David Holt specialized in orthopedics 20 years ago, and has been a regular runner for longer than that. Here is his advice on two key exercise injuries. The Achilles tendon attaches to the Calf Muscle. Strain the gastrocnemious muscle and you'll have placed great pressure on the Achilles tendon. Strained the Achilles or have chronic Achilles tendinitis...look to the calf muscle for associated injury or muscle shortness.
CALF MUSCLES Causes--see below for Achilles tendon. Include overload; running too much track speedwork; or a series of very minor twists on rough trails. Many calf muscle problems are resolved by use of a heel lift in all shoes and regular stretching. Some people say avoid walking bare¨ foot; others say walking barefoot will stretch the calf muscle to its ideal length. The gastrocnemious muscle responds well to ice, strains more when running up hills; and you may recall from the stretching page, it requires a nearly straight knee to stretch it. Because the soleus is under the gastroc, itís less amena¨ ble to ice therapy. The soleus muscle is best stretched with knees bent. Both calf muscles are receptive to massage. Use fingers or finger shaped gismos or a roller to break up tiny muscle adhesions. Massage toward the heart. Both calf muscles heal well with active rest--run on soft even surfaces. Use mental preparation when on trails. Expect and look forward to adjusting your stride. Be ready to take several short strides or relax at the knee to make those adjustments. See sprained ankle.
The achilles tendon connects the gastrocnemius and soleus muscles to the heel bone. Symptoms - Dull or sharp pain and inflammation of the achilles tendon cord or its sheath--from the back of the heel and ankle, up through the cord and could extend into the calf muscle. Pain may be gradual or come on suddenly; itís espe¨ cially stiff in the morning. The achilles tendon often thickens; a nodule may be felt; a cracking sound may be present. Causes: The Achilles tendon tries to compensate for tight calf muscles. Stress at footstrike and push-off must be absorbed by the achilles cord. Damage can be the result of a gradual increase in mile¨ age that catches up with the tendon, or a sudden introduction of hill work; short, inflexible calf muscles...perhaps secondary to increased, slow mileage! A lower heel on shoes (running or non-running); increased running intensity; sprinting--all can stretch the achilles tendon too much. Not warming up properly--calf stretches are vital. Running with the weight too far back; striking the heel; worn-out shoes. A history of weak feet or Mortonís toe (long second toe) predisposes you to this problem. The back of running shoes digging into the achilles tendon on every stride is a major culprit. For some reason, running shoe manufacturers in¨ sist the achilles tendon needs protecting, whereas all we need is suf¨ ficient support for the shoe to stay on. Shoes with an Achilles dip are not much better--the top of the ďdipĒ is often higher than the level at which runners feel pain. Overpronators are prone to achilles tendinitis injury, perhaps because after the achilles tab has slammed into the tendon, it rubs the tendon as the foot rolls inwards; in ad¨ dition, the achilles tendon is given an extra twist on every stride. Prevention - Well fitting shoes with heels in good condi¨ tion: cut the tabs off if necessary; or, make two vertical slits where the achilles tendon will go; this allows the now floppy tab to roll gently and almost innocently up and down the achilles tendon. Prepare your Achilles for speed and hill sessions with copi¨ ous stretching of calves; stretch before and after running. Avoid sudden changes in training. Loose, full length, warm calf muscles will ease the strain on the tendon during all running--not just your quality running. There are many Achilles stretch gismos on the market--visit your lumber store, a triangle of wood works just as well. Treatment - Rest the achilles if it's painful to allow swelling to decrease. Apply ice for ten minutes several times a day and take two aspirin or other anti-inflammatory at the same time--both will help reduce the swelling. A strip of tape applied along the length of the tendon when in the relaxed position will act as a splint, discouraging you from using and stretching the achilles tendon further. Massage nodules away. Do toe raises. If the pain stops on warming up and it does not put extra stress on the muscles, you may continue to run. Look for the cause in your case, if it was due to other factors, you may not need to mutilate all your footwear. In the acute phase, use heel pads such as sorbothane or or¨ thotics to raise the heel--high enough for walking to be pain free. Check your non running shoes--these can also rub the achilles tendon. Run on flat grass areas for the first few days back in training. Avoid hills and track until youíve stretched the calves for 10-20 sessions. Run some of your track miles clock¨ wise. Cortisone will not help--its use is likely to lead to rupture due to continued use of a damaged achilles tendon. A few runners may resort to surgery--scare tissue removal--easing the tendonís movement within its sheath--but it often stimulates more scar tissue. If you donít address the short calves, foot control, low heels or inappropriate training, treatments will be pointless.
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