I am lucky enough to work in a place in which it is totally normal to stand up in the middle of a meeting, perch myself on a chair, and crank out some eccentric heel drops. I am also lucky that my coworkers haven’t filed a formal complaint with HR yet over my recurrent dad-joke refrain: “My Achilles is a-killin’ me!” Perhaps they take pity on my tendinous plight, or perhaps they chalk it up to “Jana-antics,” of which this is actually a pretty mundane example.
For anyone who has ever suffered from the creaky, crunchy, burning pain of Achilles tendinopathy, however, my behavior should seem quite familiar. Unfortunately, a lot of us are plagued by Achilles issues, whether we are elite athletes, weekend warriors, or something in between. In my case, I have subdued the Achilles beast enough to make serious training a reality again, due in no small part to some AlterG TLC. But enough about me; let’s talk about YOU. Where are you supposed to begin, when it comes to understanding that pesky Achilles, what exactly is going wrong, and what the heck you can do about it? Oh, I am so glad you asked.
First off, lets talk shop, and by that I mean anatomy. The Achilles tendon is the junction point for 3 major muscles: the two heads of the gastrocnemius (big, upper calf) and the soleus (lower, baby calf). As a result, overloading these muscles can lead to a transference of the excess load to the tendon, a function for which it is not designed to perform. In his article, Achilles Tendonitis, Tendinopathy, and Tendinosis, Stephen M. Pribut, D.P.M, describes how, “The Achilles tendon is the connection between the heel and the most powerful muscle group in the body. This has long been known as a site which is prone to disabling injury. Forces up to 12 times body weight (9kN) may arise during sprinting. This tendon is named after Achilles, who according to myth, was protected from wounds by being dipped in a magical pond by his mother. She held him by the heel, which was not immersed, and later died by an arrow wound in his heel.” So, there are two main takeaways here:
- The Achilles tendon is in a very precarious position; problems “up the chain” can quickly snowball into a serious case of tendinopathy.
- Make sure to dip your children completely into the magic pond. I really wish my mom hadn’t forgotten about my Achilles 24 years ago…
Ok, now that we have a cursory understanding of the structure and function of the Achilles, let’s talk about how to know when things are going wrong. As noted by Leigh Boyle, DPT and CSCS, in Achilles Tendon Injuries: Know the Warning Signs, “One of the most frustrating things about many of the Achilles tendon overuse injuries I see, such as Achilles Tendinopathy, is that the majority of them seem to ‘come out of nowhere’.”
Indeed, most other overuse injuries are like rattle snakes; sure, if you fail to take heed of the incessant warning rattles (i.e. the slow buildup of pain), that snake will strike you hard. To be fair though, some of the onus is on you and your cognitive dissonance (“If I just keep running, the pain will surely go away. It’s not a real injury, I just need to warm up more.” Etc. etc.).
Achilles tendinopathy, however, is more like this guy:
Look at you; you’re just a chill little octopus, doing your octopus thing, making your octopus moves, when SUDDENLY OH NO NO NO. Again, Leigh Boyle relates how, with Achilles tendinopathy, often, “There’s no acute injury that we can point to and say this is what happened. There’s no dramatic pop or tearing sensation. There’s just a gradual onset of pain and stiffness that worsens over time. Sometimes, the symptoms start well after a workout while we’re sitting at home on the couch or driving home from the track.” Sounds pretty unfair, huh? There’s probably nothing we can do about it, so we should just give into the sulk, right? WRONG. Come on, guys, this is the AlterG blog; defeat is a 4-letter word around here! So buckle up, because we’re hopping aboard that Achilles pain-train, and we’re not getting off until we de-rail this thing.
Turns out, there totally are warning signs for impending Achilles doom. At a glance:
- Stiffness and Tightness– apparently (this was news to me) loud, office-disrupting crepitus is not a normal part of a healthy runner’s day. Neither is an altered, shortened gait that doesn’t loosen up for the first few miles. Are you losing training partners due to complaints of your new, loud-stepping, Hulk-esque running style? You might want to check on that Achilles.
- Clumsy stride– Are you finding that your stride is starting to resemble that of a drunken sailor? Or perhaps a manic Labrador puppy that hasn’t quite grown into its feet yet? Are you clipping the inside of your ankle and slamming your toes into the ground? First of all, cut it out. Secondly, check on that Achilles! These are all signs that you have some major dysfunction going on in your toe-off. When your Achilles calls it quits, your shins are left to pick up the slack, and they are not qualified to take on that job. So, not only are you descending ever-deeper into that Achilles pain-cave, you are also setting yourself up for a myriad of other compensation injuries, such as shin splints, stress fractures, or new tendinopathies.
- Gross(er) feet– Let’s face it, no runner is going to win an award for “prettiest feet.” But also, that is a pretty weird award; like, in what situation would that even come up? Would you put that on your resume´? Would you hang the plaque over your fireplace and make awkward small talk about it with your dinner guests? We can revisit those disconcerting questions in another blog… But for now, the takeaway is to pay attention to new blistering and callus patterns on those well-worn hooves of yours. These abrasions are signs that your feet aren’t working the way they’re supposed to be. As Leigh Boyle puts it, “An easy way to look at it is this: When the foot makes contact, it ‘rolls’ to absorb impact and transfer it from the outer part of the foot over to the big toe to prepare for push off/propulsion. This allows the ankle and calf to do the heavy lifting. If you’re getting new blisters in the same spots or calluses, then something is off and that foot is ‘rolling’ more/less than it should.”
Take a moment to reflect on this three-pronged Achilles alarm system. Don’t make the same mistake I did. Don’t give into the warm embrace of obstinacy. Don’t be that chill little octopus; be vigilant! There are sand monsters and Achilles demons lurking where we least expect them. Hopefully, this post will help some of you out there from joining the ranks of the Achilles-afflicted. For the rest of us, there is still hope. Next week on the blog, I will be going over some key intel for winning your own Achilles battle. There will even be some gravity-defying fun involved (but sadly, no magic ponds). Stay tuned for that, and stay strong, my fellow tendon-troopers! Now, it’s time for me to go find my coworkers; I haven’t made a dad-joke since that last meeting, and I don’t want them to get worried about me.