One of the most common questions that patients ask me when I'm about to discharge them
to get on with their running and things on their own is, “How do I prevent my Achilles tendon
from flaring up again?” So, there are three main things that I'm going to talk about in this video
that should help you to not have a flare-up again and just have a happy Achilles. So, for those of
you who don't know me, my name is Maryke. I'm one of the physiotherapists from treatmyachilles.com,
where you can get online physiotherapy assessment as well as treatment for your Achilles injuries.
So, have a look at the description of this video if you want a link to our website.
Good! So, first step to not flaring your Achilles tendon up or
getting it back once you've conquered Achilles tendinopathy is, do not make the mistake of
over-training your Achilles tendon with strength training because you're nervous of stopping it.
I often see this that, even after I've told my patients to cut down on the strength
training to a maintenance dose – because you always want at least one dose of heel raises,
quite nice and heavy, in your week to just make sure we maintain strength there –
I find that people still over-exercise it. So essentially, if we think of running and running
training: Initially when we do your rehab, you've got a high volume of strength training in there,
very low volume of running, if any. Now, as the tendon recovers and your strength training becomes
heavier and we start adding in running on top of that, we have to reduce the volume of strength
training you're doing, otherwise, if we count all of this load together, we're just over-training
the Achilles again, and then it will flare up. So, if you have been given the green tick to say,
"Your Achilles is pretty good now – just maintenance dose," try not to get into the
habit of doing your heel raises every single day because you're worried about it; you will do much
better if you pick one or two days in the week and do quality, heavy heel raises, but small sets. So,
using a weight that makes you tired within eight to ten repetitions and just doing three sets of
that will maintain your tendon’s strength for you. Now, as you build your running speed and your hill
repeat sessions and things, remember, those sessions act as strength training sessions
for the Achilles. So, as the intensity … or you start doing competitions … as
the intensity of your running and your training increases, then you have to bring the strength
training down so that it gets enough recovery time. Then, when you're in the off season and
you're taking it easy and you're not doing as much running or high-intensity running,
you increase your volume of strength training or intensity of that again to maintain your
tendon’s strength. So, there has to be an ebb and flow in that. Don't get panicked about your
tendon not being strong enough and doing too much strength training regardless of other training,
because that will be a mistake. Now, Number 2 is: Watch out for big breaks in training; that is when
the tendons are vulnerable, when you come back to training. So remember, when we don't train,
you lie on the couch for two weeks over Christmas holidays, just watching TV; what happens is,
you don't just lose muscle tone, you actually lose strength in all your structures of your body: your
bones, your tendons, your muscles, your ligaments, everything gets downgraded a tiny bit. Now,
depending on your fitness level to start with and depending on how long the break is, the decrease
in strength will be bigger or smaller. So, if you then go back into training thinking about
the last time you did proper training, what volumes and intensity you did,
and you just try to replicate that, chances are your tendon's not going to be quite strong enough
to cope with that, and you may very likely overstep the mark again and cause it to flare up.
Also bear in mind that it doesn't have to be total rest that detrains it; often, a lot of my patients
also – and that's sometimes the cause of their initial Achilles tendinopathy – is when workload
increases. So, you suddenly have deadlines for projects you've got to finish. So now you're not
running that regularly; you're doing one run here, one run there, just a three-miler here,
four-miler there, and then, when you have the moment, you go, “Right! Long run! 21 k’s
three days in a row,” or something, and it's just too much. Because essentially, if you look
back over the last eight weeks, you've done very little training on it. So, you've lost quite a
lot of strength in the Achilles tendon compared to when you were still able to train regularly
and really build the strength up in it. So, make sure … I know it's such a hard thing,
because when you go out for a run, you just want to enjoy it. But if you know you're sensitive in
that area and you've got a history that you've had an Achilles injury in the past, take note of the
training you did in the last four weeks, and use that as an indication of what your tendon can do.
So, if you haven't done very much, you're going to have to ease back into your training slowly and
probably leave the high-intensity runs for later on, once you've built up some strength again.
If, however, you've kept your training up, and especially if you've done some heavy heel raises
here and there consistently over the weeks in that period to kind of preserve the strength,
you may be able to integrate it more quickly. But that's really important:
Whenever there was a longish decrease in training, remember to increase it slowly again.
Okay, then the third one … I've just forgotten what it was … Oh yes!
The third and very obvious one is that you have to remember that recovery time, or recovery days,
are as important as training days. So, by far the vast number of patients that we see,
the main reason why they develop Achilles tendinopathy in the first place
is because they've over-trained, and usually not just in one session. But if you look back over
that previous year, they've usually had the best year of their life with regards to times they ran,
distances they ran, volumes they ran, and they usually would have had a good marathon or two in
there. But then suddenly their Achilles starts hurting, and it's because Achilles tendinopathy
can happen that you overload it in one session, but it's often a result of cumulative overload,
that you're not allowing the tendon to recover properly after each training session. So,
the best thing that you can do to make sure that you do not get Achilles tendinopathy again
is to make sure that you analyse where you went wrong, and you work in more recovery sessions and
more recovery times and habits into your training going forwards, because that's the best way to
bullet-proof it. So, three things to do to not get it back: One is, make sure you don't over-train
your Achilles tendon because you're worried about stopping or reducing the strength training;
keep it high-quality strength training but smaller volumes.
Two is, make sure that you whenever you have a decrease in your running training, you don't just
jump back into high volumes or high distances or intensity; you ease back into it. And three:
look out for those recovery days; make sure you get enough quality recovery and take note
of niggles and things that stay tight despite stretching and things, because that usually
precedes injuries like these. Very well! If you've got any questions, you're welcome to ask them in
the comments. But if you need more help with an Achilles injury, you're welcome to consult one
of us via video call – the link to the website is in the description of this video. Take care!