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

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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