"To keep from decaying, to be a winner, the athlete must accept pain--not only accept it, but look for it, live with it, learn not to fear it." ~ Dr. George Sheehan
I’m admittedly a stubborn person, refusing to let discomfort stop me from getting in my planned training. I have been running competitively for decades, and I have accepted that discomfort is part of running. I have recently been struggling with a running overuse injury, Achilles tendonitis, which has now developed in both legs. Unfortunately, Achilles tendonitis is also stubborn. The Achilles tendon is the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel. Virtually all of the force generated when you toe off the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. As such, 12% of runners are prone to this injury, particularly those who do a lot of speed training and uphill running (my two favorite things, seriously)! Is training injured helping or hindering recovery? Is some pain OK?
Before this injury, life was simple and running was easy!
While I don’t think it was my stubbornness that caused my injury, I am sure my persistence to train through it probably didn’t help. What started out as a dull ache at the beginning of my run turned into something much more severe over the course of a couple weeks. I remember pacing a couple runners with the track team that I coach, and by the time we finished up the 400m repeats, I could barely walk. Intense, shooting pain radiated from both Achilles. I took a couple days off, and reduced my speed work, as the faster running sessions gave me more pain and limitation on my ability to finish the workout. Some mornings, I debated wether to crawl on all fours until the pain subsided!
Knowing that no amount of ibuprofen was going to make this pain go away, I finally went to see my trusted physiotherapist Curt at Premier Therapy. It took a mere 5 minutes of me trying to balance on my sore foot, and unable to do more than 10 calf-raises for him to see I was in trouble. Finally my body was saying “Enough!” and I had no choice to listen. Realizing I had pushed my body beyond it’s breaking point, I started a physical therapy regimen, and this would required some pain.
Our bodies feel pain for a reason: to tell us when something is too much, when to back off the training, and when it’s safe to push onward. However, pain does not mean you stop.
The diagnosis and cause
Achilles tendonitis typically starts off as a dull stiffness in the tendon that gradually goes away as the area gets warmed up - it might hurt and the start of a run but disappear after 5-10 minutes. But, it typically gets worse under specific conditions - running faster and running uphill. In most cases, the pain is in the midpoint of the tendon. Unfortunately, mine was insertional Achilles tendonitis, which occurs within an inch or so of the heel bone and tends to be more difficult to get rid of (lucky me). Additionally, the bursa, a small fluid-filled sac right behind the tendon, was irritated as well.
Causes of Achilles tendonitis is related to excessive stress being transmitted through the tendon. Weak calf muscles, poor ankle range of motion, and excessive pronation have all been connected with the development of Achilles problems. In my case, I had chronically sore and stiff calf muscles, normal ankle range of motion, and normal pronation with a mid foot strike - what was 'off' in my running form was a lack of forward lean at the hips, landing in front of my body weight, which was putting even more strain on my lower leg. This along with training quantification (volume, speed and duration) resulted in damage to the tendon.
The short-term and long-term solutions
I was still able to run during the recovery period, but only if my Achilles did not flare up while doing so. Pain was my guide for training. The recovery is about a 6-12 week period. I am about 4 weeks in and have noticed significant improvements - I even raced with minimal pain! Here is a breakdown of the two main foundations for recovery (I will cover them in greater detail in following posts).
Running with some pain was necessary. The strategy and exercises are designed to cause some pain. I was encouraged to continue doing it even with moderate discomfort, but should stop if the pain is excruciating. Luckily, there is a clear difference between the two, discomfort vs. excruciating pain, and running injured was made simple.
First things, first: Running with minimal pain
Compression socks – they aren’t just fun fashion statements; they can be used for a necessary purpose. In my case, I needed them, badly! I recently had the opportunity to try a new compression sock made by Tiux. Although not a treatment for Achilles Tendonitis, wearing compression socks helped me continue to train and do the exercises with minimal pain. As far as I am concerned, they are an must have tool in your running arsenal.
Why Wear Compression Socks?
All these benefits played a key role in my injury recovery. In the meantime, read more about why Tiux Compression socks are different here.