After 18 months of struggling with Achilles tendinopathy, Strong Women editor Miranda Larbi finally decided to hang up her running shoes for a month. The break, glucose monitoring prednisone she claims, has been transformational.
A year ago, I ran the London Marathon. It was my second time on the course, and after 18 months of cancelled races and failed marathon cycles, there was no way I was going to miss out. It didn’t matter that I could barely walk to the bathroom in the mornings or that each training run had to start with a coffee and two painkillers.
I got over the finish line in just under four hours, and curiously, after six months of daily pain, my Achilles tendons felt fine. And then… the pain came back.
Fast forward a year, and I’m finally getting to grips with the problem. I’ve run through the pain for 18 months – heading out three or four times a week without stretching and doing minimal strength work. But it turns out that pain doesn’t just go away.
In fact, it reached a climax while I was on holiday last month. Every morning, my partner and I set out on an undulating run before spending the day on the beach. During the last run, the pain had become so intense that I had tears running down my face. Limping back up the stairs to my flat, I knew I had to act.
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Achilles tendon issues are common among runners. Anyone who’s had tendinopathy knows just how frustrating it can be; your muscles might feel strong and your cardio capacity is good – but you’re at the whim of the tendons that hold everything together.
The Achilles tendons are the longest, strongest tendons in the body; they connect the calf muscle to the back of the ankle and you need them if you want to walk, run or jump. Because they don’t have a very good blood supply, however, they tend to be vulnerable to injury. If you run too much, for example, you can end up with tendinopathy (when the Achilles gets damaged and stops working as well as it should) or a full-on rupture (which doesn’t even bear thinking about).
I’ve got two sizeable lumps on the back of my ankles – signs of inflammation that don’t seem to get any smaller. Unlike other forms of injury (especially when the area is swollen) the near-universal advice on tendon trouble is that you shouldn’t rest completely.
Symptoms of Achilles tendinopathy include:
- Stiffness in your tendon (which is often worse first thing in the morning or after a long time spent sitting down)
- Swelling at the back of the ankle
- Tenderness when you touch your tendon
- Pain in your heel
- A creaking feeling when you move your ankle
I had all of these symptoms for months and still did nothing about it. The thing is, the more you run, the less pain you experience. The most painful part is the first 10 minutes of any run, and then the pain subsides.
I went to a physio before the marathon who told me that while I definitely needed to stop running long distances and spend time rehabbing, he’d never advise a runner to stop moving completely. That’s because while tendons might be sore and swollen, not using them at all doesn’t make them any more resilient. What you need to do is help them to adapt to load; you want to have stronger, more bouncy tendons that can cope with the demands.
Some experts say it can take up to a year to recover from Achilles tendon issues, and while I’m not fully recovered yet, I’ve made huge progress. Why? Because I ditched running and actually forced myself to do rehab for four weeks.
How to rehab from Achilles tendinopathy
First off, it’s important to stress that I have been diagnosed with tendinopathy by two medically trained physios, so if you are struggling with pain, make an appointment to see someone before you do anything else. They’ll be able to advise you on whether you need to have an X-ray or more dramatic intervention, in which case they’ll suggest you talk to your GP. Once you’ve got your diagnosis and have probably been shamed for not doing any strength or accessory work, you’re good to crack on with rehab.
Here’s how I managed to get back up and running without so much as a stride.
Swapping long run days for non-negotiable strength classes
For years, Sunday mornings have been reserved for one thing: long runs. Whatever the weather, I’m out clocking up the miles before 10am. This month, however, I’ve swapped that Sunday service for an 8.30am Blok Strength session at my local studio. It’s brutal: every week, I forget how early the class is, and by 9am, I’m sweating like a pig.
Over four weeks, I’ve increased every weight: I’m now comfortable using two 10kg weights for upper-body work, and two 15kg for lower-body work. I feel stronger and the DOMS that made sitting on the loo painful for the first week are nowhere near as bad or as long-lasting.
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Mastering bodyweight on WFH days
Once thing I’ve never really bothered with is bodyweight strength work. I’ve always just assumed that if you either did yoga, running or weights, then a 40-minute bodyweight strength class was a waste of time. Instead of my usual 5ks during the week, I’ve been joining bodyweight classes on the FIIT app.
Usually, they start off fine. You’re air squatting, doing good mornings, rotating… and then suddenly, the trainers have you doing two minutes of squat jumps, hand-release push-ups and a whole load of other plyometric moves.
The only plyometric exercise I do is running, but after four weeks of bodyweight workouts, I’m starting to realise that you need to do plyometric training in order to run.
Prioritising barre, hot yoga and pilates
A few weeks after the London Marathon, I went to see Adrian D’Costa at R&D Physio. I told him about my pain and after watching how I ran, he suggested that the issues being caused in my tendons and ankles might in some part be caused by weak calves and side glutes. In November, he prescribed doing:
- Single leg heel raises (3 x 12 each side)
- Side-lying hip raises (2 x 15 each side)
- Heel elevated bridges (3 x 8 each side)
I didn’t stick to the plan, and so, months later, I was still in pain. But remembering D’Costa’s wise words, I started going to barre and pilates, and found that I was drenched in panicky sweat within minutes of the class starting.
Barre is brilliant for tendon issues. It’s low-impact and minutely focused on strengthening the muscles that typically don’t get stronger from running. It targets every bit of the glute matrix while building muscle endurance in the calves. Small movements, such as standing for two minutes performing pliés with your heels raised, fire hydrants or clam pulses are wildly uncomfortable. You do similar positions in pilates, but I’d argue that barre is more lower-body-focused while pilates is more core-centric. Both are excellent for lazy runners who need someone to tell them what to do.
Spending more time on upper-body strength
While it’s my ankles that have been under fire, I’ve been spending more time in the free weights section working on other parts of my body. I’m normally someone who squats and deadlifts a lot, but I’ve been carving out sessions for building arm, chest and back strength. My theory is that if your whole body is stronger and your posture is right, you’ll be putting less pressure on the areas of the body that struggle with shock absorption.
This weekend, I had my first run in a month, and you know what? I was totally pain-free. I did a 10-minute warm-up of dead bugs, lunges and cossack squats, set off slowly and gradually built up speed. I managed to run 12k without so much of a wince.
Am I fully healed? No. I still get the odd twinge and I’m hyper-aware of the fact that my tendons could get worse if I go back to my old regime too soon. But I don’t actually want to run as much as I used to. I feel stronger and fitter than ever, and I’m actually starting to wince less in those weekly barre sessions. By November, I hope to be able to run a half marathon, but I’ll be approaching that goal cautiously and by prioritising all the strength work I’ve been doing over the past month. You won’t find me running four times a week. My focus now is on making sure that I’m able to run for years to come.
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