Member Case Study: Post Achilles Tendonitis Training

author : AMSSM

comments : 0

Now that I've alleviated the pain and injury, do you think it would be okay to start running on the street/sidewalk/hills again?

Question from tbryant

I experienced an Achilles tendon injury about four or five weeks into training for my first triathlon. Thanks to your website, I learned that it was probably because I had increased my mileage too fast, run on pavement and concrete, and run up some significant hills. After a week or two of worsening pain and swelling, I quit running entirely for a little over a week. I used ibuprofen (800mg every 8hrs) and ice regularly.

I slowly began running again, but this time I ran at a park with leafy paths and smaller hills. I also incrementally increased my mileage slowly, and I just hit the 3.2 mile mark. I'm by no means a speed demon, but my times are improving and I hope to be running the entire race distance soon and then increasing it.

I went to the ortho doc today, since I had previously scheduled the appt and didn't want to cancel it even though I'm feeling better. He x-rayed and found no fractures or calcifications. He isn't a sports doc, so he didn't really have an answer for this question: Now that I've alleviated the pain and injury, do you think it would be okay to start running on the street/sidewalk/hills again? I love running in the park, but it’s so much more convenient to just go out my front door and do it. I've also purchased a new pair of properly fitted shoes thanks to the Track Shack in Orlando, and I am stretching religiously before and after I run.

Answer from Carrie A. Jaworski, MD

Member AMSSM
 

First of all, great job in diagnosing and treating your Achilles tendonitis! This seems to be a first time occurrence for you. With it responding so well to the modifications in your training approach, you should be fine to return to running on the street/sidewalk/hills again.

I would recommend that you progress a bit more gradually as you transition to running on the pavement. Tendon injuries fall into a spectrum of disorders that physicians refer to as tendinopathies. Early tendinopathy often involves an acute injury and resulting inflammation, like the tendonitis you experienced. This injury usually responds to simple modifications and medications (like your appropriate treatment.) On the other hand, repeated injury to a tendon, and its surrounding tissues, causes more complex changes that won’t respond as readily to the basic ice and anti-inflammatory medication approach.

Some basic suggestions to help you get back to your preferred routine include:

1. Use caution when running on streets that have an embankment, as one leg is always reaching a little farther than the other. Either alternate the side of the street that you run on, or aim to stay more in the middle of the road (assuming no cars are in the way!).
    

2. Reintroduce yourself the streets/hills in a step-wise fashion. Don’t just jump right back into your old routine. A good initial approach it is to do a portion of your workout on the street/hills for several days. Then, if you remain symptom free, you can transition to full workouts. The same goes for the intensity, mileage, and speed of workouts. Slow and steady wins the race.
    

3. If your symptoms recur, back off to pain-free activity only. At this point, consider getting an evaluation by a sports medicine physician. The American Medical Society for Sports Medicine website at www.amssm.org has a listing of physicians near you. A sports medicine physician often has the capability to provide you with an analysis of your running form.
    
   Many physicians and sports medicine centers are now using video to analyze a runner’s gait to help them correct any actions that may be causing injury. Often, subtle changes that occur in a runner’s gait can be picked up by a slow motion analysis of the athlete’s running style. This evaluation aids the sports medicine physician in addressing the reason behind the injury, which can help speed an athlete’s recovery.

Best of luck with your first tri!

Carrie A. Jaworski, MD
Director of Sports Medicine
Resurrection Medical Center. Chicago, IL
Member, American Medical Society for Sports Medicine

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date: June 11, 2007