Injury Focus Series 001

Updated: Sep 14, 2020

The Achilles Tendon

Happy early snow day here in Colorado! To date--we have written blogs about the story behind LEVER Running, featured athletes Marcin and Becki, and have introduced you (our reader) to how running with body weight support (BWS) affects your bones, muscles, joints, and aerobic system. During this next series will address common running-related injuries and the significant role that LEVER BWS products can play in the rehabilitation, and even prevention, of these common running injuries. We aim to release these weekly to aid you in you recovery from running injury!

We’re kicking off our Injury Focus Series with an article on injuries to the Achilles tendon, known collectively as Achilles tendinopathy. This article will be filled with a testimonial from a name we hope is familiar to our blog readers (hint: we featured her in our athlete spotlight series just a few days ago!): Becki Spellman.

What is Achilles tendinopathy?

The Achilles tendon is the strongest tendon in your body and connects your calf muscles to the back of your heel. Achilles tendinopathy is an injury to the Achilles that is marked by a dull ache which soon grows into a fiery and debilitating pain if left untreated. Typically, tendinopathy is split into two categories: tendinitis and tendinosis. Tendinitis is an acute, or sudden, inflammation of the tissue surrounding the tendon, while tendinosis is a degenerative condition in which microfibers within the Achilles are tearing, severely weakening the tendon and possibly leading to a tear or rupture in severe cases. The difference between these two categories is time: if left untreated the acute Achilles tendinitis can progress to chronic tendinosis.

How does Achilles tendinopathy occur?

While the Achilles tendon is the strongest and thickest tendon in your body, injury to this area is quite common among runners; Achilles tendons produce a lot of the force that is required to propel your body forward during running, walking, and jumping. Amongst runners, most injuries to the Achilles occur as a result of gradual wear and tear by repetitive movements and overuse, rather than a single and sudden explosive activity as in other sports like basketball or football (see photo of Kevin Durant after his sudden Achilles rupture).

Risk of injury to the Achilles is heightened by a sudden increase in the duration or intensity of runs, running in worn-out shoes (make sure you are rotating your shoes out after 350-450 miles!), and among middle-aged people, participating in sports only on the weekends (we love you, Weekend Warriors!). It can also be influenced by more subtle biomechanical issues, such as poor ankle mobility. Our spotlighted athlete Becki attests that her Achilles issues have been caused by a combination of overuse, poor dorsiflexion (ankle mobility), and a genetic component, too, as she notes her father struggled with Achilles pain as well.

Wear and tear on the Achilles can leave it weakened, dysfunctional, and painful. Considering a runner takes on average 1,400 steps per mile, it’s easy to see how a small issue can become a much bigger one and chronic. The moment you feel tendon pain, it’s important to rest and rehabilitate the area before it becomes a more serious problem as it could turn into more chronic running injury.

What does Achilles tendinopathy recovery look like?

If caught in the tendinitis stage, initial recovery typically follows classic RICE (rest, ice, compress, elevate) inflammation protocol, and the pain may be absolved within a few days. Awesome, you can return to running! However, a lot of injuries from running don’t resolve this quickly and can progress from here.

If the injury has progressed to tendinosis, the rest stage (no running, but cross training without pain may be appropriate) may last for weeks or even months before pain in the tendon begins to alleviate. In both cases, it’s important to treat the source of the injury during the rehabilitation stage of treatment. This article by PodiumRunner provides some great rehabilitative solutions, however we recommend that you work with your doctor or PT to create a personalized treatment plan.

How can BWS and LEVER help my Achilles?

If you do get an Achilles injury from running or walking, Achilles rehabilitation is somewhat unique, in that the healing process is a recurring cycle of damage and repair and should be loaded-not unloaded like a bone injury. PTs and doctors often prescribe anti-gravity treadmill walking and running when returning from Achilles injuries. This is where LEVER enters. In strengthening the Achilles the goal is to progressively load the weakened tendon, while being careful not to enter the overuse zone that got you injured in the first place. The BWS provided by the LEVER system allows you to reduce the load on your Achilles if it is injured, and then slowly re-increase the load on your tendon as it begins to heal and strengthen itself.

What could Achilles rehab look like with LEVER?

Here’s how LEVER helped get Becki healthy: 6 weeks after having reconstructive surgery on her Achilles, Becki began running for 30 minutes at 75% pain-free using LEVER. She methodically increased her running time (monitored and prescribed by a doctor) until she could run 60 minutes pain-free. Then, she decreased the body weight support provided by LEVER to 80, 85, and 90% of her own body weight. Once she was able to run at 100%, she moved every third day outside, then every other, until she had finally weaned herself off LEVER as a rehabilitation tool, and started using it as a recovery tool while at full volume.

Once fully healed from her Achilles injury, Becki used LEVER to build up to 2 hours and 30 minutes of running in anticipation of her upcoming marathon. Using LEVER she was able to run faster and get her body more quickly attuned to marathon pace while staying healthy through her training cycle. LEVER was able to allow her to prepare for the 2020 US Olympic Marathon Trials while reducing the risk of re-injury to her Achilles. But what about me? If you have two fully healthy Achilles tendons, and the time to train consistently, you might not want to rely on LEVER to heal faster. However, even in the best of times BWS and LEVER can be used to recover faster and prevent niggles from being chronic injuries. LEVER is perfect for days when your legs may be sore, you need to get a secondary run in, or even after hard long runs, as Becki is doing now.

In this blog, we’ve explained what Achilles tendinopathy is, how it occurs, and potentially how to treat it with LEVER. We’ve also shown you how LEVER helped Becki get back to training and racing after an Achilles injury. We hope you find this resource useful and thank you to Becki!

Nell Crosby, M.S.

Saxena, Amol, and Allison Granot. “Use of an Anti-Gravity Treadmill in the Rehabilitation of the Operated Achilles Tendon: A Pilot Study.” The Journal of Foot and Ankle Surgery 50, no. 5 (September 1, 2011): 558–61.

Suchak, Amar A., Geoff P. Bostick, Lauren A. Beaupré, D’Arcy C. Durand, and Nadr M. Jomha. “The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon.” JBJS 90, no. 9 (September 1, 2008): 1876–1883.

Gojanovic, Boris, Phil Cutti, Rebecca Shultz, and Gordon O. Matheson. “Maximal Physiological Parameters during Partial Body-Weight Support Treadmill Testing:” Medicine & Science in Sports & Exercise 44, no. 10 (October 2012): 1935–41.

Medina Pabón, Miguel A., and Usker Naqvi. “Achilles Tendonitis.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2020.