Tag Archives: rehab

Achilles Rehab: Running Strength Training

The steps I’ve taken in my Achilles rehab.. In particular insertional Achilles tendinopathy. Some guidelines which may help you with your achilles troubles.


One of the problems with the Achilles tendon is as you get older it can get a lot weaker. Running alone will not provide the strengthening required.

What’s made my case harder is it’s an insertional Achilles tendinopathy.
Where the Achilles joins the heel you start involving the bone and bursa. The bursa is a fluid-filled sac that usually creates a bit of glide and cushioning. This becomes inflamed and you end up with bursitis. This will create further damage.

In the acute phase of injury the most important part is don’t cause
further damage. So I stopped running, took the load off it
avoided stretching the Achilles. Kept it elevated and used iced the injury for 15 to 20 minutes about every 2 hours with 2 days worth of oral
anti-inflammatories.

Achilles Focus

Tendon injuries require loading to get better. After we get past the first 2-3 days of the acute phase there are 2 key points to follow:

  1. applied load to strengthen the tendon
  2. don’t cause anything to aggravate the injury

One of the biggest problems with an insertional Achilles injury is when you stretch it pulls the tendon across and presses up against the bursa. Any stretching we usually do for our calves will likely aggravate the injury. Doing calf exercises where you drop the heel down below level will stretch the tendon.

Limiting movement and stretch of the tendon while applying load is the early plan.

How do we do that?

Isometrics

You have 2 main muscles in your calves .

The gastrocnemius which is the main muscle that goes from the tendon itself up across the back of the knee and joins just above. You strengthen that mostly with a reasonably straight leg. The other muscle is
the soleus, which joins below the knee. To target that we need to take the gastrocnemius out of it. So you need to do the exercises with a bent knee.

The isometric protocol I used was an isometric calf raise straight leg
and an isometric calf raise bent leg. The plan was to increase the load every week on the proviso that 24 hours after a training session I didn’t have increasing pain. There could still be some discomfort but not an increasing pain from the previous day.

The aim was to do these exercises at least once a day, preferably
twice.

Loading initially was holding 30 seconds with 30 to 60
seconds rest in between. Do that for a week then increase that to 5 times 1 minute with 30 to 60 seconds rest. Progress to 3 x 2 minutes with 30 to 60 seconds rest in between finally ending on 1 x 5 minutes.

Concentrics

After isometrics we moved on to the next level and start introducing some movements.

I kept the isometric training going but this time the training sessions started with some actual movement of calf raise both a straight leg and bent leg.

With body weight the aim was to do 3 sets of starting
at 10 reps and building that up to 20 reps for each exercise. Taking 30-60 seconds rest between movements. The aim was to get it done
almost every day, but I was happy with 5 days a week.

Extra Load

Next progression was to add extra weight to the loading. Using a barbell across the shoulder for the straight leg calf raises. Or across the knees for seated calf raises.

Achilles Progression

The Achilles’ tendon requires loading to improve. It takes time. Longer than we all want it to. Plus this post only covers the early stages. Beyond these first weeks you will need to start addressing power, elasticity and reactive strength. But that is for a future post.

For a look at earlier stages of my Achilles Injury check out the video below

First Week Of Run Training At Cape Woolamai

My first week of run training went well. The first day of training started with an interval session:

3 x 4 minutes hard with a 2 minutes recovery jog.

Performed over undulating terrain this was my first real run. It was a struggle. So much slower than hoped. I’ve got a long way to go.

Finally back into my first week of training. I’ll tell you it feels good to be back running. I’ve lost a lot of fitness. If I’m really honest it’s not just since the melanoma that I’ve had time off. It’s more than two months with the injury before that. I hadn’t really put together a good training week for over four months.

Cape Woolamai

Bonus for the first week of running we went down on holiday to Cape Woolamai on Phillip Island. It’s a beautiful location with amazing beaches, nature park, wallabies and views that are fantastic. I highly recommend spending some time down here. Click here for even more details.

First Week Of Running Principles

Truly back at square one. I’m keeping easy at super easy. This means feeling way too slow. Sometimes faster running feels easier. If I was running with someone I would definitely be able to hold a conversation with no trouble.

The training format is intervals followed by three days easy running. Then back again for intervals and another three days of easy running.

Smoke Haze

Getting a lot of the smoke haze coming in from the bush fires. With a bit of hindsight I probably shouldn’t have run. Starting a couple of those runs just as the sun was coming up I didn’t appreciate how bad that smoke was. Not until I got towards the end and had enough sunlight.

For the first week those easy days were all about 60 minutes. Limited to just covering some distance to get used to running again. No worry about pace. In fact I set up my watch so that all it showed was time. No pace, no heart rate, nothing about effort or even distance. That way I wouldn’t have to worry about how fit I used to be versus how fit I am now.

Running Intervals

For the intervals. Starting with three by four minutes with two minutes recovery. That recovery is just a super easy jog. Those four minutes on are definitely not easy. The aim here is to run at a pace that I can maintain for all intervals right to the end. I went out too hard and couldn’t maintain that pace anyway.

The first week of run training went well. It’s so good to be back running.

The beauty of Cape Woolamai comes out better in video than it does in word…

Before The First Step Of Running: Returning After Time Off

They say a journey begins with the first step. But it begins before that. Getting back to running after injury, melanoma, skin graft and rehab I had to rebuild back up to that first step.

This 2020 journey begins with a less-than-ideal 2019. The main event was finding out I had Melanoma skin cancer: click for details

No Running

After injury, melanoma, a skin graft, time off work and rehab I was happy with moving a little closer to normality. The skin graft was my main limitation.

Weeks of bed rest. Weeks of no running.

Surprisingly I didn’t miss running all that much but I was getting frustrated at not being able to move like I used to be able to. More details here: 5 Weeks After Melanoma Surgery

First Run

Eventually I was able to go my first run.

It was for ten minutes and it felt awkward.

The idea of running felt great. I was happy to be out there again. But I wasn’t smooth. My body had forgotten what it was meant to do.

Bit by bit I built my running back up. The skin graft still provided limitations. I had to get creative to improve my running. Finding ways to prepare my legs without risking the healing.

Not Just Running

Those creative ways included:

  • step ups with a high knee lift
  • calf raise with a deep drop
  • directional hopping

These exercises appear in the video above. They are simple, but sometimes a visual makes it easier to understand.

The hopping was actually harder than it should have been. It’s amazing how much of the skills and coordination you lose after being bed down for four weeks.

The aim was to get back to where running felt good. Over the weeks I eventually got there. Running feels good again. That’s step one. There are many more steps to take.

For The Injured Runner: Make The Most Of Injury Time

How do you get back to running after an injury?
Running doesn’t always go to plan. This year reminded me of that.
Early in May I had some awesome plans to smash out 100km at the Wilsons Promontory Ultra with a few friends. Nervous and relaxed all in one had me on the start line. For the first 26km it was all awesomeness. Running comfortably down a moderate hill my left foot landed on a loose rock.

Rip and pop!

Two weeks of living in a moonboot and no running for four weeks. It sucked. I’m not going to lie. I got grumpy.  The injury was a high ankle sprain. There’s some potential ongoing issues with this. Running properly again takes time. I decided to make sure I rehab the hell out of my ankle. It’s crazy how many exercises you can do for your ankle and foot.

moon boot rehab
Moonboot & rehab

Not running gives you a lot of time to think about not running. The exercises, walking, physiotherapy, stretching and strength work are just details. Injuries suck. How do you make the most of your injury time out?

Change Your Focus

If you have the discipline to train hard and push yourself in races, then you have what it take in injury. You need to flip that discipline to doing the stuff that isn’t as fun and hold back. Structured rest is training.
You can still push yourself. It just has to be different ways.
  • Rehab exercises boring? -> use that to develop the ability to maintain focus
  • Have a muscle imbalance? -> work on strengthening the weak muscles
  • Core is weak? -> increase the time devoted to this

The list can go on and on. Use the injury time to improve what you usually think you don’t have time for.

Real Goals

This should be a two-pronged attack.

1. Big Goal

First decide on a big goal in the future to work towards. Something that drives you. A goal to fuel your passion. Choose a goal that will signal you are back in action.
I chose being able to run 50km as part of the Surfcoast Century relay. Not expecting to be fast. Just wanting to put in a solid effort and finish without breaking down. It was definite and timely. A 4 month time frame. I had so many moments when I couldn’t be bothered. A big goal reminds you of the bigger picture. It makes it easier to give your own a butt a kick. You can’t always rely on motivation. Knowing you have a deadline helps force you to do the training you don’t want to do now so you can do the training you want to do later.

2. Little Goals

Second part of the goal setting attack is use a series of little goals.
Often best worked out with your physiotherapist, doctor or coach. Create small goals to work towards over just a few days. Treat them as criteria you have to achieve before you can increase the training load. Having something clear to work towards in the short term makes it easier to do what it takes.
During the first couple of days of injury the goal can be as simple as don’t make it worse. Focus on that and it’s easier to rest, elevate and apply compression or whatever is needed. A few days later the goal might be to introduce movement without pain, or it might be get a follow up review with the doctor. Super simple. Focus on a small goal and make it the priority.
Further down the rehabilitation path you progress the goals. Some of mine over the weeks included:
  • complete 3×10 double calf raises without pain
  • complete 30 single leg calf raises without pain
  • complete 3×10 hops without pain
  • walk briskly for 30 minutes without developing discomfort over the next day
  • run for 5 minutes without developing discomfort over the next day
  • run at a steady effort for 60 minutes without feeling instability in my ankle

There were steps in between these goals. The idea is if I can’t achieve the current goal, my body isn’t ready to progress. You have to earn to right to train at the next level.

Extra Thoughts

Mentally it wasn’t easy. I doubted myself. Every week I wondered if I was doing enough. With no high end training I couldn’t see myself being race ready. I stuck with the plan. When asked how I was doing I made an effort to keep my reply positive. Even if I didn’t believe what I said. The power of repeating something can rub off. Maybe it’s a case of fake it until you make it. Little by little the training increased. Nothing fast, but I was happy with the mileage. The weekly totals turned out like this:

4-18-34-58-57-62-68-78-82-61-86km

Sometimes the pace crept up a bit too much in runs. Aches and feelings of instability let me know about it the following day. The final 86km was right on my limit. Soreness and failure in support muscles forced a couple of days rest afterwards. Right at taper time. Have I made it? Next Saturday will have the answer.
Injuries can be a good reason to review why we do what we do. You can do a lot in injury time.
How do you deal with injuries?

Make the most of injury time