could play around with it a bit, but things like calf raises on the leg press, calf raises on the squat rack, seated bent, knee calf raises you could do. The standing calf raises the standing bent knee calf raises. I usually pick three and make sure they’re not back to back.

[00:04:22] So you kind of fit them in with your other exercises that you’re doing. And again, when I say heavy slow resistance strength training program. Tempo is usually a 3, 2, 3 tempo. So three seconds up, two second hold, three seconds down. And the weight needs to be heavy, like you don’t wanna be able to do any more than one or two reps afterwards.

[00:04:41] Furthermore, because the tendon is insertional, you don’t wanna be doing like if you’re standing on a step and letting your heel drop down. Reason. As the heel drops down, it places more compression on that insertion of the tendon and the tendon won’t like that. So for an insertional Achilles tendinopathy, you’re doing these calf exercises where the heel lands flat back on the ground.

[00:05:01] So you’re not sure how to actually fix your Achilles calf or shin issues, or what to do next. Don’t worry, I got to fix. Grab my free Achilles. Caf recovery and base training plan. It puts everything we talked about into practice, and if you wanna get mentally stronger too, you’ll automatically sign up for our weekly newsletter that takes you five minutes or less each week to read.

[00:05:21] Write in your email inbox. Check the QR code right here, the link below, or the link in the show notes of your podcast players app. Let’s get back in into the episode. With podcasts you might have zoned out when she was speaking about the difference between, uh, an Achilles tendinopathy and the insertional achilles tendinopathy tendinopathy.

[00:05:37] Uh, it’s the pain at the lower heel. It, for me, it almost feels like planter, like I almost an ankle issue. Like I feel like pulling Yeah. Correct. And I get really confused with it. Yeah. And the, the, the chunk, which is the achilles at that big fat chunk at the, uh, where, where everyone knows their Achilles tendon is Mm.

[00:05:51] Um. That’s absolutely fine. And it confused me because I was like, do I have plantar fasciitis? Do I have that? So, uh, just again, just I’m dumbing it more down. Okay, good. So people know the difference. Um, but with the regular achilles tend tendinopathy, so uh, the mid portion, yeah, mid portion. Yeah. Uh, sorry, not regular mid portion.

[00:06:10] Um, what’s more common? Oh, it is more common. You again, haven’t got stats on that, but clinical observation, yes. Uh, the people coming in and having issues. So I’m the weirdo with the insertional one. You want to drop, you wanna be on a stair or raised, uh, point and drop below for that. Correct? Correct.

[00:06:25] Because it increases the range of motion. You also have more eccentric activity. Got, got you. And, and eccentric is the muscle lengthening phase of a movement, which is the downward phase, the down for this exercise. Yes. Yes. And concentric is going up. Correct? Um, we’ll talk about that actually. In the episode, either before or after this, we talk about the difference between concentric, eccentric and isometric.

[00:06:45] Uh, because I’m sure you’ve heard that, but you may be like, what the hell’s the difference? Mm-hmm. And I’ve got some cool ways of, uh, of remembering that, but I digress from that. Mm-hmm. So she’s, uh, she’s somewhat healed. Mm-hmm. Kind of never goes away. ’cause the achilles is, the achilles tendon is deteriorating as she gets older.

[00:07:03] Um, AKA me and, uh. It’s always kind of there. Yeah. It’s tolerable. It’s always a one outta two. Mm-hmm. Sometimes you get one, sometimes you get three. Mm-hmm. Uh, what would the follow up be over the next one or two years even? We’ve gotten it tamed. Mm-hmm. She can increase her load, uh, which is volume and intensity.

[00:07:19] Yeah. She’s now running a hundred ks a week or whatever she’s doing, you know, smashing herself. What would you say to, to make it never go back to that, um, shoe choices, heel drop, any of that. Oh yeah. I mean, you would be, I mean, I still like runners to vary, like, you know, provide variation in what shoes they’re wearing.

[00:07:35] But if it’s, again, more irritable, you do wanna have a higher heel. Um, whereas if you constantly running in a, you know, a flatter heel drop, um, it’s gonna put place more stress on the tendon. So I think if you’re wanting to protect longevity is obviously have a shoe with a bit more of a stack, but be mindful if you’re gonna make any rapid changes from one to another.

[00:07:52] Mm-hmm. Hopefully by this stage the athletes had a bit of, um, education on how to manage these things when they tend to pop up. ’cause sometimes they pop up, go away and then pop up again. And you need to be really well aware with what you’re doing in your training. Obviously the strength and that stuff needs to be consistent.

[00:08:07] It needs to be, you know, three, especially with a, a painful tendinopathy three times a week. And then other things I recommend, and this is a little bit, again, it’s, it’s going to be no fix, but it may be an adjunct to what you’re doing. But there’s a bit of evidence coming out around collagen supplementation and Achilles, particularly with Achilles tendinopathy.

[00:08:25] Mm. So again, it’s not gonna fix the condition, but I’m more of one of those people. You throw the book of things. I have collagen in my coffee every day. ’cause I know it’s good for my tendons, but there’s stuff coming out is exciting. So here’s an example. They had one group that did the strength training program where one group.

[00:08:39] Didn’t, uh, plus the collagen. The other group just did the strength alone. The group that had the collagen had a faster resolution of symptoms, as well as another trial that looked at Achilles tendinopathy. Um, one group took Voltarin, which again is an anti-inflammatory. The other group took collagen and the group that took collagen again had a faster reduction in pain levels.

[00:08:59] So I think that’s kind of interesting in that context, but really over when it’s becoming more of a managing condition, it’s about listening to symptoms when they pop up, modifying your training, not stopping completely unless it’s too painful. Keeping up the strength work and, yeah. Awesome. All right. Uh, I’m gonna end it with, uh.

[00:09:19] With my take on it because this is actually an injury that I know very, very well. I’m not gonna say I’m an expert on treating it, but I know how to treat myself. Mm. Um, I managed it with strength training. Mm. Collagen supplement, um, and. The heel drop in, in the shoe. Mm. Uh, I actually went as high as 12 millimeter.

[00:09:38] Mm-hmm. Which I thought was gross and it felt like I was wearing high heels. But luckily Millie and, uh, Trent Yes. At Balmaine Sports and Sigrid, they’re all fantastic. Yes. Yeah. Yes. And, um, I ended up. Being able to test out these different, you know, eight millimeters. So I went from, got away from zero. I don’t think I’m ever gonna really touch zero ever again except for walking around.

[00:09:58] Uh, four millimeter is like my usual hangout shoe run, easy shoe. Eight millimeter is my normal shoe. And then I was messing around with 12 millimeters. Actually I have 12 millimeter. 12 millimeter again, and that’s the heel drop. Um, and most runners should know what the hill drop is. Uh. You can explain what the heel drop is or you can Google it.

[00:10:14] I’ll have you explain in a second. Um, and cycling between. So I’d, if I really felt a lot of pain, I didn’t just stay in my 12 millimeter. Eight millimeter for a lot of, uh, the fast runs and the the longer runs. And then I, again, like I said, I dropped down a four, so I’d be cycling between the three and that that works very well for me With Achilles tendinopathy, again, it can be one that can stick around for a little bit and frustrate runners, or it may go away and then come back again.

[00:10:38] If it has been that real chronic, you know, around for a long time. It’s often that area of tendon that has the tendinopathy, it’s never quite gonna get back to where it was. I don’t wanna alarm people with that, but basically you want to get the rest of the tendon as strong as it can be, lots of people have tendinopathy in their bodies and they don’t even know about it, and that’s what we’re aiming to do is get the rest of their tendon as strong and as healthy as it can be, so it becomes one very good functioning unit.

[00:11:03] Again, if you’re dealing with any Achilles calf or shin issues right now and you wanna fix it, hit the QR code. Right here to get the free download, which is a recovery plan plus base training program. But here’s the thing about Achilles issues. It’s really just a symptom of a bigger problem, a weak foundation.

[00:11:20] If you had Achilles pain, it’s a warning sign that you need proper strength training specifically designed for runners. So me and Sam created an entire episode breaking down why these specific exercises, five of them can prevent not just Achilles pain, but also shin splint, runner’s, knee IT band issues, and other common running injuries.

[00:11:37] Click the link here. Or link below in the description or in the show notes of your podcast players app. If you’re listening, peace.