Spring is here and thousands of runners of various skill levels will return to pounding the pavement. Unfortunately, a rather sizable subpopulation of these folks will find themselves in my office with Achilles and/or other heel injuries such as plantar fasciitis.

While running happens to be great exercise, especially in this time of “social distancing,” running too much, too soon can lead to a variety of injuries. There are proactive steps, however, that you can take to prevent injuries to your Achilles heel this spring.

• Stretch. You may know to stretch, but are you doing so correctly or long enough? Some of us may not choose to do it at all, because we “didn’t have time.”To stretch the Achilles tendon, I recommend the regimen below:
  • Eccentric Calf Stretches:
    • This move will stretch and strengthen the calf muscles.
    • Stand on a step with your heels hanging off the edge. Hold on to a rail or wall for balance or add weights for an added challenge. First, rise onto your toes (concentric movement), and then very slowly—to the count of 10 seconds or so—drop your heels below the level of the step (eccentric strengthening). Push back up and repeat. Do 3 sets of 15 reps daily.
  • Plyometric Squat & Jump:
    • This exercise builds the muscle by stretching it before a forceful contraction and helps to generate power.
    • Stand straight up with your feet just wider than shoulder-width apart and toes turned slightly outward. Grip hands in front of the chest. Send hips back and bend knees to squat down as low as possible while keeping your chest lifted. As you return to standing, explode back up as high as you can to jump and land softly. Maintain good anatomical position and keep the motion controlled, landing softly after each jump. Do three 3 sets of 15 reps daily.
  • Down Dog Position:
    • This move stretches the muscles and helps the gastrocnemius limber up after a strenuous workout.
    • Start on all fours, with wrists under the shoulders and knees under hips. Step the feet back to come into a high plank position. Send hips up and back so your body forms a triangle with the ground. Keep your spine straight, think about pointing your sitting bones toward the ceiling and pressing chest to thighs, not placing too much weight on your hands and arms. Bend your right knee as you push your left heel into the ground, feeling the left calf stretch. Hold the position for 10 seconds then repeat with the other leg. Do 3 sets daily before or after your run.
  • Straight Leg Calf Stretch or Wall Stretch:
    • This stretch is excellent after exercise for reducing muscle pain.
    • Stand facing a wall with your arms straight in front of you and your hands flat against the wall. Step your left leg forward, knee bent, foot flat on the floor, and extend your right leg straight back, placing your heel flat on the floor. Keep the right leg straight. Lean into the wall until you feel the stretch in the right calf. Hold for 30 seconds and switch legs. Repeat twice for a total of 3 sets. Perform this stretch daily and up to 3 times a day if you are tight.
• Increase mileage gradually. No matter your skill level, after a winter of downtime and reduced overall activity, your muscles, ligaments and tendons will be tight. Once you are stretched out, ramp up your time and pace gradually. Overdoing it too soon leads to injuries.
• Don’t ignore pain that persists beyond 72 hours. If you have continued pain after resting, icing, compressing and elevating (RICE) an injury, seek medical attention. This includes pain that continues after taking OTC or prescription strength NSAIDs. Many athletes try to run through pain and make a minor problem a major one. Don’t push an injury, especially early in your training.
• It’s the shoes. Proper shoe fit and style are paramount. Do not order shoes from the internet and hope for the best. Go to your local reputable running shoe store and try out different brands. While certain shoe companies may make a model that works well for your running partner, that same model may be terrible for your foot type, gait, running substrate or running style. Some shoe stores will have a treadmill where you can test shoes. They may also be able to analyze your gait and offer critical recommendations. Even if it costs a little extra, properly fitted shoes are worth it, and in this specifically difficult time for small business owners, buying local will support your community and country.

Even with the most careful preparation and protocols, injuries may occur that are outside of the runner’s control. If the runner saw a doctor years ago for an Achilles injury or pain and thinks they know what is best to self-treat, some of the past recommendations and protocols are outdated. Evidence-based medicine has led to some exciting new treatments. Specific forms of sports medicine physical therapy maneuvers can not only help loosen a tight calf/Achilles but can even stimulate the tissue to heal itself. There are also options to utilize stem cells to treat a more chronically irritated Achilles. Noninvasive extracorporeal sound wave treatments have also shown to be effective and can be performed in the office setting. Surgery is reserved for more recalcitrant cases and is rarely a commonly utilized first-line treatment.

If you do experience an Achilles tendon injury, Premier Orthopaedics can help get you on the road to recovery right away.

Jason R. Miller, DPM

Premier Orthopaedics

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