Achilles and the Mountain Goat…
With the Mountain Goat Race on the horizon, I thought it appropriate to write a bit about Achilles tendonitis. Due to the relative cold weather and the steep hills encountered early in the race, it is a virtual certainty that a number of runners will develop a new Achilles tendonitis or aggravate an underlying problem with this sensitive tendon during this year’s race. Here’s hope for prevention.
Three muscles originating from behind and below the knee come together several inches above the heel bone (calcaneus) to form the belt-like Achilles tendon. The dual gastrocnemius muscles and their deeper counterpart, the soleus, are all “plantar flexors” of the foot. They enable “pushing off” with the forefoot. This means that they help push the toe-end of the foot down, enabling one to push on the gas pedal, stand on one’s toes, and ascend stairs and hills. There is considerable strain on the Achilles tendon during normal walking. Force plate studies have shown forces 125% of body weight during the toe-off phase of normal gait for walking, and forces increase drastically over this amount for running, proportional to speed. In addition to increased force, running necessitates greater range of motion of the joints of the lower extremity, again proportional to speed. For instance, the total range of ankle motion required for walking is 30 degrees, versus 45 for running on level ground. Add to this the increased demand for more dorsiflexion (extension) for the 10-12 degree inclines in the first four miles of the Mountain Goat course, and it is easy to appreciate the strain on this tendon.
Many runners will be training on this course in early mornings to prepare adequately for the race, in temperatures often ranging from 0-40 degrees F. The Achilles tendon is not well insulated from the environment, as it is close to the surface. The importance of adequate stretching before hill training runs and before the race itself cannot be overstated. Two types of stretches for the calf muscles are especially useful, and every runner should know how to do them. With the heel on the ground, and the foot positioned two to four feet from a wall, lean into the wall until you feel a good stretching sensation in the calf. Keeping the knee bent will concentrate the stretch down low in the Achilles tendon, and keeping the knee straight will concentrate stretching forces higher in the calf muscle. Avoid bouncing stretches, and try to hold these stretches for 6-10 seconds. Variations include stretching with the heel lower on a slant board, with the heel off of a step, pulling on the balls of the feet with a towel while seated, and using rocker devices sold commercially.
Symptoms of Achilles tendonitis include pain and soreness in the tendon, tenderness, swelling, and difficulty walking up stairs or running up hills. The troubles may resolve during a run, at least initially, but this is not a signal that things are improving. Often things are worse early in the morning, or at the end of the day.
Once Achilles tendonitis is underway, this problem can be difficult to resolve with continued training, especially if running hills. Stretching now becomes as important as breathing, both before and after running. Icing for twenty minute sessions after runs and intermittently during the day may help to “put out the fire”, along with aspirin, ibuprofen, and naproxen, if there are no stomach problems, such as gastritis and ulcers. Another useful tip is using a heel lift of 1/8” to ¼” placed beneath the insole of the shoe. A heel cup or felt pad works well for this purpose, and serves to reduce the strain on the tendon by lifting the heel, simulating a minimal downhill grade. New shoes or a cushioned insole may help reduce forces on the injured tendon. If you have symptomatic tendonitis going into the race, suffice it to say that the Mountain Goat course, run at a racing pace, will not make the condition better.
Long-standing symptoms (greater than 3-6 months) usually necessitate avoidance of uphill running, a trial of cross-training, pool running, or some other distraction while waiting for the condition to improve. Danger signs include palpable nodules in or about the tendon, and persistent appreciable swelling and/or thickening of the tendon. The worst case scenario is a tendon rupture, fortunately a rare event, typically associated with jumping and push-off sports such as racquetball, basketball, and volleyball. I have seen cases of ruptured Achilles tendons following a protracted course of tendonitis.
Now is the time to avoid or minimize this problem by religious stretching, breaking in a new pairof shock absorbing shoes, and preparing your Achilles’ for the Goat by training on hills in a slowly progressive fashion. Gradually increase the length and grade of your hills during training to prepare adequately, and try to avoid running up hills until midway into training sessions. Good luck with the Goat!