Learning From the World’s Healthiest People

Learning From the World’s Healthiest People

INJURY PREVENTION / HEALTHY LIFESTYLE

Learning From the World’s Healthiest People

 

I don’t typically feature content from other websites, but I have to admit that I’m a “health nut” and I’m fascinated by the theory of “Blue Zones” and how to live a healthy lifestyle. Secrets of people who live long, healthy lives are discussed in the article I link to below.  Blue Zones are certain towns or regions throughout the world where residents are happier and healthier. In order to qualify, there must be an unusually high number of centenarians—people living to over 100 in the area. 

The following article not only identifies where these Blue Zones exist, but also details how the people in the most recognized Blue Zones live their lives. 

​The #1 lesson revealed is all of these healthy people regularly exercise. This is great news for us middle age runners.  Other benefits of regular exercise, not just running, include:

  • It can Make You Feel Happier
  • It can Help Your Brain Health and Memory. 
  • It can Help With Sleep Quality.
  • It reduces your risk of heart diseases.
  • Helps you manage blood sugar and insulin levels.
  • It can Help With Weight Loss.
  • It Can Increase Your Energy Levels. 

I think two other keys to longevity are healthy eating (the article discusses the benefits of swaying towards a Plant Based Diet) & sleep. 

A plant based diet has been proven to reduce your risk of heart disease, certain cancers, obesity, diabetes and even slow cognitive decline.

The article doesn’t specifically reveal sleep as a lesson learned from those in the Blue Regions, but I have to believe that they have a history of getting 8+ hours per night.  Research shows that consistently getting seven to eight hours of sleep per night is beneficial for adults. Poor sleep is strongly linked to weight gain, which is consistent with findings showing sleep-deprived individuals have a bigger appetite and tend to eat more.

Click here to get more lessons learned from people in these Blue Zones.

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Symptoms, Root Causes, Proven Treatment & Prevention Strategies for IT Band Syndrome

Symptoms, Root Causes, Proven Treatment & Prevention Strategies for IT Band Syndrome

INJURY PREVENTION

The Ultimate Middle Age Runner’s Guide to IT Band Syndrome

 

Iliotibial band syndrome (ITBS) is the one of the most common running injuries [1]. It is the main cause of lateral knee pain in runners.  In this article, I will discuss signs & symptoms of IT band syndrome. Additionally I will review how best to diagnose, treat & cure ITBS.  Lastly and most important, I will review strategies to strengthen and prevent ITBS from recurring or occurring in the first place.

I’m not a trained medical professional, so please use the contents of this post as guidance. As a certified coach, I have used a network of medical professionals as resources for my injuries to whom I refer my local clients. If you’re experiencing any kind of pain that forces you to change your gait, then you should stop running and seek professional medical attention to properly diagnose, treat and prevent recurrence of your injury.

​The iliotibial band (IT band) is a thick band of fibers that runs from the pelvis and down the outside part of the thigh until it attaches into the tibia (shinbone). The gluteal or buttock muscle fibers and the tensor fascia latae (muscles of the hip joint) attach to it. The IT band serves to coordinate muscle function and stabilize the knee during running.

Iliotibial band syndrome (ITBS) shows itself as pain caused by inflammation of the band as it crosses the lateral femoral epicondyle (this gives attachment to the one of the ligaments of the knee-joint. A bursa or sac in this area allows the IT band to glide over the end of the femur.  If you’re suffering from this injury your IT band usually gets sore after a set distance into a run. 

It’s common that you may not initially feel pain for the first few miles, but eventually the outside of your knee will start to ache and ultimately the pain progresses from a dull stiffness to a sharp or burning pain in your knee.

If your IT band is too tight, bending your knee creates friction. This leads to swelling of your IT band and bursa, which results in the pain of IT band syndrome.

Unfortunately, if these symptoms are ignored, further inflammation and scarring may occur in the bursa, causing progressive knee pain. Most runners report that their pain is worse when going down hills.  They also feel pain when sitting with their legs bent for a long time.

Root Causes and Risk Factors IT Band Syndrome

Inflammation of the IT band most often occurs because of overuse. It’s very common with long-distance runners, especially athletes training for longer races. 

Root cause is typically one or more factors:

 

  • Bio mechanical issues such poor flexibility and weak quads, glute & hip muscles (discussed below). Weak hamstrings are another contributor. Other less common mechanical issues (such as leg length discrepancy) can cause the injury. 
  • Training errors such as running on one side of the road only where there’s slight slant will cause one leg to always be downhill from the other.
  • Excessive pronation
  • Hip abductor and external rotator muscle weakness . In a healthy and strong runner, these muscle groups keep the hip abducted (moving inward towards midline) and the knee externally rotated, which limits the strain on the IT band. Unfortunately, when these muscles are weak, the hip adducts (moves away from midline and the knee internally rotates after impact with the ground. This results in pressure on the IT band and the underlying sensitive tissue as discussed above. Since the hip muscles control the mechanics of your knee, if you have weak hip abductor muscles and poor hip rotator muscle strength, your knee will be at a higher risk of injury.

Diagnosis – When to See a Doctor

If you’re experiencing any of the above symptoms and the pain is causing you to change your gait, I strongly recommend getting with a medical professional to discuss your pain. A physical examination is often necessary to confirm ITBS.  Typically they will look for general tenderness over the site of the iliotibial band at the knee joint, and they’ll seek tender points where the bursa is located.

Oftentimes the medical professional will complete additional examination so they can see if some weakness or imbalance in the hips, glutes, quads and/or hamstrings is root cause. 

This imbalance or weakness is the most common root cause. 

Also, because many athletes complain that their IT band is tight, a qualified health care provider will having the patient complete a variety of stretches and not only confirm tightness, but also recommend appropriate stretches.  

 

IMPORTANT: DON’T STRETCH THE IT BAND 

It’s not a “stretchy” tissue. 

Research suggests that you should target the muscles that attach to the IT band: the gluteus maximus and the TFL.

Pain should be a signal to a runner that a problem exists and often signals an overuse situation. Rest, ice, and appropriate use of over-the-counter antiinflammatory medications) may be adequate therapy to return to your previous activity level. However, keep in mind that pain can be a signal that some kind of bio-mechanical problem exists, and left untreated it may lead to future injuries.

If this conservative home treatment fails to completely resolve IT band pain or if the symptoms worsen, or if the symptoms occur with decreasing amounts of activity, it’s time to be seen by a health care professional for further evaluation and treatment.

Medications & Treatment Options for IT Band Syndrome

Initially the goal with a diagnosis of IT Band Syndrome is to control & minimize the pain. This can be accomplished with anti-inflammatory meds such as ibuprofen.  Also, ice can be applied to reduce inflammation.

Since IT Band Syndrome typically occurs with runners, the medical professional treating the injury may recommend that the athlete stop running for a short time. Acceptable exercise alternatives during treatment are usually non-impact activities such as swimming, elliptical, rowing and biking.  I recommend discussing what’s acceptable with your treating health care professional, because each case varies.

Physical therapy is a common treatment option for many patients. To ensure the most appropriate treatment, the PT will often assess the patient’s running gait and style.  Their goal is to identify any underlying bio-mechanical causes of the IT band inflammation. In addition to the gait analysis, my PT also completed a flexibility and muscle strength assessment.

  • Although the root cause of IT Band Syndrome is typically from weak hip & glute muscles in addition to weak hamstrings, I’ve interviewed a couple of PTs who suggested that depending on the runner’s gait, changing to a more stable running shoe or an orthotic insert did help correct any imbalances or abnormalities.

In my experience and in discussing with my PT, rest, ice, and physical therapy should be able to resolve the injury. However, if pain continues to persist, the health care provider may consider a corticosteroid injection into the inflamed area. This can be painful, therefore it’s typically a last resort. 

Foam Rolling 

Use a foam roller to loosen up soft tissue around the IT band, however, avoid rolling over the painful area.

The Best IT Band Exercises

For Preventing, Correcting & Managing Your Injury

CLAMSHELL with band – Lie on one side.  Prop your head in your hand. Bend knees at 90 degree angle. Use fitness band below your knees. While keeping the feet together, lift the keen on the top leg. Make the small movement shown in the photo (lift the knee until you feel a contraction in your glute. Repeat 10-12 times and then switch sides. 

clam shells

Bridge – Lie on your back on the floor. Bend your knees & keep your feet flat on the floor as shown. Lift the hips us as high as you can until you contract your glutes. Keep squeezing your glutes as you slowly lower your hips to the ground. 

For additional challenge, lift up & straighten one leg while pointing your toe.  Another variation is with a resistance band around your legs, just above your knees.

clam shells

Lateral Band Walk – Put a resistance band around your legs as shown below. Bend your knees slightly and facing forward, take small steps to one side while squeezing your glutes and hip muscles. Repeat the same movement, but in the opposite direction. While performing this exercise ensure you keep your chest and head upright and facing forward.  Go about 25 – 30 feet in each direction. 

clam shells

Single Leg Squat – With legs slightly further apart than shoulder width, face forward. Lift one leg up and point toe forward while slowly squatting with the other leg (to prevent falling backwards, keep a stool behind you and keep squatting until just above the stool). Keep check & head upright.  Outstretch arms to improve balance. Do not let the knees move forward of your toes. Repeat the squats 6-8 times initially and then increase as you get stronger. Repeat on the other leg. 

clam shells

Planks – Very effective for maintaining upright running form and strengthening your core. This helps to make you a more efficient runner, which can takes the pressure off your knee. If you’ve never done planks, starting by holding position shown in photo for 30 seconds.  Gradually increase hold in 15 second increments to 1:30.

clam shells
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How To Correctly Stretch & Ultimately Fix Plantar Fasciitis

How To Correctly Stretch & Ultimately Fix Plantar Fasciitis

Two months ago I posted a detailed article to help athletes prevent & fix Plantar Fasciitis.  I was motivated to complete the research & report my findings because I’ve been suffering from this nagging and common runner’s injury since early in the Summer.

Now as the Summer ends, the pain from my plantar fasciitis is not as sharp, but it still persists.  So, I visited my Physical Therapist and found the following video which backs up his strategies for relief.

My PT always seems to find the root causes of my injuries.  99% of the time, they exist above the injury.  As you can see in the following video, it’s not simply enough to roll with a lacrosse ball & ice under your foot.  This may relieve the pain, but it’s not addressing the root cause.

In my case, I have stiff calf muscles.  I have been rolling and stretching, but in the same manner as recommended in this video. It’s a slightly different stretch, but it addresses the root cause of my problem (stiff calf muscles and muscles that connect to the foot).

Watch the video & put this stretching strategy (for calf and gluteus medius).

 

Related Articles

Why Weak Glutes Are a Runner’s Biggest Enemy and How You Can Fix
Risk Factors For Achilles Tendonitis & How To Prevent
Risk Factors, Treatment & Prevention Strategies for Plantar Fasciitis

Risk Factors, Treatment & Prevention Strategies for Plantar Fasciitis

Risk Factors, Treatment & Prevention Strategies for Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It’s not unusual for people to manage their plantar fasciitis effectively, only to have their symptoms come back when they stop treatment. For this reason, it’s important to develop strategies to help prevent recurrence. This article will present the risk factors, diagnosis, treatment & a proven prevention program.


I’m not a trained medical professional, so please use the contents of this post as guidance. As a certified coach, I have used a network of medical professionals as resources for my injuries to whom I refer my local clients. If you’re experiencing any kind of pain that forces you to change your gait, then you should stop running and seek professional medical attention to properly diagnose, treat and prevent recurrence of your injury.



Similar to many other running injuries, Plantar Fasciitis is often an overuse injury. It’s described as a stabbing pain that usually occurs with someone’s first steps in the morning. As the athlete gets up and continues to move around, the pain normally decreases. However, it might return after long periods of standing or after rising from sitting.

The pain comes from inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Risk Factors

There are a number of factors believed to increase a person’s risk for developing plantar fasciitis. Plantar fasciitis is most common in, but not limited to runners. It’s often reported in athletes between the ages of 40 and 60, although anyone can get it. People who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. People who are overweight and run, can put extra stress on their plantar fascia.

The most common causes of plantar fasciitis are either structural (in the foot) or muscle/tendon weakness. For example, people who have problems with their arches, either overly flat feet or high-arched feet, could be more prone to developing plantar fasciitis.


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The injury can be brought on by certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, among other activities, can contribute to an earlier onset of plantar fasciitis. Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces may damage their plantar fascia.

Plantar fasciitis is typically aggravated by tight muscles in your feet and calves.

Wearing non-supportive footwear on hard, flat surfaces can put abnormal strain on the plantar fascia and can also lead to plantar fasciitis.

All of these risk factors can cause plantar fasciitis. Understanding which, if any risk factors you exhibit can help you prevent or minimize the effects of this injury.

Symptoms

You should AVOID self diagnosis of injuries.  Plantar Fasciitis is not limited to the following symptoms.  Instead, these are the most common symptoms reported by runners.


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The pain described by people suffering from plantar fasciitis is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it.

Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring. It’s purpose is to support the arch in one’s foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Ignoring plantar fasciitis may result in chronic heel pain that hinders an athlete’s regular activities. If a runner changes the way they walk or run (their gait) to minimize plantar fasciitis pain, this might lead to foot, knee, hip or back problems.  Bottomline, if you suspect you may have plantar fasciitis, seek positive diagnosis from a qualified medical professional.

Diagnosis

Because heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or in some rare cases, a cyst. It is important to have it properly diagnosed by a medical professional.  A foot and ankle specialist is able to distinguish between all the possibilities and to determine the underlying source of your heel pain.  Proper diagnosis will lead to correct treatment and hopefully speed recovery.

Accurate diagnosis begins with the athlete describing symptoms and discussing specifics of their injury. The doctor will examine the foot to pinpoint the source of the pain. The exam, along with the patient’s medical history, will help properly diagnose the condition. During the examination the doctor will look for areas of tenderness in the foot. While holding the affected foot, the doctor may bend the patient’s toes toward their shin and then press along the plantar fascia from the heel to forefoot.

A doctor may also order imaging tests so he or she can rule out any other causes of the pain, such as fractures or heel spurs.

Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. In my research, an MRI scan only seemed to be used if the heel pain was not relieved by initial treatment methods.

Treatment

After diagnosis, the first priority with plantar fasciitis as with other injuries is to treat the pain. There are a few options your doctor could try to ease the pain and reduce inflammation. In my experience & research, it’s often recommended to try a few therapies at the same time to resolve the issue as quickly as possible.

Nonsteroidal anti-inflammatory drugs (NSAIDs) will help reduce pain and inflammation of the plantar fascia. A doctor may prescribe multiple doses a day for several weeks.

Depending on the severity of the pain, decreasing or even stopping the activities that make the pain worse are typical first steps. It’s common for a doctor to direct an athlete to temporarily stop activities like running.

Other typical treatment options include rolling affected foot over a cold water bottle or ice for 20 minutes. This can be done 3 to 4 times a day. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.


(New) TheraFlow Foot Massager Roller – Plantar Fasciitis, Trigger Point Relief – Acupressure Reflexology Tool for Foot Pain, Relaxation, Stress Relief and Diabetic Neuropathy. Christmas Gift


Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area. If surrounding muscles have become tense because of the pain, massage those areas as well.


Tip:  Dealing with early morning Plantar Fasciitis pain provided by the Hanson’s:“If you run early and find it difficult until the plantar warms up (or loosens), I suggest putting the foot in the bath tub under running warm water & keep adjusting the temperature until it is as hot as you can stand. This (will) help the early run hobble.”


Exercises that stretch out the calf muscles help ease pain and assist with recovery. When you walk without shoes, you put undue strain and stress on your plantar fascia.

Wearing supportive shoes with extra cushioning and orthotics if prescribed by a medical professional can reduce pain, especially if the patient is frequently standing and walking.  I wear and recommend custom orthotics that fit into my running shoe.  Although orthotics are not for everyone, if prescribed, they help correct underlying structural abnormalities that contribute to plantar fasciitis. A cushioned shoe or insert reduces the underlying tension and microtrauma that’s causing pain with the plantar.  Soft heel pads can also provide extra support, they are inexpensive and work by elevating and cushioning your heel.

Although medication, rest and ice often eliminate the pain, working with a physical therapist (PT) can address bio-mechanic, muscle weaknesses or imbalances that were actually the root causes of the injury.  A Physical Therapist will help with strengthening and stretching exercises (discussed below) that can prevent injuries to the plantar fascia, achilles tendon, and also lower leg muscles.

Kinesiology tape, straps and splints

Although I could write multiple detailed posts about the use of tape, straps and splints. I’ll keep it simple here.  I have experience with using tape to alleviate pain (either myself or athletes I coach).  Tape can help, but it must be applied correctly to achieve it’s maximum benefit. Below are a few videos that may be of interest. Proper taping of the foot or use of straps help support the foot and reduce strain on the fascia. The tape & straps will allow your foot and ankle to move well. Before applying kinesiology tape to your foot, be sure to speak to your physical therapist or doctor to ensure you are applying it properly.

Wearing a night splint can help to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some athletes. Remember that these devices help relieve the pain, but they don’t correct the root cause. The good news is that they won’t be needed once the pain is gone.  As long as a regular preventative routine is implemented to address risk factors.


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Other (less common) Treatment Options

For those patients who don’t show progress after several months, a small percentage of patients may require surgery. From my research, the surgical option was rarely used and typically only considered after 12 months of aggressive nonsurgical treatment. A foot and ankle surgeon would discuss the surgical options with their patient and determine the most beneficial approach.

A few other treatment options are ultrasound, which is used to target and remove scar tissue. This procedure may allow the patient to get back to their regular routine much sooner than with surgery.

Stretches & Strengthening

Stretching exercises should create a pulling feeling. They should not cause pain. Ask your physical therapist or doctor which exercises will work best for you.

People can speed recovery, relieve pain and prevent recurrence with specific foot and calf stretches and exercises.  Perform these exercises two or three times every day.  Often, muscle tightness in the feet and calves can make the pain of plantar fasciitis worse. So, a good strategy is to gently stretch the plantar fascia, as well as the muscles around your foot and ankle.  The more frequently you do this, the more you will improve foot flexibility, mobility and promote healing of the irritated fascia.

Calf stretch – Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.

Achilles Tendon & Calf Streching Exercise

Plantar fascia stretch – This stretch is performed in the seated position. Cross the affected foot over the knee of opposite leg. Grasp the toes of the painful foot and slowly pull them toward the body in a controlled fashion. If it is difficult for the patient to reach their foot, then wrap a towel around the big toe to help pull toes inward. Place the other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of the foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

Placing a round object under the foot and roll it back and forth. This will help loosen up the foot muscles. People also use a rolling pin, golf or tennis ball or specialized foam roller for this.

Plantar Fasciitis Stretch

Flexing the foot increases blood flow to the area and relieves tension in the calves, which can help with pain. This exercise uses a towel or elastic stretch band, which people can buy from sports stores or online.

Plantar Fasciitis Towel Stretch

Curling a hand towel or facecloth with the toes can stretch the foot and calf muscles. Try doing these stretches before walking or doing any other morning tasks.

Picking up a marble with the toes will flex and stretch the foot muscles. This exercise is tough, but highly effective.

If you’ve read through this whole article, you understand the pain resulting from plantar fasciitis and how frustrating and what a painful problem it is to manage. The upside is that there are steps you can take to help alleviate your symptoms, address the root causes of the injury and prevent it from returning.  Regardless of the treatment you undergo for plantar fasciitis, you must address the underlying causes. Therefore, it’s important to continue with preventive measures which may include long term wearing of supportive shoes, regular stretching, strengthening and possibly using custom orthotic devices as discussed above.


I used many sources in my research for this article. I interviewed a Physical Therapist and numerous athletes who have suffered through plantar fasciitis. I also used articles from the following online sources.

mayoclinic.org
webmd.com
aaos.org
medicalnewstoday.co
foothealthfacts.org


Related Articles

Why Weak Glutes Are a Runner’s Biggest Enemy and How You Can Fix
Risk Factors For Achilles Tendonitis & How To Prevent
Four Great Ways to Avoid Running Injuries


Stretches To Help Prevent & Relieve IT Band Pain

Stretches To Help Prevent & Relieve IT Band Pain

Most IT band problems are caused by hip & glute weakness. Performing various strength exercises prevents the injury from occurring, However, to relieve the discomfort if you start to experience IT band pain, I have found that a regime of foam rolling, stretching and massage works well.  My recommendation is to start a program of strengthening in parallel with the foam rolling, stretching & massage.

How Middle Age Runners Stay Injury Free
 

 

The strategy revealed in the following video is really for any athlete experiencing or wanting to prevent IT band syndrome.  Follow along to work out the tightness and trigger points in the IT band, quad, glutes, hip and hamstrings.  Static stretching of these areas after a massage can also help.


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Related Articles

Why Weak Glutes Are a Runner’s Biggest Enemy and How You Can Fix
Risk Factors & Prevention for Achillles Tendonitis
Four Great Ways to Avoid Running Injuries

Risk Factors for Achilles Tendonitis – Best Strategies to Treat & Prevent

Risk Factors for Achilles Tendonitis – Best Strategies to Treat & Prevent

Risk Factors for Achilles Tendonitis

Achilles Tendonitis is a very common injury among runners of all abilities. A University of Wisconsin Study of track injuries reported that during a 17 year period, tendonitis accounted for nearly 9% of reported injuries. It is an inflammation of the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

 

I suffered through this injury for over a year until I was properly diagnosed and treated. It really slowed my training, so my goal with this article is to share the symptoms, risk factors, treatment options and best prevention strategies so you can prevent achilles tendonitis from slowing your training.


I don’t recommend self diagnosis of any sporting injury because every injury is different in some way and each requires specific assessment and treatment. If you suspect you may have achilles tendonitis, I urge you to get it properly diagnosed by a trained and certified medical expert.  It would be irresponsible of me as a certified coach to attempt to manage your injury in an article.

Use the following information for guidance only. Although I provide much researched details along with a logical and effective rehab program recommendations, I am not a qualified medical professional, so I encourage athletes to seek professional medical opinion for diagnosis and to confirm treatment protocol for any injuries.  


Symptoms & Warning Signs

 

Achilles Tendonitis is often characterized as an overuse injury. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe. You may also have trouble finding shoes that fit comfortably.

Risk Factors & Treatment for Achilles Tendonitis

Photo by Jenny Hill on Unsplash

For most athletes, the injury starts as mild discomfort or ache in the back of the leg or above the heel, typically experienced at the beginning of a run. Tenderness, stiffness or the ache may just be in the morning, but often improves with mild activity. However, as the injury persists untreated or more typically untreated properly, the pain becomes more severe and continues after prolonged running (especially on hills), stair climbing or sprinting.

As the pain persists and if left untreated, where the athlete continues to train, the tendon gets weaker, making it more vulnerable to a tear (rupture). This a painful injury that usually requires surgical repair. This is why if you experience persistent pain around the Achilles tendon and it’s affecting your running gait, you need to seek professional medical attention. Do this before the pain becomes too severe or the achilles tendon becomes torn (ruptured).

 

Risk Factors

Achilles tendonitis typically has two causes. One is muscular and the other structural. It’s more common as you age, because the structure of the Achilles tendon weakens with age, which can make it more susceptible to the injury.


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The structural cause of achilles tendonitis is weakness in ankles and feet. Excessive pronation (rolling inward on the foot when walking or running) turned out to be the primary factor for my injury. A naturally flat arch in your foot can put more strain on the Achilles tendon. Other structural causes include chronic ankle instability or a recurrent “giving way” or rolling of the ankle.


 

Also runners with a slight leg-length discrepancy, can cause the body to compensate and put soft-tissue structures like the Achilles tendon more vulnerable to a tear.

The muscular cause is short, inflexible (tight) calf muscles which can develop over time with runners who don’t perform regular stretching & strengthening exercises. There are two large muscles in the calf. When they are strong and stretched out, they create the power needed to push off with the foot or go up on the toes. However, if the calves are short and inflexible, the achilles tendon will then attempt to compensate for the limited range of the calf muscle, so any strain from footstrike to takeoff will be absorbed by the tendon.

In my experience, it’s common for runners to have tight calf muscles, so as you can see below, calf stretches is one of the primary focuses for rehab and prevention.

Other risk factors for achilles tendonitis include:

-Athletes new to running or just starting on a training program.
-Sudden drastic (more than 15% per week) increases in weekly mileage.
-Sudden increases in speed work or hill training
-Wearing high heels regularly can shorten the Achilles tendon, making it more prone to injury
-Prior history of achilles injuries
-Old (worn-out) or improper running shoes (shoes that don’t offer sufficient heal support or stability)
Achilles Tendonitis Risk Factors

Photo by Daniel von Appen on Unsplash

-Weakness in the hips & glutes
-Poor biomechanics (form or gait), which is often the result of structural or muscular issues discussed above.
-Overweight runners

The bottomline is that there’s many risk factors that contribute to achilles tendonitis. Typically it’s a combination of these factors that result in the onset of the injury.

Diagnosis

A physician should diagnose the cause of the pain. This is very important. Although this is a comprehensive article, it should only be used as a reference. Do not use the contents of this article to self diagnose your injury.

A doctor’s diagnosis will come from a combination of a physical exam, the patient’s history (filling out a questionnaire) and if necessary, diagnostic tests. The tendon will be very tender when palpating (feeling) or squeezing it from the sides. There may be a nodule or lump felt in the middle of the tendon.

Another test is the “calf-squeeze” where they test the integrity of the Achilles tendon. The doctor may also ask the patient to do a series of exercises such as hops, jumps or leg lifts. They want to understand the level of activity-related pain, as well as exactly where the pain occurs.

Besides the clinical exam, the doctor will ask questions of the patient to ensure all details of the injury are understood.

For example, patients may describe pain as sharp versus dull, intermittent versus constant, and mild or severe. What makes the patient better or worse, such as whether the pain increases with activity. There will also be questions about his or her recent sports involvement, including any changes to the training schedule, surface or type of sport being played. Patients should expect to report past injuries and/or inflammations of the Achilles tendon, including when and how they occurred, if they recurred, and what treatments were used or have been recently used.


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Lastly, the patient will be asked to describe any changes in the Achilles tendon area, such as increasing pain at the bony prominence at the back of the heel, swelling, tenderness, redness, or loss of strength or range of motion.

X-rays aren’t typically used in diagnosis of tendonitis, instead they can be used to help diagnose if there’s any bone problems. However, an MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis

 

Treatment

 

The main treatments for Achilles tendinitis DO NOT involve surgery. However, it is important to remember that it may take at least 2 to 3 months for injury to properly heal.  Although most athlete’s don’t want to hear it, they will need to temporarily decrease or stop any activity that causes pain. If they can do so without pain and if their physican gives the “go-ahead” the athlete may be able to continue run or walk on smooth, soft & flat surfaces. I would definitely recommend avoiding hills & speed activity.

Different therapy options can get you back to the trails and running healthy. Typically a doctor or physical therapist will recommend any number of the following nonsurgical activities:

To fight the pain, oral nonsteroidal anti-inflammatory medications may be prescribed to reduce pain and ease swelling. People with asthma, kidney disease, or liver disease should first check with a doctor. Steroid injections, like Cortisone, can reduce tendon swelling, but they don’t cure the problem. In my research, I found a number of sources indicate concerns that taking these kind of shots were associated with a greater risk of tendon rupture. Remember, managing the pain is only the initial part of the treatment.  The ultimate goal should be to address the root cause and prevent recurrence.

Other pain management strategies involve elevating the foot and keeping it raised above the level of the heart to help reduce swelling. An icing program involves applying ice to the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the injured area gets numb.

 

Alternatively, runners can switch to low impact activities such as biking, eliptical, swimming, rowing machines or other activities that put less stress on the Achilles tendon.

Once the pain is managed, physical therapy and shoewear modification the most typical treatments for patients with tendon inflammation and early degeneration. For overweight runners or runners who pronate or have bio mechanical risk factors, high stability running shoes will help to prevent the injury from recurring. If you’re not sure what shoes are high stability, ask the experts at your local specialty running store. I while back, I wrote a detailed article about how to pick the right running shoes.

One of the treatments that my physical therapist tried in order to allow me to run a race, was heel lifts. These moved my foot away from the back of the shoe. Unfortunately, it only helped for about half the race, before the pain returned and became unbearable.

One unproven treatment option is with platelet-rich plasma (PRP) injections. I don’t have any experience with this treatment, but during my research for this post, it was identified as an option. However, a recent study couldn’t conclude that this was a viable protocal to treat the injury.

 

How Middle Age Runners Stay Injury Free

 

If the above treatments DO NOT improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur. These options are rare, but I wanted to point them out.

In most cases, lifestyle changes help improve symptoms. However, it’s important to remember that symptoms may return if you DO NOT limit activities (risk factors) that cause pain or if you correct bio mechanical risk factors, including stabilizing the foot, strengthening weak supporting muscles and correcting short calf muscles.

This is exactly what happened to me years ago. I would rest, ice, change to a more stable shoe and attempt to strengthen my calf muscles, but the root cause for me was a combination of pronation, weak glutes and hips and my footstrike was mostly on my heal (as opposed to fore or mid foot).

It’s really important that you ultimately understand which risk factors are causing your Achilles tendinitis. Left unproperly treated, the injury may make you more likely to have an Achilles rupture. This condition will cause a sharp pain that feels as if you have been hit in the back of the heel with a stick and surgical repair will be necessary.

 

Prevention

Prevention is by far the best way to avoid potentially major problems with Achilles tendon pain. It is far better to complete a program of 10 – 15 minutes of stretches & exercises a few times per week than have 2-3 months out of training or risk an Achilles rupture.

Below are stretching exercises that would be perscribed by your health care provider or physical therapist. they should be done under the supervision of a physical therapist, at least initially, because they could damage the Achilles tendon if they’re not done correctly:

Gentle calf stretching exercises can help stretch the muscles and aid recovery

 

Stretching Exercises

There are a number of exercises you can do to stretch your Achilles tendon. Here are some of the most popular:

Calf Stretch: Place your hands on a wall with one leg straight and the heel to the ground. Place the other leg, with the knee bent, in front of the straight leg and push your hips toward the wall. Stretch your calf to the point where you feel a strong pull but no pain. Do not let your heels come off the ground. Hold the position for 10 seconds, then relax. Repeat 20 times on each foot in a slow controlled manner.
Achilles Tendon & Calf Streching Exercise

 

Sitting Heel Raises

Sit on a chair and raise your toes up as high as you can without pain. Slowly lower your heels. Do this 20 times a day. You can make it harder by pressing down on your thighs or holding a weight on your thighs.

Bilateral Heel Drop

Stand at the edge of a stair or a raised platform that is stable. Put the front part of each foot on the stair. This position allows your heel to move up and down without hitting the stair. Hold on to a railing or support to help your balance.

Slowly lift your heels off the ground and slowly lower your heels to the lowest point possible. Be sure to do this in a controlled manner 20 times. You can also do this starting on the floor rather than the stair.

Achilles tendon & calf strengthening exercise

Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis. As long as the leading risk factors (as diagnosed by a medical professional) are addressed, performing eccentric strengthening exercises is one of the best ways to ensure that a full recovery can be achieved.

 

Strengthening Exercises
Farmer’s Walk on Toes – watch video or follow instructions below

Grab a pair of heavy dumbbells and hold them at your sides at arm’s length. Raise your heels and walk forward (or in a circle) for 60 seconds. Be sure to stand as tall as you can and stick your chest out. Choose the heaviest pair of dumbbells that allows you to perform the exercise without breaking form for 60 seconds.

Single-Leg Standing Dumbbell
Achilles Tendon Strength Exercise

Grab a dumbbell in your right hand and stand on a step, block or 25-pound weight plate. Cross your left foot behind your right ankle and balance yourself on the ball of your right foot, with your right heel on the floor or hanging off a step. Put your left hand on something stable—a wall or weight rack, for instance. Lift your right heel as high as you can. Pause, then lower and repeat. Complete the prescribed number of reps with your right leg, then do the same number with your left (holding the dumbbell in your left hand).

Straight-Leg Calf Stretch

Stand about 2 feet in front of a wall in a staggered stance, right foot in front of your left. Place your hands on the wall and lean against it. Shift your weight to your back foot until you feel a stretch in your calf. Hold this stretch for 30 seconds on each side, then repeat twice for a total of three sets. Perform this routine daily, and up to three times a day.

Foam Roller – Calf Roll
Foam Roller for achilles tendonitis

Place a foam roller under your right ankle, with your right leg straight. Cross your left leg over your right ankle. Put your hands flat on the floor for support and keep your back naturally arched. Roll your body forward until the roller reaches the back of your right knee. Then roll back and forth. Repeat with the roller under your left calf. (If this is too hard, perform the movement with both legs on the roller.)

Foam rolling can be a great tool for recovery, but I would caution that it doesn’t always work immediately, especially with really tight calf muscles. It’s not unusual for tight muscles to take a few weeks to release as long as you’re consistently rolling.

 

Regular Prevention Program

1. Intelligently increase your distance and intensity – Many runners get impatient and make sudden increases in distance or time, especially if they’re falling behind with their scheduled training. Schedule your program then be disciplined enough to execute it. Very often tendonitis is caused by a sudden increase in load or force. If you do have a hard session(hills, intensity), no problem- but it’s very important that you choose to rest the next day or perform a low impact session the following day.

2. Introduce changes gradually. Be careful with hill sessions, change of running shoes or change of terrain.

If you go from road running to off road- or vis versa- the altered terrain can cause tweaks in the Achilles tendon.

If you feel tweak or a strain, revise your training immediately and do not try to push through. It is better to have one week off then to attempt to push thru, make the injury worse and require 2-3 months off of training due to injury. Also, if you get new running shoes, I recommend walking in them first and slowly increasing the distance and intensity for 7-10 days to allow your body to adjust & to break in the shoes.

3. Always complete a proper warm up and cool down. This includes after run/training stretches. Even though you may be pressed for time. It’s essential to stretch after your run. Just take 3-5 minutes to slowly stretch out your calf muscles, achilles, hamstrings, IT band and lower back. If you’re in the habit of performing these stretches, you’ll likely prevent recurring injuries.

4. Regularly perform foam rolling. Calf, quad and lower back muscles tend to get very tight.  Sometimes stretching is not enough. I highly recommend foam rolling at least 2-3 times per week to prevent tight and knotted muscles. Rolling out the calf muscles will help prevent your Achilles tendons from getting get injured.

5. Regularly complete strength training. Especially the exercises listed above.

6. Get a sports massage – These can really help preventing injuries. Massages enhance flexibility, help to improve blood flow in muscles and tendons and a can help heal little tweaks in muscles and tendons quickly before they become problems. During marathon training, if you can afford one and have the time, it’s ideal to get a sports massage monthly.

7. Gait analysis – How you run is VERY important in the prevention and treatment of Achilles tendon pain. In most cases, runners with Achilles tendon pain have poor running mechanics. They over pronate, they have weak hip muscles and have very tight hamstrings and calf muscles.

Top Prevention Tip:

Get your gait analyzed – this is VERY important. I suffered for over a year with this injury before a sports therapist video taped me on a treadmill.  He reviewed my gait in slow motion & confirmed that I was pronating.  He also identified some issues with my stride. I had been running for 30 years and didn’t think I was a pronator, but it turned out that I had developed this condition which was ultimately affecting my achilles.

There’s a lot you can find out from a video analysis, I highly recommend this solution. You will be amazed at all the ways you can improve. For me, this was the best way to prevent injury and also dramatically improve your running speed.


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