Tendon Pains Slowing me down
You are out at Park run or charging around Pitville having a blast when all of a sudden OUCH - something isn't right in my ankle. So what do you do? You slow down, have a cheeky stretch and probably try to run again but guess what, it still hurts.
This is exactly what a patient of mine told me last week, Or to put it in her own words -
"It's pain in my ankle that's troubling me when I'm running. I had been running without any issues, and now basically I cant run because it all hurts too much". Sue, Cheltenham.
Sue has got back into running after taking some time away from the streets and trails. She's got back into it gradually, being boringly sensible. You know 15 minutes 3x a week, building up over the next month. And that's when it happened - this niggling pain began and now 6 weeks later she can't shift it, and definitely cant run, and that's whats annoying Sue more than the pain and ache itself!
Ankle Pain in running can be caused by a few different structures but Tendonitis is the classic runners foot and ankle pain.
Tendons have definite functions and act to stabilise the foot. Some even help to keep our arches nice and upright, acting as a shock absorber when load is put through the foot be it walking, running, jumping….the lot.
The tendon that stabilises the arch passes down running behind the inner ankle bone to insert into the bones of the inner mid-foot region. It is this here where patients often report pain as it is the tendon itself which becomes inflamed and/or degenerate.
What goes wrong???
The Tibialis Posterior tendon becomes inflamed or torn. This generally occurs from overuse or due to an increase in demand on its function as a shock absorber e.g running further, increased impact, change in terrain. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in pain. We mainly see this as an overuse injury but damage to the tendon can occur acutely following a fall or ankle sprain.
More often than not, pain is on the inside of the foot and ankle and can go up the inside of the calf. Tenderness around the inner ankle bone and there may or may not be swelling. Pain is generally is worse with activity – particularly high-intensity or high-impact activities, but sometimes just with walking or standing for prolonged periods.
What can be done!?
Fear not…there is lots that can be done to treat these symptoms and with good effect!
Rest: yep...you’ve guessed it! As with a lot of injuries, the first step is to rest. Continuing to run on it will only make it worse and mean you need an extended rest period in the long run. Low impact activities like swimming and biking are OK as long as they don’t cause pain
Support/Offloading: Tape can be used to offload the tendon and allow the inflammation to settle.
Good, supportive footwear is also essential to help reduce the amount of strain put through the tendon day to day which means sloppy Ugg boots are a no no!!!
However...unfortunately, rest alone won’t solve it either.
We also need to establish and correct the underlying cause of the injury BEFORE returning to sport.
Footwear: Look at your current training shoes. Are they the right ones for you? Or, have they just got too many miles on the clock and your well overdue some new ones? Unsure? why not have your gait analysed? This will highlight if you do require additional support from your shoes which will help your symptoms - it may be as simple as popping some insoles into your current trainers.
Exercises: A physios’ favourite! Start gently and once the pain has subsided, it’s time to optimise the tendons strength and ability to tolerate load. This is key to preventing the pain coming back as you start to up you miles again.
Return to sport: Again, like with other injuries, a graded exposure to sport is required to break it in gently after its period of injury.
A question we as therapist are so often asked is ....'So when can I run again??' which, as sports people ourselves, we totally get!! Sadly, there is no set recipe with this one but what is vital is that the return is GRADUAL. Pushing it too much too soon is likely to cause the pain to return, eventually forcing you to stop again = frustrated athlete!
Lets not let it get to this stage. If this is something that you are struggling with we can look to set up an individualised programme based on your current stage/level and see if there is anything else that might need tweaking to help you on your way back to full performance!!
If you’d like more quick tips like this to help ease Sports Injuries, visit our website where you can download my free tips guide instantly: http://www.straightbackphysio.co.uk/sports
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