Physical Training Jan 2005

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Water Works: Running Injuries III

Copyright Michael Moon © 2005 all rights reserved
Mike Moon, Deep Water Exercise
Mike Moon, founder of
Deep Water Exercise
Sport Medicine and Injury Rehabilitation: Running Injuries

Two issues ago we introduced this series of articles with an overview of the stresses that result from running on land and the injuries that very often result.  Last issue we looked at stress reactions and/or fractures.  This article will focus on an injury common to many athletes, Achilles Tendinitis.

Achilles Tendinitis

    Achilles tendinitis is “characterized by pain and stiffness, with tenderness, swelling, and nodularity in the substance of the Achilles tendon or at the site of its insertion into the calcaneus”(1).  This injury often presents in runners in a progressive and ordered fashion over an extended period of time.  There are in fact three distinct stages that differentiate the extent of the injury.  It is possible though for a runner to develop a more advanced stage of the injury in a short period of time from one or more excessively intense training sessions.  The first stage is characterized by an inflammation of the peritendinous tissue surrounding the tendon.  This progresses to tendinosis where the tendon itself begins to show degenerative changes.  Finally if the excessive stress continues, macroscopic tears and partial disruption will result (2).  There are many factors that can play a role in the development of Achilles tendinitis but the main initiation of the problem is again a result of over-stress through increasing the intensity or quantity of training too rapidly.  Consideration must also be given to biomechanics, which could partly be due to muscular imbalances/weaknesses in and around the lower leg as well as structural deficiencies.  A tightness or lack of flexibility in the calf muscles could precipitate this injury as well.


    A gradual appropriately structured increase in training loads will usually prevent this problem occurring.  This assumption does however presuppose that any bio-mechanic, muscular weakness and range of motion issues have been addressed.  Biomechanical issues in this case usually come down to a problem with over pronation.  “If the foot remains pronated excessively as normal knee extension occurs, the Achilles experiences unusually high forces”(2).  These bio-mechanic problems may be alleviated with a proper motion control shoe or in severe cases with the insertion of an in shoe orthotic. 

    Strengthening and stretching of the musculature of the lower leg, which goes into and around the Achilles tendon, should be a part of any well-planned running program.  These exercises will act to support the Achilles in its role and prevent the possible onset of tendinitis

Treatment and Rehabilitation

    If Achilles tendinitis is caught in its earliest stage than a simple reduction in the training load in conjunction with standard inflammation treatment may be all that is required.  As this injury advances more extensive steps must be taken.  A complete period of non-running is often required to allow healing of the damaged tendon to take place.  In one study 56% of track and field athletes with Achilles tendinitis had to take at least four weeks off to promote healing (1). 

    After the initial acute stage of treatment the athlete should begin working on strengthening and range of motion exercises.  It is especially important to strengthen the Achilles eccentrically, as this is the manner in which it functions on impact while running.  This eccentric strengthening can be done by performing calf raises and then drops on the edge of a stair, again, focusing on the drop aspect of the exercise.  This exercise should be introduced slowly and only after healing is well underway and the athlete is pain free.  Another modality that may be introduced in the latter stages of rehabilitation would be cross-friction massage.  This treatment will help to break up any adhesions that may have formed and help to insure a complete pain free range of motion. 

Maintaining Fitness

    In the most severe cases complete rest may be needed for a short period.  In the majority of situations however the runner can begin cross-training activities almost immediately.  The activity of first choice should be deep water running.  This activity would present the least amount of stress on the Achilles while allowing the athlete to maintain their cardio-vascular conditioning.  Deep water running will also provide the greatest crossover effect for running athletes.  A complete description of deep water running procedures will be the focus of the last article in this series.  The reader can also visit the website for further information.

 Next Issue: Illiotibial Band Friction Syndrome

8. Shrier I., Matheson G.O., Kohl H.W. Achilles Tendinitis: Are Corticosteriod Injections Useful or Harmful?  Clinical Journal of Sport Medicine 1996:6:245-250.
2. Fredericson M. Common Injuries in Runners.  Sports Medicine 1996:Jan.;21(1):49-72.

For more columns check out the column archives.

Mike Moon has a M.Ed in Coaching (UVIC) B.PHED, BA, B.ED (UBC) and has been Assistant Coach of UBC Track and Cross Country for 15 years. He is also Head Coach, St. Georges Junior School Track and Field Program. He has developed the Deep Water Exercise program which is used by elite level and professional athletes for rehabilitation and training. Mike continues to compete at the Masters level (in distances from 5000m to the marathon).

His website is:

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Physical Training Jan 2005