Runners with Achilles and Calf Issues...What do we do? A response to a reader's question

Uncategorized Nov 16, 2019

Recently, one of our readers reached out with a great question: 

Readers Question

"I currently have a few marathoners who seem to be having recurrent Achilles tendinitis and gastro/soleus strains.  I have tried stretching, Graston tech, eccentrics, and other traditional exercises / treatments.  Any suggestions on what to look or suggestions for training modifications would be greatly appreciated. "
 
 

Our Response

You're doing a lot of great things already.  Keep up the great work! This can be a population that is often really easy to help....or really difficult and challenging.  Here's a few things you can look into and see if any of them may apply to your runners.
  • Here's a blog we wrote that summarizes some of the literature and give ideas on plans for insertional achilles issues:  https://www.certifiedrunninggaitanalyst.com/blog
  • Types of runs: One really big thing for this group is to limit their hill running initially and then slowly...
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Treating Runners (and others) with Insertional Achilles Pain: Why We’ve Been Doing It All Wrong

The Struggle

For years, I despised treating the insertional Achilles tendon pain patient.  I tried everything I was told by different gurus.  One well-established ankle and foot orthopedist swore by heel lifts and prolonged stretching off a step: 3 minutes, 3x/day and you would get better.  The next told me to place patients in a walking boot to unload the insertion.  Another podiatrist requested I ultrasound and ice massage them.  My PT Mentors told me to exercise them.

At this point, my head was spinning and I begged not to see these patients anymore.  Finally, I began to see the light.  For some reason, this condition is poorly understood, causing it to not be treated properly.  To effectively treat it, we really need to understand why it is happening.

Understanding the MOI

It is not that the Achilles or calf is too tight as many had suggested to me.  It’s certainly not that we only need a modality-based treatment plan.  A...

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The Test You're Missing With Your Runners

core running Aug 27, 2019

Treating runners can be a difficult task.  There are many types of injuries and they originate from a number of different areas. Is it a running form error? Is it weakness? Maybe something is too stiff?  The number of possibilities is partially why so many runners struggle to return to activity.  We discuss this throughout our running courses as look at the ACE Running Readiness Assessment to identify the “weak link(s)”.

Here, I wanted to talk about the Unilateral Hip Bridge Endurance Test¹ and its amazing utility in runners with knee pain, back pain, and many other issues.  If you’re not familiar with the test, you can watch me explain it below.  On the surface, the test appears to be a simple test of the glute max, but as you look deeper, the knowledge you can gain from this is extraordinary.

 

 

The first step of the test is to perform a bilateral bridge.  At this point you gain a few points...

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The Building Blocks of Running: Posture

posture running Aug 27, 2019

 

I constantly see runners working on their core.  They do planks.  They do sit ups.  They do a terrifying exercise because they saw it on the internet.  They all hear that they need a strong core, so they strive to achieve it!

As a clinician, I also see a number of non-runners, many of whom have heard the same thing.  Build your core.  Sit with better posture.  Both groups typically have a misunderstanding of what this means.  In fact, I think most of us have struggled through the years at exactly what this means.

Posture is one of those things that gets talked about endlessly, but few truly understand what it means.  We constantly hear, sit up straight, stand up tall, but the fact of the matter is, this isn’t what good posture means!

Good posture is being able to adapt to the demands of an activity.  It is not bad to sit for an hour, slumped in a chair to relax and watch a movie.1  It may be problematic for a 40+...

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Running Issues? Maybe You’re A Collapser

collapser it band knee pain May 24, 2019

Running seems simple.  All kids do it, so we should all do it well, right?  Unfortunately, many of us develop compensations that can correlate with issues.  One of these common
compensations, we like to call, “The Collapser”.

The Collapser is exactly what it sounds like.  Someone who conforms to the ground way too much.  They absorb force in an alternative plane to the sagittal, leading to abnormal forces.  How important is this?

Let’s look at what a Collapser looks like first.  You’ll notice the 2 hallmark signs of a Collapser (Picture to the Right):  Pelvic drop and an adducted/internally rotated hip. 

Typically, a runner will have one or the other, but you’ll note that this runner has both.  This can correlate with anterior knee pain3, lateral hip pain1, and a host of other issues.

So back to why it is so important.  When we walk, 3x our body weight goes through our knee.  When we run, this...

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