Lower Limb running injuries - by Running Physio Brodie Sharpe
This week’s blog will help you with prevention and management of most lower limb tendinopathies including plantar fasciitis, achilles, hamstring, patella and hip tendinopathies. The information provided will cover 95% of cases out there, I am aware rare presentations may all outside of this advice. Here we go.
1. A tendon reaction will always be due to a sudden overload: As I have discussed before, every tendon in the body has a certain load capacity. If you train just below this capacity in time it will adapt and get stronger, increasing its capacity.
If there is a spike in load which exceeds a tendon’s load capacity it will signal pain. These spikes can come in several forms including hills, mileage, intensity, change in shoe type or change in surface. A sudden increase can also be in one training session or over the course of a week. If you have developed tendon pain and your training load has remained unchanged, I would investigate change in medication, stress and quality of sleep. This is crucial knowledge for prevention.
2. Never completely rest a sore tendon: In the clinic I often discuss the ‘downward spiral’ of tendon pain. When someone runs and a tendon undergoes a reaction it’s load capacity actually drops! If you then proceed to rest for 1-2 weeks because of pain then capacity drops further.
Once complete rest has alleviated pain the runner tries to return to their previous mileage and the same symptoms occur, lowering the tendon’s capacity further. I have seen extreme cases of this downward spiral where the result is pain with daily walking and stairs. An experienced physiotherapist should recognise how much load you can tolerate at begin ASAP to avoid this spiral.
3. Six months of tendon pain will result in irreversible changes in tendon structure: The amount of times I want to slap my palm on my forehead when I see a runner with 1-2 years of the same tendon pain. A stubborn runner will be surprised when they look back and realise how long their symptoms have been going on for, yet still think it will resolve on its own. A tendinopathy that exceeds 6 months begins permanent structural changes and can no longer revert back to healthy tendon fibres. This doesn’t mean we can’t work back to pain free and fully functioning, however progress will be slower and with increased likelihood of reinjury. The sooner tendon pain is addressed the better.
As runners, we cannot just try and run fast or run far. We also need to run SMART in order to get the best results.
By Brodie Sharpe
Brodie Sharpe is a brilliant running specialised physio that we work with and we highly recommend you follow him on his instagram at @brodie.sharpe