Hi, good evening, everybody! My name is Maryke. I'm one of the physiotherapists
from treatmyachilles.com, where you can get online physiotherapy treatment for your Achilles pain.
So, tonight's session is about how you can avoid recurring Achilles pain; and it's in
reaction to one of the questions that somebody posed in the Group … or posted in the Group;
the Sports Injury Physio … no, sorry, just the Sports Injury Group in Facebook. If you’re new
to the lives: if you have any questions, pop them in the Comments, as you join the live,
let me know that you're there. And if you're having any trouble with sound or … Well,
if you have trouble with sound, you won't hear me at the moment. But if you have any trouble with
sound or visual, just let me know in the comments, because Facebook freezes this image for me, so I'm
not quite sure if it works or not. So, the things that I'm going to discuss tonight are the main
things that I feel people don't quite get right, and then they over-strain their Achilles again and
the pain comes back. And the first one is that you have to learn from the past. The second,
we're gonna look at how you can strengthen your Achilles properly – and emphasis on the word
properly. Thirdly, we're gonna look at slow return to running: what does that actually mean? Then,
we're gonna look at how to analyse your training programme and your training volume and stuff so
that you don't over-strain your Achilles. And then lastly, we're going to look at why taking a break
from training for a short while can be a problem or may pose some danger to you. Excellent! So,
learning from the past. I'm a firm believer that if you understand why an injury occurred
in the first place, you can one, prevent it from going back, and two, treat it properly. So,
you have to go and look back at what caused your specific Achilles injury. Now remember,
Achilles tendinopathy or tendinosis or tendonitis, depending on what you want to call it, is an overuse
injury. So, what that means is, you've done some sort of training that was too much for that tendon
to cope with. And it can be acute overload – so, it may be a session that was extreme compared to
what you’re used to; so, if you've done a really hilly long run and you're not used to that,
or loads of hill reps or loads of sprinting when you're not used to fast running,
that can cause an acute overload of the tendon. But it can also be a cumulative overload; so,
slowly happen over time. And that's usually when you don't get your recovery periods right. So,
remember that normal part of training is that we get micro-trauma in our tendons, our muscles,
or joints, everything. And that's normal, because that's the way the body then repairs this and
rebuilds itself stronger. So, that's how you build bigger muscles and stronger tendons. But you need
a certain period of time to recover from your bout of exercise. And if you don't give it enough time
to recover, you end up with condition ... overuse injuries like Achilles tendinopathy. So, go and
have a careful look at what you did: Was it your training? Was it shoes you wore? Was it … What was
it that caused your injury? Secondly, you have to strengthen your Achilles tendon properly,
and then you have to make sure that it stays strong throughout the rest of your life. So,
what do I mean with properly? Now, as soon as you injure something, the capacity of that
structure – in this case the Achilles tendon – to deal with load decreases. Because remember,
it used to have hundred-percent fibres that's nice and strong and can deal with the loads you put
through it when you run. Now you've injured part of that. So now it's about 80% of the fibres that
can do that; the other 20% has to be replaced by new, strong fibres through the body. And
the first fibres that are created aren't ever as strong as they should be; they grow stronger over
time as you strain them carefully. So, the other important thing to remember is that when you run,
forces of ... in the vicinity of three to six times your bodyweight go through your Achilles tendon.
So, if you can do three sets of ten of single-leg heel raises and you think you're strong enough to
go and run on that Achilles, then think again. Because that may not be enough for the load that
goes through it during running. And that's why a lot of people re-injure themselves as
soon as they go back. So, you've got to make sure that the volume of strength training as well
as the weight that you … or the intensity that you put through it actually is enough to
get you back to running. How much strength training or volume or intensity you've got
to do will depend on your specific circumstances. When I rehabilitate somebody who's in their 50s,
60s and just want to jog over the weekends, the programme I use for them and the goals we set for
them are very different from somebody who's quite a high-level recreational athlete or a triathlete
and needs to be able to sprint and run fast for ten kilometres or so. So, you've got to make
sure that whatever you want to be doing with your running, your strength training actually caters
for that. Yes, so that's the main thing about the strengthening: Everybody knows that you've got to
do strength training for the Achilles tendon, but make sure that it's actually enough before
you go back to running. On that note: As soon as you start introducing the running, you've got to
kind of cut the strength training of the Achilles back – not necessarily the intensity but just the
volume. Because now the running also counts as strength training. So, usually what I do then is,
I switch people onto a slightly more intense programme, so the Achilles exercises they
do are a lot heavier and harder, but they do them once a week maybe, or twice a week, depending on
the rest of their training. So, make sure that you keep a maintenance dose for your Achilles
in there. We did a research study – gosh it must be about two years or so ago; we’re just in the
process of trying to get it published – where we looked at, if you make people do the strengthening
exercises for the Achilles tendon – heel raises – what happens in an Achilles over a period of time.
And it was patients who had Achilles tendinopathy in their tendons. And the ultrasound scanner that
we used could also show you the stiffness of the tendon. Now, we know from the research that when
you've got an Achilles tendinopathy, the tendon loses some of its stiffness and that's ... essentially
it becomes a bit weaker. What we found was that everybody’s Achilles tendons gradually became stiffer
through the exercises, which is what we want. But interestingly enough, it didn't reach its
full potential yet at 12 weeks. And then, when they stopped doing the exercises, it de-trained
and regressed again. So what that showed us is that you likely have to do the strengthening
exercises for a lot longer than just 12 weeks to fully rehabilitate your tendon. Doesn't mean you
can't get back to running by 12 weeks, it just means that that tendon is not fully strong yet,
which leads me on to the next point. It's really important when you do go back to running that you
make sure you don't increase it too quickly. Every running session you do when you return from injury
actually acts as a strength training session as well. But now remember, the capacity of the
tendon has decreased; so, it can't cope with the same training loads you used to be able to do. So,
you've got to make sure that you have a lot more rest periods in your training week than what you
would normally do. I usually don't get people back to running more than maximum three times a week,
depending on their tendons, depending on their fitness level. If there's somebody who is
relatively fit and light, then I may get them back to three times a week running; also depending,
of course, on what volume of running that is. If it's a run-walk, then they should be okay
to do it on alternate days. But yes, make sure you build in enough rest period in that initial
phase especially, so that your Achilles tendon can recover fully, because then it will grow stronger
after each run session. But if you don't, then it will create pain again. What else is
important there? I've written a few things down. Yeah. And basically what I've written there is:
Just forget about what you could do before you had your injury; because remember, that tendon … it's
strength has decreased, so you've got to rebuild that up again. Then, analysing your training:
People who train at a high volume and are quite competitive are usually really good with logging
their training, and they know exactly what training volumes they do; they plan their training in advance,
they know when they're gonna put in strength ... speed sessions and things like that. What I find
is that my recreational athletes, who's not … who aren't that competitive, often just like to run
for the sake of running; they tend to go on feel, they don't always even time themselves when they
run. That is great, but the problem with that is that you don't have anything to look at to quickly
tell you whether you are heading for overtraining or not. And especially with novice runners, what
I find is, they see a massive improvement in their initial fitness, and it's usually in the form of,
“Oh, I can run a Park Run.” And then it's, “Oh, my time for the Park Run is coming down!” And
then they try to push those times, doing way too many fast runs. So in the end, some of them end
up doing a quick run with every single run they go out for, and that's not how it works. If you want
to do high-intensity sessions, really, when you’re new to it, it's about one a week, otherwise you're
heading for overtraining again. So, the big thing with analysing training is that it's not just the
volume of training you've got to look at, it's also how many intense sessions or hard sessions
you're doing. Because remember, the Achilles tendon works the hardest when you're doing
things like hill sessions, fast running, track sessions. Anything ... We're talking about runners,
so it doesn't really apply, but anything that would have had hopping or jumping in it ... again. So,
you want to have an idea of the volume of that that you do, and make sure that you don't
increase that too much. So, as a rule of thumb, the research tends to say that if your training
volume is low and the intensity is low, you should be safe to increase it by about 20% per week.
But if your training volume is large and your intensity is high, then it's better to just stick
to a 10% increment of increasing the intensity or the volume per week. The easiest way to analyse
your training is to ... Like, for instance, I use a Garmin watch, I use the Garmin app on my phone.
As soon as I've run and I connect to the wi-fi, this thing uploads it as I'm unlocking the door still.
And then, if I want to look back at my training volumes, it throws out a lovely graph for me,
and I can see that it goes up over time or it goes down or “Whoops! There was a gap of my training!”
or actually there was a massive increase in training this week compared to last week. And
that doesn't have to pose a problem, as long as you know that the following week you should
then pull back a little bit and give it time to recover again. So honestly, if you're not in the
habit of tracking your training and looking at what you're doing, then I would really,
really, really encourage you to start doing that, because that is where most people go wrong. Okay,
that's basically what I wanted to say there. So yes, just on the same note there: Another
problem that I see often in my novice runners is that there are loads of training programs available for
free on the Internet. And that's great, but you've got to remember that somebody who has trained for
quite a few years and is really fit recovers much quicker, and their muscle fibres and tendons and
things have a much quicker or better ability to recover from training, and they don't get as much
damage. So, if you're relatively new to training – and I will class any runner who's within … who
started within a year ago, running, that's a new runner still – your tissue won't repair as quickly
as people who are more trained or have more miles in their legs. So, a programme that you take off
the Internet may not actually be right for you; it may put in too many run days, it may have too many
high-intensity sessions. And it's not that there's a problem with the programme, it's just that it's
written for somebody who's at a different stage of their training than you. So, make sure that the
programmes you follow are actually appropriate for yourself. And try not to listen too much to
what other people tell you you should be doing; go according to what you feel in your body. If you're
knackered, then it's not the time to go do another training … a sprint training session. You've
got to start reading your body and understanding when it's tired, it needs to rest. Trying to push
through it will just lead to some sort of injury. Now lastly, watch out for breaks in training. And
this ... with this I mean things like, for instance, if you've had a cold for a couple of weeks and you
didn't manage to go out running or if you have had to travel a lot with work or just crazy with exams
and you couldn't quite get out there and training. It is literally a case of if you don't use it,
you start losing it. Now, don't get paranoid about this, but it is just that, as soon as
you don't do exercise for a week or two, you start losing the strength in your muscles, your tendons,
your ligaments, everything; because the body goes “Oh, we don't need it to be this strong;
I'm not going to waste energy on it.” So then, you get a detraining effect. So, all that means is,
if you've had a break in your training, don't go, Bang! Right in where you left off! Have a look at
what you could do, and reduce that by a certain percentage, and just ease back into it, and take
a couple of weeks to get back to where you should be. The more experience you get with running and
with training, the better you'll get at this. But the biggest mistake you can make is going back
after illness or a big break and try to jump right back in where you left off. There was something
else that came into my mind as I said that … Let me just quickly think … Breaks in training … Oh,
it's just gone out of my head now again … No, it's not coming back. Okay! Well, let me know if you've
got any questions. As always, if you ask them in the Comments, if you can tag me - Maryke Louw - in there,
I'll make sure to answer them for you, and yeah, especially if you're watching this on
replay. And remember, if you need help with any Achilles injuries, you can also consult
us via Skype. We do all the consultations via video feeds; so, we can see you move, we can do
all the tests that we would do in clinic, and then we can help you with … work out a bespoke
training programme that can help you get back to running. Excellent! Take care! Bye-bye!