Hi guys! In this video we're going to look at "prehab" exercises for Achilles tendinopathy. So,
exercises that will stop you from getting Achilles pain while you're doing marathon training. Now,
we're first going to look at what causes Achilles pain while you're doing marathon training:
Why do you get injured? Then we're going to look at what exercises may be helpful: How often you
should do them? What type of exercises? And also how this will vary depending on your training ...
the status as well as the part of your training year you're in. 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 assessments as well as treatment for your Achilles injuries.
Have a look at the description of this video if you want a link to our website. Okay, so
what causes Achilles tendinopathy or Achilles pain when you're training for a marathon?
It's overload ... overtraining. So the first step to understanding that is to
understand what happens in your body when you train. So if you look at this graph, the
line ... the stable line there is your strength at the beginning of your training session.
Now, as you train, you accumulate micro damage, so your strength in your tendons, your bones,
everything declines a bit. But then as ... when you stop training, your body rebuilds
that micro damage, and then after a while you're stronger than before ... you can train a bit more.
The problem comes in when you don't allow enough recovery time and that micro damage accumulates.
That's when you develop Achilles pain and Achilles tendinopathy. So the first and most
important thing for avoiding Achilles pain when training for a marathon is to ensure that you
do the work you should be doing before you get to training for the marathon. So, you can't go from
not running much at all to suddenly jumping into a marathon training program. You're very likely to
overload the Achilles. And it doesn't matter what exercises you do for strength training;
it won't really prevent that. So, it's important to build up to marathon training through doing a
few years of other types - shorter distances - beforehand. That's step one. Now step two. Yes,
specific strength training exercises for the calf and the Achilles tendon specifically
can help to strengthen that, make it more robust, and make it possible that it can bear more load
and don't overload that quickly, because the fitter you are and the stronger your tissue is,
the less micro damage it will get during the training and the quicker it will also recover.
Now, it's not rocket science what exercises to do. It's basically heel raises - over the side
of a step is a good way to do them - but depending on your training status you will
likely do it with either no weights, some weights, heavy weights. Now let's look at this whole thing
as a picture again. If you've not done strength training regularly throughout the year and you're
starting your marathon training program, this is not the time to start hammering your calves
and your Achilles with lots and lots of strength training at the same time, because it will count
towards the overload from the running. Your prehab exercise for the Achilles should start before you
start your marathon training actually, so, in the low season. So, typically if you look at an elite
athlete specifically, their training program. Through the year, they will have periods of
high volume but low intensity and just kind of ... they're building their base, and during that time
is when they will do lots of strength training to really make their muscles and tendons robust.
But as the intensity of their training then increases and they get closer to competition time,
the volume of the strength training decreases to allow their legs to recover,
although they will keep a low dose of high intensity strength training in there to just keep
that strength there. So that's the first thing: If you're not used to regular strength training,
it's not the time to start hammering it daily with strength training as you start your marathon
training. So, during marathon training, which typically is about 16 weeks or longer
depending on which program you take or you follow: maximum of two strength training sessions a week
and you want to make them count, so we're looking for quite heavy strength training,
but not lots and lots of repetitions. So you want to aim for being tired within about 10 repetitions
of your heel raise exercise. Now, someone who's not used to strength training the calves may find
that three sets of 10 with body weight is where they start, because they're tired at that stage.
Somebody who's done a lot of strength training for the calves may find that they actually need
to load up a bit and they need to use extra weight to get tired within those 10 repetitions
or even eight repetitions for those people, but maximum twice a week. And then, as you get
towards the end of your marathon training where you now have load, really large volumes
of running, and not ... you're struggling to recover really from all the running,
you want to bring that strength training down to just once a week, that you just keep a maintenance
dose in there and you allow your Achilles and your tendon, your calves, to recover enough.
So that's the important thing to understand here, is: prehab and strength training to
make your Achilles robust to withstand marathon training needs to happen ... the heavy strength
training needs to happen months before you start your ... your training program for the marathon.
When you're in that program's phase, only twice a week at the beginning, and as that marathon
fatigue starts to accumulate in your legs, you want to come down to just once a week strength
training towards the end of that program to allow enough recovery time. What am I leaving out?
Yeah, so preventing Achilles pain in marathons is a combination of making sure you build up enough
running endurance during the the years preceding the marathon training
so that it's not a too sudden increase in training load that way,
and it's also doing your strength training exercises already months leading up to it. Now,
you may see on the internet if you google for Achilles rehab exercise, to treat that, that
there are programs that say you should be doing strength training exercises more than once a day
to get ... That's rehab - it's not the same as prehab, okay - so don't ... you can't apply that.
The other question that was in that e-mail was whether it's best to do the Achilles exercises
before a long run, after a long run, or on a separate day. And it should definitely not
be before a long run because then you tire your Achilles and your calf out and then go run on it.
You're more likely to actually injure yourself and overload it. The best time will ... where you'll
get most benefit from your strength training ... is if you do it on a day that you're not doing a
large running volume as well. And best do your running of the day first and later on do your
strength training, that you can rest out. You're better off strength training on tired legs than
what you are running on tired legs. Excellent! Let me know if you've got any questions, and remember,
if you need any help with any Achilles injuries or prehab advice, you're welcome to consult one
of the physios in our virtual clinic. Link to the clinic is in the description of this video.