A Runner with Achilles Tendinopathy
George came to me with 9 weeks to go before his first ever London Marathon, presenting with a right sided achilles tendinopathy, which brought his training to a complete stand still. His achilles tendon was sore after 10 minutes of walking, and his running was limited to half a mile before he experienced symptoms and had to stop.
George left his marathon training until very late, starting in mid-January, but was determined to prove to his friends, colleagues and family that he was up to the challenge.
However, due to the increase in training volume (total mileage per week) and frequency (number of runs per week), along with an underlying weakness of the gluteal muscles of his right hip and reduced single leg strength and stability, his achilles tendon simply couldn’t cope with the load.
An achilles tendon has a load capacity, and when that load capacity is exceeded, the tendon reacts and a tendinopathy develops. There are 3 stages, a reactive tendinopathy, tendon dysrepair, and degeneration. George had developed the first stage of tendinopathy.
Within this stage, there is a non-inflammatory proliferative cell response (an increase in the number of cells) in the tendon matrix. The increase in the cell and tendon matrix increases the cross-sectional area of the tendon, which decreases the stress on the tendon in the short term. The changes at this stage to the tendon are reversible with reduced loading or sufficient rest.
But sufficient rest and reduction in loading wouldn’t have been enough for George, with his aspirations to run the London Marathon in 9 weeks time.
I therefore started George on an eccentric loading programme to strengthen his achilles tendon, alongside a home exercise programme to strengthen his weak gluteal muscles and work on his single leg strength and stability. Furthermore, I temporarily reduced George’s training load by getting him to cycle, and then adopted a phased return to running when his tendon was ready.
I complimented this home exercise programme with 3 sessions of Extracorporeal Shock Wave Therapy, which is an evidence based treatment used to speed up the healing timescales of a tendinopathy.
9 weeks later, George completed his first ever London Marathon symptom free. What a result! This is what George had to say about us on Google: –
“Professional, Skilled, and got me to finish the LONDON MARATHON! Jonathan Clark Physiotherapy diagnosed me with Achilles Tendinitis, and helped me get back to fighting fit to finish the Virgin Money London Marathon 2019. His plan to get everything on track for me to finish was perfect. I would recommend Jonathan extremely highly to fix and advise any sports injury!” George Purchon
If you’re a runner with an achilles tendinopathy, then don’t delay your treatment. A reactive tendinopathy can get worse and progress onto stage 2 and stage 3 if left without the correct advice and treatment, at which point, they take longer to treat. A typical tendinopathy takes 3 months to overcome.
Jonathan Clark
