Member Case Study: Laxity of the Tendons

author : AMSSM

comments : 0

I've been told I have laxity in my tendons which sets me up to be more prone to overuse injuries. Do you have any suggestions on what I can do to eliminate my chronic achilles pain?

Member Question from tbryant
I have been training regularly now for over eight months and have completed one sprint triathlon.  I'm hooked.  I've suffered the expected "itises" from trying to increase my distance and intensity too quickly - plantar fasciitis, achilles tendonitis and even peroneal tendonitis.  Now that I've learned to SLOWLY increase my training, I've been able to avoid any injuries that have sidelined me but, I have chronically sore achilles tendons.  

I've been told I have laxity in my tendons which sets me up to be more prone to overuse injuries.  I've actually reduced my stretching before a run and instead now I do the warm up exercises from the Chi Running book and only do light stretching after I run.  This has seemed to help.  I do the "leg drain" exercise too which seems to help greatly and I massage my heels, the achilles tendon itself and the area where it inserts into the muscle.  

I bought my shoes at a well respected running store and they analyzed my gate before putting me into a pair of shoes so I feel pretty confident that it's not my shoes.  I bought them 9 months ago but probably only have a couple of hundred miles on them.  I wonder if I still should replace them, or maybe I need an orthotic?  The local ortho docs are not sports medicine people so their normal response to injury is to stop running - NOT!  Do you have any suggestions on what I can do to eliminate my chronic achilles pain?

Answer from William Roberts, MD
Member AMSSM
 

You will need to let the injury heal, so running is out until you are pain free. But any activity that does not hurt during or after, like swimming or biking, is ok. You mention eight months of training, and I am not sure if you are completely new to running or just recently started in the triathlon. From my experience working with running based activity, it takes several years to really toughen the tissues for the rigors of running. Remember that the energy transmitted to the foot in toe-off is stored in the tendons so they have to be tough to weather the storm of heavy training. I consider it a two- to four-year project to build that toughness into the soft tissues that are stressed with heavy running. When you return to running, start with every other day and build slowly.

The usual treatment for Achilles tendonopathy is eccentric strengthening using toe raises off the end of a stair through the full range of motion, letting the heels slowly drop to full length and then rising back up again to a full toe stand. First up and down on both feet, then up on two feet and down on one, and finally up and down on one foot.

As you recover, you might try some light barefoot running on a nice grassy surface if you can find one that seems safe for you feet. Do not do this while you are injured. This will help strengthen the muscles that support your feet and toughen the support tissues and tendons. You can try an off-the-shelf orthotic; my favorite is Superfeet™. You fit them to your arch and not to your shoe size. Use them while you are injured and as you increase your training.

If you have someone in your area who does manual therapy, you should look at the joint motion through your feet, ankles, knees, and pelvis (especially the SI joints) to make sure you have normal kinetic chain motion from head to toe. The other area to address during your healing is core strength. Lower leg injury can be a result of weak core muscles and strengthening the hip abductors and adductors may improve your chances of injury-free running as you continue your triathlon pursuits.

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date: November 4, 2007