If recurrent Achilles pain blights your training, Jenny Blizard has some tips to help prevent it

Achilles tendon problems can be the bane of an athlete s life. Studies show that half of all male runners suffer pain or injury to their Achilles at some point in their career and despite much of the evidence pointing towards calf-strengthening exercises to help cure the problem, many athletes often struggle to return to full training.

What causes Achilles pain is never straightforward and it is now known that the nervous system has a huge influence in an Achilles injury that fails to recover. In patients who present with a burning sensation around the Achilles, calf and foot when they are resting, for example, the root cause is often unrelated to loading of the Achilles and more linked to stress, loading of the nervous system when sitting down, tiredness and poor diet.

All long-standing problems will need some level of clinical investigation, but the following approaches should help to improve matters and hopefully offer a return to running.

HOW TO CARE FOR YOUR ACHILLES

Sitting down all day can cause problems. A person who habitually sits at a desk or on the phone all day may need the joints in the neck mobilising, which would then allow for more mobility of the nervous system and therefore less stress further down in the calf and ankle.

Direct treatment to the nervous system itself may be required, such as direct localised movement of the nerves along with massage.

A physio will be able to mobilise the soft tissue just below the knee, which sits superficial to the tibial nerve, while the athlete maintains a calf stretch.

It s really important to reduce sensitivity in your nervous system. Good sleep patterns along with healthy eating and drinking habits are the simplest ways to do this. It is important to stop obsessing about your Achilles pain; if it is a nerve-related problem, this will only serve to increase the cycle of sensitivity. In practice, I have found many athletes achieve symptom relief from acceptance that their nervous system is sensitised, helping the path to recovery. Focus your thoughts on positive treatment.

Massage the calf muscles regularly. You can do this yourself and it helps to reduce sensitivity around the nerves by keeping the calf muscles relaxed.

Stretch the gastrocnemius muscle as shown in the calf. Often athletes do this by extending their knee and leaning into a forward stretch. A much better way is to keep the knee flexed and to extend the hip and ankle, then add in knee extension at the end. It is much more effective and helps to mobilise the tibial nerve behind the knee, a common area for restriction in resistant Achilles problems. Hold briefly for two seconds and release before repeating 20 times.

Full recovery can be a lengthy process, yet you should be able to return to running again pretty soon. In my clinical practice, I don t advise people to stop running for this type of problem, but to reduce the length and intensity of runs. If the nervous system is the source, it responds more favourably to predictable healthy routines. Running daily, steady for 30 minutes is preferable to running two times per week for longer periods and then resting in between.

Jenny Blizard is a chartered physiotherapist who competed for GB in athletics, triathlon and duathlon. For more, visit blizardphysiotherapy.co.uk

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