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Multi-dimensional coaching advice

To complement the article on Achilles injuries in this week’s issue of Athletics Weekly magazine, here are some short action clips

• Straight leg technique

  

• Straight leg extra weight

  

• Bent knee technique

  

Doctors LEON CREANEY and PAUL DIJKSTRA looks at how to treat and prevent one of the most common injuries in athletics

ACHILLES was an ancient Greek hero who fought in the Trojan War. His only weakness was said to be his heel – and he was eventually killed by an arrow to the tendon connecting his calf and heel, which was later named after him. Thus the expression ‘Achilles heel’ has come to mean a person’s weakness and for many athletes it continues to be a source of trouble in their own careers.

The Achilles tendon is the strongest and thickest tendon in the body; it needs to be since the full weight of the body is transferred through it during walking and running, with up to 12 times body weight passing through its structure during maximal sprinting.

Many athletes will have experienced Achilles tendon problems. In this article we cover some of the more common ones.

► Achilles tendon rupture
THE most serious of all Achilles injuries is a complete rupture. The tendon is sometimes sore leading up to the event, but frequently not. Often the athlete feels a crack or biting sensation behind the heel when trying to accelerate. Afterwards they cannot push down on their foot with any great force, the area becomes swollen and tender, and a gap can be felt where the tendon used to be. For most people the best option is surgical repair, unless the tendon is only partially torn, in which case it can be treated in a plaster cast. It usually takes at least six months to heal.

► Achilles paratenonitis

OCCASIONALLY the sheath lining the tendon can become acutely inflamed. The athlete may be able to feel some crackling around the tendon, which will be sore when moved or pressed. Overuse and biomechanical problems are often causative factors.

This is a less serious condition and can often be addressed with an injection under the direct vision of an ultrasound scan, together with correction of any causative factors.

► Achilles tendinosis
ACHILLES tendinosis or tendinopathy, used to be called ‘tendinitis’. Doctors no longer use the expression tendinitis because it implies inflammation, but we now know that it is predominantly a condition of ‘wear and tear’ caused by overuse.
Over time the collagen from which the tendon is made develops tears and weaknesses as a result of either overtraining or incorrect training.

The tendon becomes thickened and painful, and often becomes stiff after a period of inactivity. Many athletes find that, at first, it is possible to make the pain go away after a good warm-up before a session. Frequently, however, the condition deteriorates to a point where the athlete finds it difficult to run at all. It is at this point that the advice of a doctor is usually sought.
The diagnosis can be confirmed clinically or with an ultrasound scan and there are many possible treatments. It may be helpful at first, to put a heel raise in the trainers.

This offloads the Achilles a little and can help with the pain.
The mainstay of treatment is an exercise programme which involves eccentric heel drops. These work by stimulating the damaged tendon to heel. The programme takes 12 weeks but is worth it since the tendon can be restored to normal.

► Eccentric heel drops

THE main exercises for Achilles tendinopathy are very easy to do:

• Find a step in your house.

• Perform a calf raise over the edge of the step using both legs, but come down slowly on one leg to below the level of the step (see images here and videos on www.athleticsweekly.com)

• The exercise should be done with both the knee straight and slightly bent.

The exercises work better if you can make the Achilles painful when you are lowering down. This can be achieved by adding extra weight (by wearing a backpack with weights inside) or alternatively you can do the exercise in a gym which has a calf raise machine. We recommend doing 3x15 repetitions with the knee straight, and 3x15 with the knee bent. You should do this morning and night. It takes about 12 weeks tofix the tendon this way.

► Not getting better

SOMETIMES the tendon does not get better with these exercises. Often the only problem is that you are not doing them quite right. A sports doctor or physiotherapist working together will be able to advise you. It may also be that the diagnosis is wrong since there are many other causes of pain in the back of the ankle. It is worth seeing a sports doctor from the outset, as there are other treatments which a specialist sports doctor can employ for stubborn cases.

► About the authors

Dr Leon Creaney is a former GP and currently specialist registrar in Sports and Exercise Medicine at the Royal London Hospital. He works for BUSA and UK Athletics as a medical officer, and is part of the medical team for the World University Games later this year.

Dr Paul Dijkstra is a consultant in Sports and Exercise Medicine. He qualified as a sports physician in South Africa where he worked with many Olympic athletes from all over the world at the Centre for Sports Medicine, Potchefstroom.

He was the North West regional medical officer for the National Olympic Committee of South Africa (NOCSA) before the 2000 and 2004 Olympic Games. For the past year he has been based in London working for UK Athletics and the English Institute of Sport (EIS). He is also the medical officer for the ‘On Camp with Kelly’ scheme.

From this week's Athletics Weekly, - available in WH Smith and all good newsagents, or on subscription

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