In this video, I'll be discussing whether or not you can run a marathon with Achilles
pain and in what situations the answer is yes and in what situations it's no.
My name is Steph. I'm one of the physios at treatmyachilles.com, where you can get an online
consultation for your injury and a personalised rehab plan. If this is something that interests
you, then please take a look at the Description of this video, and the link to our website is in
there. Here's a super quick recap for anybody who is new to our videos or hasn't watched any
of the other ones on our Channel. In very basic terms, your Achilles tendon attaches your calf
muscles to your heel bone, so it's a continuation of you calf muscle. It's impossible to strengthen
your calf and not your Achilles. You've got two main calf muscles, your gastroc and your soleus,
and they provide the force and the power, in order to move your ankle. The Achilles tendon attaches
those muscles to your heel bone. A healthy body is regenerating tissue all the time; so,
it's always breaking down old tissue and laying down new tissue. And that's how come we can train
and get stronger and fitter. So, when we train, we end up putting a demand on the tendon or muscles,
in which case the body recognises that the regeneration process needs to regenerate
it and build it stronger than last time. When you've had a high-demand training session or a
series of high-demand training sessions with not enough recovery, then that regeneration process
gets disrupted and you can develop an overload tendinopathy. If you're training for a marathon,
you don't need me to tell you that it's a great demand on your body. Apparently it's about
25,000 to 50,000 steps, depending on how fast you run and how long your strides are.
And if every step is broken down into what you're mechanically demanding on
your calf and your Achilles, you're landing and you're absorbing up to 12 times your body
weight in ground reaction force – depending on the study you look at – sometimes it's 6 to 12 times.
Then, you're having to push your whole body weight off the ground against gravity,
and that's a lot of cumulative load. Imagine doing 12,000 to 25,000 calf raises in one set. That's
essentially what you're asking of it. So, if you can't go up and down on your toes in your
house without any pain, it’s going to be a real struggle for you to go through a whole marathon.
But if we go back to our original question, which is, can I run a marathon with Achilles pain?
The answer really is that every individual case is different. So, I would always suggest that you
go and see a health professional, preferably one who is experienced in treating runners,
to assess your individual situation and give you the right advice.
I say experience in treating runners, because very easy for some doctors or some health professionals
to say, “Nope, don't run it!”. Because in some situations it might be okay, and I'm going to
give you two examples of patients I have seen with Achilles pain, one who successfully ran their
marathon and even got a PB, and the other that had to pull out. I'll start on a positive note,
with the one that did make it. So, this person was about three weeks until their race day. They were
getting very mild pain towards the end of their longer training runs, they scored an only two
or three out of ten on our sort of numerical rating scale, and there was some stiffness after a run.
However, they would go to bed; by the following morning there was no pain; it was back to normal.
When we did the heel raise testing, they didn't really have any pain; it was a little bit ...
there was some awareness there, but it wasn't painful. It didn't hurt to hop on it. They then
tapered the last couple of weeks of their training and they completed their marathon, no problems.
So in that situation, the pain is only mild. The symptoms don't last. It was more a case
of the calf and the Achilles actually being just about able to cope on the longer runs. But it did
just about cope, and that tapering time allowed it enough recovery to really be ready for the race.
Without the tapering time, perhaps they may have struggled a little bit more,
but as it was, that was okay. Whereas my other patient was, again, three weeks until race day,
but they were sore every morning for at least half an hour, hobbling, unable to walk properly.
Around the house, they had mild pain, and it was sore to do a single-leg heel raise. It was
painful to hop. It was very painful at the start of a training run. It would get better
and easse off for a little while, but the pain would return on the longer runs, further into the run,
and would steadily get worse. Every time they did a longer run, the distance
they could go before this pain came on was getting shorter and shorter, and there wasn't enough time
between where they were at and the three week race day for it to sufficiently rest, offload,
and rehab before the day. So, this person had a much more reactive and irritated Achilles tendon.
In an ideal world, if there wasn't a race, they would have offloaded it and then gradually built
the rehab back up again to the point where they could run without pain. But they didn't have that
time. As it happened, this person had trained for so long, they'd raised a lot of money for
charity. They did actually attempt to do it in the end, and … because they had passed the date
at which they could defer their entry … but they were unable to complete it and had to pull out.
So, that gives you a vague example of where people have been with this and when it's okay or not to
run. I think the main concern for a lot of people is, if they run it, will it rupture? So,
the considerations for that is that rupture is firstly not that common during running.
It's more common in sports like explosive sports, like basketball or soccer or tennis.
So, for example, in one study, they looked at the incidence of Achilles rupture, and during ... They
combined running, hiking and stretching together, that made up about 6% of sports-related Achilles
rupture, whereas basketball alone was more like 43%. So, it's less likely, and it usually comes
from an excessive sudden load or sudden stretch, but it can occur from cumulative,
degenerate changes, which is why, again, if you're very symptomatic for a long time, you really ought
to get it assessed properly and have a proper management plan rather than just running through
it, because that does put you more at risk. You're also more at risk of rupturing it if you've had
any steroid injections into the tendon or near the tendon, or if you've been on antibiotics such
as fluoroquinolones or ciprofloxacin, which has the side effect of degenerating tendons
when the antibiotics are in use … That's not all antibiotics; that's only certain types,
and it will say that in their side effects. It's also worth bearing in mind that a lot of ruptures
are completely asymptomatic before they happen. So, there's not really much you can do about
preventing that. A lot of people that rupture their tendons will not know that they even have
a tendon problem before it goes. So, it's very difficult to prevent something like that. However,
more commonly, it's just worth noting that the longer you're symptomatic for, the longer
the recovery takes afterwards. So, if you push through for many, many months, ignoring the pain
as it gets worse, it's going to take you a lot more months on the other end to try and get it
better than if you dealt with it fairly quickly in the first couple of weeks of developing the pain.
Anyway, I hope that's been helpful. As I said, if you want to consult us, then please do look
at our website. We've got lots and lots of good information on there with different videos and
different blogs. And also, you’ve got the option of booking a consultation with one of us so that
we can actually look at you as an individual and work out what you can and can't do.