A common injury for runners and triathletes is the Achilles Tendon.
With running and cycling we put a lot of load through the calf complex.
Sometimes this can lead to pain in the Achilles.
Here’s how I would rehab it as a triathlete:
Before we get into the framework, an anatomy reminder.
The Achilles tendon is the large common tendon coming from the calf complex and attaches into the heel. It’s made up of the peroneal and gastrocnemius muscle. These muscle groups are responsible for pushing the foot down into the ground.
As a runner the calf complex is key for generating force.
Which is also what can lead to irritation and pain.
Step 1 - Calm down the tendon
The first step in this journey is getting the tendon to calm down.
As a triathlete, this is going to mean a short pause in running.
But as I was telling one of my athletes this week you can build a robust cross-training routine with swimming and cycling.
This is also a great time to revisit your recovery habits. Your training load, sleep and nutrition can all play a role in managing your pain.
The other thing that can be helpful for the calf complex is a trial of heel lifts. There can be some benefit to lifting your heel to off-load the tendon slightly. (You can also achieve this with higher heeled sneakers).
I use this as a temporary fix and only when we can’t seem to calm the tendon down at all.
Step 2: start initial loading of the heel
Early in your rehab phase, we want to start loading the calf.
Tendons respond well when we increase the load - gradually.
A progression I use a lot:
- ISO wall pushes
- ISO lunge hold with heel raised
- Step heel holds
- Flat ground heel raises (single and double)
My goal in the clinic is to find a variation that you can do that does not flare symptoms up but starts to load the area.
Once you can tolerate these moves you’re ready for more load.
Step 3: Build the calf back up
When it comes to the calf muscle there are 4 big parts to re-building strength:
- full range loading
- heavy loading
- rhythmic loading
- plyometrics/jumps
Each one of these is critical in getting back to running stronger.
Full range loading
For these exercises, we are trying to take the calf muscle through it’s entire range. As a runner, you move through 10 deg dorsiflexion through to 50 deg plantarflexion. That’s a big range to train.
Some moves I like: step calf raises and Johnson (foot elevated raises).
Heavy loading
For these exercises, we are trying to increase the peak force of the calf muscle. In order to do that we need to increase the weight that you’re using.
Some moves I like: smith machine raises, DB step raises, and DB Johnson raises.
Rhythmic loading
The calf muscle works very rhythmically, so re-establishing a consistent timing of heel raise can be helpful. For this we are going to use one of the calf raise variations and add a metronome to pace your lifts.
A good starting point: 60-75 BPM, building to 90+
Plyometrics and jumps
For these exercises, we are aiming to increase your ability to generate force quickly and repeatedly (like running). A small dose of plyometrics is really helpful in building up the Achilles tendon.
Some moves I like: double leg hop, single leg hop, bounds and lunge switches.
Now that you’re building some strength it’s time to build back your running.
These can all be built into a full-body strength training routine with the right template.
Step 4: Return to running
As with any running the key is to have a gradual build.
Your goal is to slowly introduce more running while still respecting pain.
3 key things for the Achilles tendon:
- Keep running as rehab. Use other sports for building and maintaining fitness.
- Use a walk-run progression a the start. This can help you introduce more running while still monitoring pain.
- Watch your hills and speed work. These are going to be the most challenging on the Achilles and might be a source of a setback.
Start with this guide if you need help re-building your running.
That’s all for today.
Chandler
Ps. This mini-framework is just one of the potential calf issues that runners and triathletes face. You can get even more guidance with my calf pain rehab blueprint. Pre-order it here