Stiff and sore Achilles Tendon in the Morning?
Written by James Naughton 05/05/23
Does your Achilles tendon feel stiff and/or sore when you take your first few steps in the morning? This may be a sign that you have Achilles tendinopathy. This blog will help you understand why it feels like that and what you can do to help the healing process.
So, what is Achilles tendinopathy you may ask?
Achilles tendinopathy (AKA Tendinitis) is a term which describes pain and dysfunction within the Achilles tendon predominately caused due to overuse injuries in recreational and professional athletes. Studies have shown that Achilles Tendinopathy can affect up to 29% of middle- and long-distance runners (1). The Achilles tendon connects the muscles in the back of your calf to your heel bone.
There are two types of Achilles tendinopathy:
1. Mid-portion Tendinopathy affects the middle section of the tendon.
2. Insertional Tendinopathy which affects the bottom of the tendon where it attaches to your heel.
What causes Achilles tendinopathy?
Achilles tendinopathy occurs when the demand placed on the tendon exceeds its ability to cope with the current workload. Sharp increases in running distance, running hills when you are used of flat surfaces or going for run after a long period of inactivity are common causes of excessive overload which may lead to Achilles tendinopathy. Often, once the tendon becomes irritated then any action using the tendon can provoke pain. Symptoms are usually amplified upon weight bearing after long periods of rest and can prove difficult to manage if not addressed.
What can you do to help the healing process?
Firstly, you need to calm down the tendon, which means initially reducing activities that provoke pain, not stopping totally but just reducing the total workload. In the meantime, starting some gradual exercises will enable the tendon to get stronger and increase its capacity to handle workload and will also help reduce pain. It is important that the rehab exercises are set at correct intensity for your Achilles tendon. A typical rehabilitation program should start with low load exercises that will gradually increase in complexity as your tendon recovers and gets stronger. If you wake up in the morning and your Achilles tendon is significantly stiffer and/or sorer than it usually feels, it can be a sign that your exercise program/activities you done the previous day were too much for the tendon. Monitoring 24hr pain/stiffness response can be helpful to ensure your rehab exercises are pitched at the correct intensity for you.
Rehab programs must be tailored so the exercises are pitched at the correct intensity for your current symptoms. Exercise therapy is the most evidence-based treatment for Achilles tendinopathy (2). With the help of your physiotherapist a rehab program can be designed to help kickstart the rehab process.
In conclusion, there are 3 key takeaways:
1. Achilles tendinopathy is an overuse injury where sharp increases in training load exceed the tendons capacity to cope with the workload.
2. Activity modification and getting an individualised rehab program are two important first steps kickstarting the healing process. Rehab exercises will promote better regeneration of the tendon tissue than complete rest.
3. If your tendon is stiffer and sorer in the morning than normal, this may be a sign that the previous day’s activities were too much for the tendon. Monitoring this 24hr pain/stiffness response provides valuable information to ensure your rehab plan is pitched at the correct intensity.
References:
1. Janssen I, van der Worp H, Hensing S, Zwerver J. Investigating Achilles and patellar tendinopathy prevalence in elite athletics. Research in Sports Medicine. 2018;26(1):1-12.
2. Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. Journal of Foot and Ankle Research. 2012;5(1):15.
Why are my shins so sore when running?
Written by James Naughton 28/04/23
Do you have radiating pain down your shins which gets worse when you ignore it? You might have shin splits, aka medial tibial stress syndrome! The pain is mostly felt on the lower 2/3 of the inside aspect of the shin.
So, what's causing your shin splints?
Shin splints can have multiple causes, but the most common symptom can be pain when running. The muscles responsible for dorsiflexing (raising foot) and supporting the foot’s arch during weight bearing exercise, tibialis anterior and tibialis posterior can play key roles in the onset of shin splits. When these muscles can’t handle the workload placed upon them (e.g going straight into a 10k run after a long period on inactivity or a sharp increase in running mileage), shin splints may occur! Initially it may feel as if the muscles are just tired and sore, but this can develop into excruciating pain if not addressed. It has been shown that up to 35% of new recruits to running can develop shin splints (1)
How to differentiate between shin splints and other running-related conditions
If you are new to running, building up your mileage gradually is important to avoid aggressive spikes in training load. It’s important to note that not all pain in your lower legs is due to shin splints. Differential diagnosis may include a stress fracture (a microfracture). Shin splints are more likely to feel stiff/sore in the morning and the pain tends to radiate down the length of the muscle. A stress fracture may be less painful in the mornings, but this pain will increase throughout the day as you are weight bearing. A stress fracture also tends to be more pin-pointed pain in your shins. A one-legged hop test can be a simple test used to differentiate between shin splints and a stress fracture. A runner with shin splints can usually hop 10 times on the affected leg. Conversely, a runner with a stress fracture cannot hop without extreme pain. It is important to note any severe cramping, burning pain, numbness, pins, and needles on the calf and shins as this may indicate chronic exertional compartment syndrome which will require you to seek immediate medical intervention.
Management of your shin splints
The management of shin splints is focused on activity modification, with less repetitive weight bearing exercise. A graded loading exposure program can be developed with your physiotherapist. Increasing the calf complex’s local load capacity while improving overall strength focusing on key muscles are important aims when rehabbing shin splints.
The 3 key takeaways:
1. Shin splints are a type of shin pain, usually caused by sharp increases in training load. You will usually experience pain and tenderness along the medial aspect of the shin which gets worse if not addressed.
2. Modifying your running load is important to address the pain. This can be done by reducing milage, intensity and duration of the runs until your body adapts/recovers. A rehab program designed to improve strength and range of motion is an important step in the recovery process.
3. It’s important to visit your physiotherapist to differentiate between various forms of shin pain and receive the most appropriate treatment plan. Severe cramping, burning pain, numbness, pins, and needles on the shins and calf are signs to seek immediate medical attention.
References:
Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sports medicine. 2018
