Simon Katich suffered an injury blow by limping through most of day three of the Ashes Match in Adelaide with a “heel” problem.
This was later clarified as being an Achilles swelling see -Lump on Achilles Tendon .
His pain was compounded further by knowing that he was going to have to bat for a long period to help Australia save the game.
He also managed to get himself run out in the first innings without facing a ball!

Australia’s captain Ricky Pointing later admitted that
“He’s been pretty hindered in the field.
His achilles is quite badly swollen and we have got him on and off the ground a couple of times to get some ice on it knowing that he’s got plenty of batting to do over the next couple of days.”

In fact Katich did manage to bat for a few hours until after lunch before being dismissed caught behind for 43.

The Australian Medical Team have a lot to do if they want to try and get him fit for the Third Test in Perth starting on the 16th December. It depends on how bad the Katich Achilles tendonitis injury is and whether he has had significant previous problems here. As Achilles Tendonitis is a degenerative condition this is very likely. See Achilles Tendonitis Injury- Your Top 10 Questions Answered for much more information.

What is Achilles Tendonitis / Tendinosis

Achilles Tendonitis, or more correctly Tendinosis, is thought to be caused by overuse which causes microscopic areas of damage to the tendon.
These areas of microtrauma are quite common with exercise and normal daily activities, and the body copes by repairing these damaged areas on an ongoing basis.
However the cause of Achilles tendonitis with increased running is due to the fact that this repair process is not able to cope with the repeated strains below the injury threshold of the tendon, inducing microdamage or as I will call it from now on “damage”.
This “damage” accumulates and leads to mechanical breakdown of the Achilles tendon which develops areas of degeneration – Achilles Tendinosis.

Training Causes of Achilles Tendonitis

• an increased frequency of running over a short period of time
• a sudden increase in the length and/or speed of runs
• repeated running uphill as part of a training regime
• conversely repeated runs downhill!
• running on cambered surfaces

Damage / Repair Cycle of Running

As mentioned above there is a normal ‘damage / repair’ cycle that takes place in the tendon.
If you allow enough time after a training session then there is full recovery of the “damaged” area.
This is represented diagrammatically.
The blue dotted line represents injury.
The red line represents the “damage” done by a training session.
There is enough time for full recovery to take place.

Achilles Tendonitis with Increased Running or Training Sessions

If you suddenly increase the number of runs or training sessions that you do each week then the repair part of the cycle has less time to finish its role before you start your next session.

This leads to a cumulative effect of degenerative changes taking place in the tendon.
When this reaches the blue dotted line – you feel injured and there is breakdown of the structure of the Achilles Tendon.
In simple terms degeneration (tendon breakdown) is exceeding regeneration (tendon repair).

Avoid Achilles Tendonitis with Increased Running or Training

If you were to repeat the same runs or training routine at a frequency that allows full recovery then the tendon actually gets used to the level of stress applied to it.
This reduced “damage” with each successive run is represented in the graph.
Think of this as a training effect on the tendon.
However the idea behind regular training is to get fitter and achieve more so training at the same intensity is pointless.
The key to success is to progressively increase your training in such a way that you allow the “damage” to the Achilles recover sufficiently before increasing the loads on it.
That is where cross training and structuring your workouts is essential.
The 10% rule for runners weekly mileage comes to mind.

The 10 Percent Rule for Runners

The runners 10% rule states that you should not increase your weekly mileage by more than 10% week on week.
Personally I don’t necessarily agree with that but it’s not a bad place to start.
It’s too restrictive for beginner runners and perhaps too generous for elite runners.
If you are starting out and especially if your are starting back after an injury or lay-off then my advice would be to “listen to your body”.
By that I mean if your are sore after a session then take it easy for a few days – do some cross training instead of running.
Follow hard runs with easy runs or rest days.
Space out your workouts evenly through the week or month.
Build in an “easy” week (about 70-75%) every 4-5 weeks.
If you feel tired or sore then you are doing too much – REST!!

The Achilles can actually respond to regular loads over a period of time. Some studies have shown that there is an increase in cross-sectional area of the tendon (thicker / bigger) after ongoing regular exercise. Other studies have shown a difference in cross-sectional area between the dominant and non-dominant legs of the same individual – you use the dominant leg more. Yet more studies have shown no difference at all!


The more regularly you exercise the more the tendon is able to withstand the stresses applied to it
BUT and it’s a BIG BUT ….
you need to allow for the repair part of the cycle to take place effectively.

That’s why marathon runners like Paula Radcliffe can churn out apparently massive mileages each week and stay injury-free.
However when they do get injured it takes them a long time to get back to normal because World Record holder-or-not she has to follow these same basic rules on her rehab journey back to full race fitness.

Question :- How long have you had the pain?

1. Less than 4 Weeks AND you have never had Achilles pain before

It would be advisable to stop running
Wait until you can do 3 sets of 15 reps of the Eccentric Calf Exercise and be pain-free.
I know that this may seem a bit overly protective but think about it

• you have Acute Achilles Tendinitis
• when it settles you will be fine to restart normal training
• if you allow it to become CHRONIC Tendinopathy then
• there are permanent (degenerative) changes which take place in the tendon
• it stays with you for a very long time
• you will have to regularly do rehab exercises for the tendon
• there is an increased risk of tendon rupture as you get older

It makes much more sense to me to take an extra week or so doing cross training or cycling to avoid these possibilities.
Make sure that you include stretching your calf twice a day into your routine.

2. Less than 4 Weeks AND you’ve had Achilles pain before

OK you’ve probably rested for a day or so and then tried it out again only to find the pain returns.
If you don’t want to get worse then ease back SIGNIFICANTLY on your running -

• easy runs rather than tempo runs etc.
• NO hill running
• NO speed sessions

Start the Eccentric Calf Exercise and only when you can do 3 X 15 reps with some additional weight (dumbbells or rucksack with books) should you consider gradually increasing your mileage or speed.
You should also be stretching your calf twice a day.

3. Pain for more than 4 weeks

3a. If you HAVE RESTED from running for a few weeks because of the pain it is important that you can do 3 sets of 15 reps of the Eccentric Calf Exercise and be relatively pain-free before starting back to running.
This is because it is necessary to build up the strength in the calf muscles to cope with the forces of running.
Resting allows the muscles to lose tone quite quickly and you need to get them functioning normally again before starting to pound the roads again.
Weak muscles lead to increased stresses through the tendon and further injury / degeneration.
It is important to keep the calf muscles lengthened at this time so make sure you are stretching your calf twice a day.

3b. If you have NOT RESTED much from running because the pain is not too severe then my advice would be to :-
Ease off your running slightly, especially HILLS and SPEED
Start a proper stretching routine for your calf especially after runs and first thing in the morning
Twice a day do 3 sets of 15 reps of the Eccentric Calf Exercise 
You can progress this to off a step and then add weight using dumbbells, weighted shopping bag in each hand or wear a rucksack loaded with books etc.
When you can do 3 x 15 reps off book then you can gradually increase the speed and distance of your runs.

Restart Running after Achilles Problems

I would recommend using a treadmill to restart my running.
Yes I know it’s boring! BUT

1. You can run a steady predetermined pace
2. the time of your session can be controlled exactly
3. there are no uphills or even worse downhills
4. you can introduce inclines progressively
5. you can accurately increase the pace of your runs
6. underfoot conditions remain constant

Treadmill Running

Start off at no more than 20 minute runs (5 -10 minutes if you are a relative novice to running).
Use cross training to supplement your workouts.
Run at very slightly less than your distance run pace.
Do not be tempted to run too slowly – this affects your running gait too much.
Ice your tendon after each run for a few weeks.
If there is no reaction to a run then run on alternate days and slowly increase your mileage.
After a few weeks you can start to raise the pace of some of your runs.

Good Luck!

WARNING – this is general advice only!
NEVER run through significant pain!
ALWAYS seek the help of a health professional specialising in sports for specific advice.

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Achilles Tendonitis or Achilles Tendinosis?

Achilles Tendonitis (or its other spelling – Achilles Tendinitis) is an acute flare up of tissues around the tendon and is short lasting – only a few days.

Achilles Tendinosis is a chronic degenerative condition lasting for ever!.

It’s a bit like a puppy – not just for Christmas but for LIFE!

Once you’ve got it I’m afraid to have to tell you that you’ll never be without it!

However that doesn’t mean that you have to stop running or exercising – in fact quite the opposite but I’ll come back to that later.

Achilles Tendinitis

Tendinitis or paratenonitis is an inflammatory reaction in the body of the Achilles Tendon itself or more commonly in the paratenon that can surround the tendon.
The inflammatory response is a reaction to micro tears and this produces pain and swelling locally in the paratenon and surrounding soft tissue structures such as an associated bursa. The bursa is a small fluid filled sac found at the base of the tendon as it attaches to the heel bone.

Achilles Tendinosis

Tendinosis is non-inflammatory condition which is as a result of degenerative changes in the structure of the tendon. These degenerative changes produce thickening of tendon and compromise the integrity of the tendon itself.

Normally there is a constant cycle of breakdown and repair in the tendon but now due to chronic inflammation of the paratenon this has led to more “breakdown” than “repair”.

In the repair phase the collagen fibres (the main fibres of the tendon) that are laid down are not of a good enough quality and strength to produce effective healing.

If you were to examine a tendon at this stage, you would see varying amounts of dead tissue, small tears running along the length of the tendon and perhaps calcium deposits in the tendon. All of this weakens the tendon and makes the possibility of rupture more likely.

Recovery

The good news is that recovery is possible.
In severe or persistent cases it may be necessary to have surgery to strip the paratenon off and clear away the dead areas and remove the calcified areas in the tendon before starting on a rehab program.

The key to recovery is relative rest – that is avoiding the activities that were aggravating the problem in the first place WHILE starting activities that promote stronger and more effective healing.

Exercises that progressively load the tendon produce the correct type of collagen fibres in the repair phase which in turn produces a stronger and healthier tendon. [Find out more here]
Remember however that when you stop exercising that the degenerative process still continues. As you take a break and do nothing your tendon gradually weakens and it will not be able to withstand the same forces when you start back.
This happened to me a few years ago. I had rehabilitated my tendon well and built up to running a few half-marathons. I took 3-4 weeks off due to increased work commitments and my Achilles pain came back within a mile when running downhill!!
So be warned keep doing your exercises when you stop running.

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