I have been lucky to avoid major injuries for most of my time as a runner. The two exceptions have been (a) an Achilles problem in my mid-thirties and then more recently (b) and Achilles problem in my mid-forties. So perhaps you could say that tendon is my, er… one particular weak spot. Please note this post a summary of my personal experience with this, not necessarily an advice piece for others, although there may be some general lessons that are useful.
The recent incidence of Achilles tendinopathy came about just as I was finishing my peak training period before the 300km Northern Traverse. Generally I’d been feeling on good form and everything had been going well. Then, as I started to taper, my heel started hurting on what was a fairly easy-paced, flat run. Ever since the previous Achilles problem, I’d stretched my calves pretty diligently after running and that had kept it away, but that didn’t seem to be enough this time around. I followed what had worked last time – keeping active, running gently and stretching after, and the problem eased but didn’t entirely go away. I adjusted my taper to be as kind to it as possible without entirely laying off. I turned up at the start line reasonably confident it would be ok.
Let’s point out the obvious. Perhaps running 300km on a dubious Achilles isn’t a great plan. On the other hand, I’d say over several years of churning out lots of running, regular ultra efforts and races, there’s usually been some kind of niggle and generally it has sorted itself out through stretching, strength and conditioning, and even the godawful spectacle that is me attempting yoga. During the race, I could feel some minor twinges early on but they went away. Around half way I caught my foot awkwardly, over-extending the tendon, and it complained a bit thereafter, and then with about 40km to go, it began complaining rather more noisily, but I was (kind of) almost there by then. I finished with a limp, and the swelling was big enough to cause blisters where the swollen cankle met the rest of my foot.
The Achilles problem then led to a longer layoff than normal. Even after a really big effort, I have normally waddled around a 5k or similar before a week has passed, and then gradually built up from there. Fast recovery has generally been one of the strongest aspects of my running, but not this time. I had three weeks completely off, and wasn’t even walking normally – in general I wasn’t using the Achilles, and therefore keeping my heel on the ground rather than pushing off my toes. That had a double effect on my running subsequently – recovery took longer, and by not being able to generate that push from the toes (part of the “triple extension” where good running form uses power from hips, knees and ankles), my running was both slower and more effortful.
The twin-pronged approach which built the tendon back into working condition is as follows:
- Specific exercises to rebuild it – drawn from the NHS website. Improvement has been gradual but noticeable – for example in month 3 of recovery I could do a single-leg heel lift with just a hand resting on something for stability – basically where you lift your body weight via the Achilles.
- Actually running. Faster flatter running was more of a problem as it required that painful push from the toes. But I discovered slower-paced hilly runs, which happen to be my favourite, were fine provided I didn’t stand up on the toes of the problem foot (until the progression described above kicked in). So it was fine on my 2-day jaunt to Scotland toward the end of month 2, and even more surprisingly, fine with the 87km run across the Bannau Brycheniog roughly three months after the Northern Traverse.
The runs actually made it feel better as well – part of the reason being that blood flow is an essential part of recovery. There isn’t much blood flow around the heel, so exercising will promote recovery. It wasn’t 100% pain free on these runs, but the key thing is to restrict yourself to activities where any discomfort is minor (up to 3 on a scale of 0-10, where 0 is no pain and 10 is excruciating). Over time, the discomfort has gone down, then strength in the tendon has gone up, and corresponding its been easier to run at a somewhat brisker pace.
Another good piece of advice, from the NHS and elsewhere, is that progress won’t be linear, and I have certainly found this. I have sometimes encountered a small backwards step despite the overall progress, and my advice would be not to get disheartened by this. Trust the method, stay diligent with exercises, and stretches, and do a bit less if you need to. Overall it has been going the right way. Also my experience has been that I’ve lost fitness through the combination of the injury, the longer layoff and naturally being tired after a big effort – it’s ok to have dropped a few levels and rebuild. One of the reasons for sharing this blog post is to show that nobody is indestructible (I have been extremely consistent, certainly over 8 years or so), but there’s always a way back from injury, especially if you take the right steps.
In terms of training again, it’s been a useful experience in that it’s helpful in identifying a bit of weakness and imbalance down my right side – my right leg in particular is less flexible and weaker than the left, which perhaps is why the Achilles on that side went first. So there’s one thing to work on. I’ll need to think about re-introducing speed work – the result of running slow for a while is it’s harder to pick up the pace and my “cruising speed” has become slower. For self-coaching (is that a thing?), I need to carefully transition from recovery and gradually feed in some more focussed training. But, now 4-5 months after the big race, I’m at the point where that looks feasible. (The NHS advise recovery from Achilles tendinopathy can typically be 6-9 months.)
So, what caused it? There are numerous possible causes of running injuries, many of which stem from a too-abrupt increase in training in some way – basically an increase in volume or intensity that is too much. I don’t think that’s it for me, my race training was unusually structured and built gradually. If anything, I probably don’t do enough high intensity activity. Having reflected, I think it may be the shoes (what’s that about bad workmen?) – I had new trail and road shoes in circulation during my training, one of which was zero-drop, and one had an unusual shape around the heel. This is a theory rather than a certainty, but I think I need a certain amount of heel stacking to prevent this kind of injury. (The “drop” is the difference in height between the heel and toe inside a shoe – most of my shoes have a 6mm or more drop. There’s nothing wrong with zero-drop in principle, but it does depend on the runner.) In my earlier injury (10 years or so earlier), I also had used some similar shoes, and attributed the problem to a lack of stretching, but now there’s a small pattern emerging. I’ll go back to shoes with a 6mm+ drop and see what happens.
Final thoughts? In some ways it’s been sad times – having peaked earlier this year with a good performance in the Northern Traverse, the rest of Spring and all of Summer has been somewhat shadowed by injury. But, it’s unrealistic to do this kind of thing for years and not expect anything to go wrong. I’ve also been lucky to be able to be able to have some fun solo adventures and still do club activities such as organising the Marple Runners’ trail series.
A good demonstration of a positive way of viewing these things was Ben’s Fleetwood Lakes 40 in July – I wasn’t on good enough running form to do my usual thing of running a leg or two of the challenge, but had a really great day doing a combination of road support and some gentle runs out to the hills to resupply Ben en route and run shorter sections with him. I’ve always fancied doing road support, having a day out in the mountains with some cafe time alongside the mission of the day – and this was first time I’d actually done it. It’s always better to think about what you can do than miss or regret what you can’t, and this is the perfect example.
