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ACHILLES TENDONITIS

What is Achilles Tendonitis?

The Achilles tendon is the largest tendon in the human body. It is the cord of tissue below your calf and above your heel. It points your foot and raises you up on your tiptoes. Achilles tendonitis is a common problem that occurs when the tendon becomes irritated and inflamed resulting in heel pain. There are a number of activities that place extreme loading forces on the Achilles tendon. Running, especially uphill running, is definitely one of them.

Signs and Symptoms

• Gradual onset of pain and tenderness in the Achilles tendon often made worse with activity.
• Pain and stiffness along the Achilles tendon first thing in the morning.
• Swelling and tenderness of the Achilles tendon.

Treatment Suggestions

REST! There is no quick magical fix when it comes to tendonitis. You cannot make the pain and inflammation settle if you continue to push through your pain. Resting doesn’t mean you have to become a temporary couch potato. Try cross-training activities such as swimming or cycling (as long as they are pain free). This will maintain your cardiovascular fitness while your Achilles tendon gets a much needed rest.

Heel lifts Purchase a heel lift like the one shown in the picture below. This can be worn temporarily to reduce strain on the Achilles tendon. Even if you only have Achilles tendonitis in one heel make sure you still put an insert in both shoes so there’s no asymmetry. https://www.amazon.ca/Plantar-Fasciitis-Silicone-Achilles-Tendonitis/dp/B07HQ46XR1/ref=sr_1_5?ie=UTF8&qid=1547583030&sr=8-5&keywords=heel+inserts+for+achilles+tendonitis

Eccentric strengthening exercises. Standing on a step rise up on your toes then lift your good leg. Very slowly lower your injured heel towards the floor. Aim to repeat 15 times and do this exercise twice daily. Some discomfort during the exercise is okay but it should not linger. If you have increased pain after doing eccentrics stop the exercises and consider seeing a physiotherapist to get some individualized care.

Calf Stretches: There are 2 calf muscles (gastrocnemius and soleus). In order to stretch the gastroc you need to keep the back leg straight. To stretch the soleus bend the back leg. Keep the heel on the floor. Hold stretch 30-60 seconds (no bouncing). Repeat 3 times. Always stretch after you run not before!

Correct any training errors

• Did you recently start or return to running? Maybe you progressed your distance/pace too quickly.
• Did you recently start hill training or running hillier routes than normal? Maybe you did too many hill repeats or you ran hills too many times in one week.
• Did you recently start doing any cross-training exercises that involve a lot of repetitive hopping, skipping or jumping?
• Have you recently changed footwear? Did it involve transitioning to a more minimalist shoe without a heel?

Basically think back to just before your heel pain started. Often with runners it’s a result of a recent change so figure out what that was and don’t make the same mistake again!

When to seek professional help!

If you try the above treatment techniques and are still experiencing pain; I would suggest booking an appointment with a physiotherapist (That’s me!) who can do an assessment and come up with an individualized treatment plan. This may or may not include taping your Achilles, dry needling, cupping and soft tissue release.

As always, if you have any questions about ANY type of injury, running or otherwise, feel free to contact me at the clinic!
🙂

If the cold winter and ice covered sidewalks has you moving your runs indoors, give these treadmill workouts a try! I get very bored on the treadmill and have a hard time running more than 5km! However, these interval workouts help me spice things up a bit!

Disclaimer: If you haven’t been running hills outdoors or on an incline on the treadmill lately introduce these hill workouts cautiously. Too much too soon with hill training can put a great deal of strain on the Achilles tendons, calves and plantar fascia which can lead to injury.

Workout #1: Sprint intervals

1-2km Warmup

3X400m sprints with 200m walk/slow jog between.

2X600m sprints with 400m walk/slow jog between.

2X400m sprints with 200m walk/slow jog between.

1-2km Cool Down

Workout #2: Hill repeats

5 minutes jogging warmup.

1 minute at 4% incline, 1 minute at 5%, 1 minute at 6%. 2 minutes at 0%.

1 minute at 5% incline, 1 minute at 6%, 1 minute at 7%. 2 minutes at 0%.

1 minute at 6% incline, 1 minute at 7%, 1 minute at 8%. 2 minutes at 0%.

1 minute at 7% incline, 1 minute at 6%, 1 minute at 5%. 2 minutes at 0%.

1 minute at 6% incline, 1 minute at 5%, 1 minute at 4%. 2 minutes at 0%.

5 minutes jogging cooldown.

Workout #3: 10km rolling hills

1km Warmup

3 sets of the following:

500m at 3% incline, 500m at 0%.

500m at 4% incline, 500m at 0%.

500m at 5% incline, 500m at 0%.

Workout #4: Hill repeats

Jog 5 minutes to warmup.

Repeat 4-8 times.

90 seconds at 6% incline. 1 minute recovery jog at 0%.

60 seconds at 7% incline. 2 minutes recovery jog at 0%.

Give these a try and remember, we’re always here to help with any questions or concerns you may have!

Happy Trails! (or treadmills)

When I see a runner in our clinic my first goal is to get them pain free again. Once I accomplish this I then need to analyze their running form and try to correct any poor body mechanics they might have. Heel striking and excessively swinging the arms, rotating the trunk and bouncing up and down are all common running technique errors. If I had to choose one thing I would work on with everyone presenting with these issues, it would be cadence!

What is cadence?

Cadence is the number of times your feet hit the ground per minute. The ideal cadence is 180 steps/minute, or 3 steps per second. However, the majority of runners especially beginners have more of a 150-160 cadence.

Why is cadence so important?

If you heel strike you have a large stride length. This in turn will increases your joint reaction force. This excessive force can eventually lead to joint pain and injury. You also are putting the brakes on and slowing yourself down with every step by placing your foot way out in front leading with the heel. By improving your cadence to 180 you don’t have time for a long stride length therefore you start landing on the midfoot as opposed to the heel. You also don’t have time to excessively swing the arms around, rotate the trunk or bounce up and down so it greatly improves running technique and removes unnecessary movement patterns that waste energy!

What’s the best way to work on your cadence?

• Start by running on a treadmill. Warm up for 5 minutes at a relaxed easy pace.
• Settle into your regular comfortable pace (for example the pace you would do on a long run).
• Over a 15 second interval count how many times your feet hit the treadmill. Multiply this number by 4. Ideally you want to be around 180!

If you are below 170, it will take a little bit of work. Try to shorten your stride and try to land on the middle of your foot as opposed to your heel. Recheck your cadence and it should be closer to 180. You’ll notice a difference in that you usually run very loudly on the treadmill but it’s quieter when you make this change. Once you’ve mastered this on a treadmill, you can move things outdoors. Some running watches like Garmin can actually track your cadence and will beep at you if you go below a preset number.

Initially it will take a lot of concentration to improve your cadence but with practice it will become natural and you will be able to run with a 180 cadence without focusing on it constantly!

Feel free to contact me with any cadence/running/physio questions.  I’m here to help!

PEANUT BUTTER FUDGE

Makes 12 squares

Treat yourself to a healthy treat for the Holiday Season!

Ingredients

• 12 Medjool dates
• 1 cup natural peanut butter
• 1Tbsp dark chocolate chips (optional)

Preparation

1. Remove pits from dates
2. Process the dates and peanut butter in the food processor until the dough turns into a ball. Add chocolate chips and mix just a bit more. Press the mixture firmly into a pan lined with parchment paper.
3. Freeze for 2 hours. Cut into squares. Serve and enjoy. Extras can be stored in the refrigerator for up to 1 week or the freezer 1 month.

Helpful Hint: Cut your fudge while it is still frozen, but then allow it to sit in your refrigerator for up to 3 hours before serving for the best appearance and texture.

bon appetit!

Having difficulty staying motivated to continue running throughout the winter months? Why not consider joining one of these FREE running groups?

Bushtukah Stittsville Trail Running Group

This friendly welcoming group either trail runs or snowshoe runs every Saturday morning at 8:30am. They choose a different location every Saturday. I moved to Ottawa in August and with this group I have explored so much of the Green Belt trails in the west end. Start your weekend off right with fresh air, exercise and great company! Join their Facebook group “Bushtukah Stittsville Trail Running” for more info.

Natural Fitness Lab

If you are looking to snowshoe regularly and would like to incorporate more hill work into your routine, check out Natural Fitness Lab. They meet every Wednesday evening in Gatineau Park at 6:25pm. Join their Facebook group “Natural Fitness Lab” or go on their website: http://www.naturalfitnesslab.com/

Running Room’s Free Run Club

Use the following link to look up a Running Room near you. https://www.events.runningroom.com//training/?id=5161

They offer free group runs throughout the week! Usually Wednesday evenings, Sundays at 8:30am and either Friday evenings or Saturday mornings.  I joined the Westboro location last month for an evening run and met a great group of people!

(Wayne Cuddington / Ottawa Citizen) 112182

Boost your immune system to fight the cold and flu!

Fun fact: 80% of your immune system is housed in the lining of your digestive tract.  The remaining 20% is circulating in the blood stream.  This means that the long- term ticket to strong immunity is great digestive function. It is primarily the bacteria in the gut that communicate with the immune cells in the blood to control immune function.

If you suffer from chronic constipation, food allergies or intolerance, experience gas or bloating, if you are stressed or take NSAIDs like Advil, it can degrade digestive bacteria and leave you with a weakened immune system.  You will be prone to get every bug that comes around!

Here are some antioxidants you can take to give yourself a boost to help reduce the oxidative stress and strengthen your immune system:

• Vitamin E, C, A, D
• Selenium
• Zinc
• Probiotics

Best food to incorporate:

• Avocado
• Berries
• Greens – eat a variety of colorful vegetables!
• Eggs
• Nuts and seeds
• Cod liver oil (source of Vit A, D and fatty acids)
• Kefir (you can use this in a shake!)

Lastly, stay away from sugar! Sugar feeds pathogenic bacteria in the gut – so sugar and processed carbohydrates are not your friends this winter.

Trying to motivate yourself to run throughout the winter months can be a struggle, but trying to stay injury free while you run throughout the winter months can be even more of a challenge! Check out these winter running tips that should help keep you running consistently all year long without pesky injuries slowing you down!

Temporarily reduce your weekly mileage with the first snowfall.

When you are running on snow as opposed to a hard, slip free surface you are using stabilizing muscles you haven’t used in a long time. This places you at increased risk of injury. Week 1 run 50% of your normal weekly mileage. Week 2 increase to 75%. By week 3 you should be able to return to your normal weekly mileage.

Avoid switching to the treadmill for 100% of your winter running.

First of all running on a flat uniform surface involves repeating the exact same movement over and over again which increases your risk of repetitive strain injuries like achilles tendonitis and plantar fasciitis.  Second of all when the snow melts and you switch back to running outdoors you will have to drastically decrease your mileage or you’ll risk injury. Running on the treadmill does not mimic running outside! The impact force from running outside is much greater than on the treadmill. Also on the treadmill you are trying to keep up with the track as it glides under your feet, whereas outside you actually have to propel yourself forward. It’s very different therefore your body needs to be allowed the time to adjust!

Make sure your important stabilizing muscles are strong!

Running on the snow and ice demands more muscle effort than running on the treadmill or outdoors on dry pavement. Especially from the glutes and core. (See previous glute strengthening blog!)

Wear the proper footwear!

Yaktrax

Either wear sneakers that are meant for winter running and have soles with studs or spikes, or purchase an ice traction device such as Yaktrax that fit over your sneakers.

Warm up!

Warming up is more important during the cold winter months. If you are standing in a parking lot waiting for others in your group to show and you are shivering and chilly, your muscles are tight and cold as you start to run which can put you at increased risk of injury. Jog on the spot, do high knees or bum kicks, or wait in your car with your heat blasting!

Ignore the pace on your watch!

Focus on effort level as opposed to pace if you are used to running with a running watch. You will run slower in the winter months. If you try to maintain the same pace you did on the clear dry pavement you could end up with an injury. Use the rate of perceived exertion scale. Perceived exertion is how hard you feel your body is working. These feelings are not objective like monitoring your heart rate, but they can give an estimate of your heart rate and your exercise intensity zone.

Try snowshoe running!

It’s a great way to get outdoors and enjoy the snow covered trails. You have to make some small technique adjustments such as running with a slightly wider stance and lifting your feet higher. This will challenge your hip abductors such as your glute med and min and your hip flexors so make sure you ease into snowshoe running gradually. It is much slower than road/trail running so don’t focus on pace. Again use the rate of perceived exertion scale above! Also, purchasing snowshoes that are designed for running such as the Atlas snowshoes shown below can definitely improve your comfort level and speed while snowshoe running.

Last week I described a great glute max test that you can do to assess for weakness and asymmetry. So if you did the test and realized you have weakness and are wondering what to do about it; continue reading!

Why is it important for runners to have strong glutes?

The glutes help stabilize your pelvis and your knees. It prevents issues such as patellofemoral syndrome, Achilles tendonitis and IT band syndrome which are common injuries among runners. When the glutes are weak it affects lower extremity alignment while running which can create issues. Weak glutes also  make other muscles kick in and compensate which can (and will) eventually lead to problems.

Why do runners often have weak glutes when they are fit/active?

Sedentary lifestyles play a huge role in how our muscles function. Many people have sedentary jobs and spend a great deal of their time off sitting. This means they are sitting on their glutes which are in a lengthened/weak position for the majority of the day. Even though they might consider themselves strong and fit because they are runners, the glutes can still be weak because the large amount of time spent in the sitting position.

How can runners know that their glutes are weak?

First of all try the test I posted last week! Then ask yourselves the following questions:

• Do you notice you kick your inner calves/ankles while running?
• Do you notice after a hard run that your hamstrings are sore but the glutes feel fine?
• Do you have low back pain during/after your run?
• When you see pictures of yourself running are your knees angled towards each other?
• If you are still unsure but you have issues book a physiotherapy assessment and your physiotherapist will be able to assess for muscle imbalances!

What are the best ways to strengthen the glutes?

Side Plank

Side Plank with Leg Lift

Glute Bridges

Weighted Single Leg Deadlift (Square Hips!)

Single Leg Deadlift

Side Stepping w/ Resistance Band

Single Leg Glute Bridge

Last week I discussed how much targeting my glutes has helped improve my running performance over the past 2 months. For those of you who have been wondering if your own glutes are up to par, here is a helpful follow up blog!

This is a great test for glute max strength so give it a try at home! You do not need any equipment.

•       Lie on the floor with your arms across your chest and feet shoulder width apart.
•       Lift your bum off the floor so that you are only balancing on your shoulder blades and heels.
•       Now try to lift your left leg! Can you do it? How long can you hold it for?
•       Now try to lift your right leg! Can you do it? How long can you hold it for? Is it easier or harder than when you lifted your left leg?

For runners, asymmetry is not our friend! There are certain sports when muscle strength/flexibility asymmetry is normal and maybe even necessary to perform well (think golf/curling/baseball). But runners should be equally flexible and strong throughout the body. So if you do the above test and you find it more difficult to lift the left leg, your right glute needs some attention! And vice versa for the opposite side.  

Tune in next week for Part 3 where I’ll go over functional strengthening movements for runners!

The main goal of an initial assessment is to determine possible causes of your injury or impairment. We also ask: What can we do to remove or alleviate the pain?

One thing to keep in mind is that sometimes, you may be a bit sore after an assessment.  This is largely due to the fact that we’ve probably just moved your body in ways you’ve been avoiding due to discomfort or pain.  In order to determine a course of action, we as therapists trust in functional movement assessment techniques to help us get you back to the best version of yourselves as quickly as possible!

What to Expect

• Our initial assessments typically consist of a 1 hour one-on-one session with a therapist, and 99 percent of the time, treatment will be provided on the first visit as well.

• The therapist will review your health history as well as pose a series of helpful “red flag” questions with the purpose of eliminating any sinister causes as the root of your injury/impairment.

• Expect to move!  Our bodies were designed to do so and chances are, you’re here to figure out what is keeping you from pain free movement.

• It’s always a good idea to come dressed in non-restrictive clothing so that when a therapist is assessing your squat for example, you’re not going to be doing so in a suit or skirt.

• If you have any diagnostic imaging available to you (x-ray, MRI), we will be happy to have a look at that with you.

• Homework is probably going to be assigned.  Getting you back to feeling great will require your active participation and expectations will be set out for you by your therapist.  We are always available by phone or email if you ever have any questions or need clarification on what your homework is.

The initial assessment is the first step in getting you back in action.  Just remember, we want to see you as little as possible, but as much as necessary to get and keep you pain-free and functioning well.