Ryan’s Winning Streak Continues!

Painful Husband

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My husband has very painful Achilles. The pain runs from below his heel into his calf. The one leg has a very thick tendon. In the morning he has to wiggle his feet before getting out of bed! He has changed his shoes, worn orthotics, he has taken anti-inflammatories, been to a physio and a chiro, and has had acupuncture. He also stopped running for a year and took up mountain biking in an attempt to stay active. He has started swimming, but it is just not the same. He is getting very irritable and despondent. Please help before I go crazy! – CONCERNED WIFE, SOMERSET WEST


ANSWER
Overuse injuries involving the Achilles tendon are common among recreational athletes, especially in runners. As you describe thickening of the tendon, there will no doubt be changes inside the tendon that will be seen on ultrasonography and his condition would be described as chronic Achilles tendonosis.


Successful rehabilitation of Achilles problems is dependant on early diagnosis, rest and icing. Physiotherapy is often required to settle pain and swelling as well as the assessment of predisposing factors such as tight Achilles tendons, abnormal biomechanics, training errors and muscle imbalances. If the injury is ignored and allowed to progress, it is often unresponsive to conservative treatment and develops into a chronic condition that is difficult to treat.


A few studies have been conducted on the treatment of chronic Achilles problems where conservative treatment has failed. These studies suggest an exercise programme with a combination of eccentric muscle training (muscle lengthening contraction) and stretching, and have shown good results compared to conventional concentric muscle training (muscle shortening contraction). Eccentric exercises have the potential to cause damage if performed wrongly or excessively. Pain may be experienced when beginning the strengthening programme and at each new load. You should only move on to the next exercise of the programme when the previous activity is pain-free during and following the activity.


The standard exercise used in the rehabilitation of an Achilles tendon injury is the heel drop off a step. Lowering the heel below the level of the step requires an eccentric contraction and rising onto the toes in a concentric contraction. The exercises should be performed with knees both extended and flexed, and you should wear a stable shoe.


Stand on the injured leg on a step with the weight on the forefoot and heel hanging in free space. With the knee straight, lower the heel slowly as far as possible and then rise back on to the toes using the uninjured leg and/or arms. In your case, as both Achilles are involved, use your arms predominantly and both legs to rise onto your toe and then lower on one leg. Repeat the exercise lowering on the other leg. The exercise is then repeated with the knee of the weight-bearing leg slightly bent. Each of the two exercises includes 15 reps performed three times. These must be done twice a day, seven days a week, for 12 weeks.


Expect muscle soreness in the first two weeks. During the exercise, pain is often experienced, but you should stopped if the exercise become disabling. When the eccentric loading can be performed without pain or discomfort, increase the load on the tendon by adding weight in the form of a backpack with increasing load, or by using a calf-strengthening weight machine.


Cycling, swimming or walking is allowed. After four to six weeks, jog if pain-free. If orthotics are not required, heel-raises should be placed in both shoes to shorten and offload the tendon while running. These should be weaned out at a later stage once recovered. My suggestion for starting running would be no more than 10 minutes on a flat surface, on alternate days, and no more than a five-minute increase per week, if pain-free.


The reported success rate of participants on this programme is over 80%. The only other option is surgery, followed by a long period of rehabilitation, and there could be potential complications. This programme would therefore be a worthwhile option to follow, but you have to commit to succeed.


What to Wear?
When I read the article on the Ironman 70.3 in Modern Athlete, it immediately caught my attention. The 70.3 is not something I would previously have considered, but when I looked at the training programme, I realised that with commitment, it would be possible to complete the race. I entered the next day, flights and accommodation are booked, so I’m off to East London next year to do my first 70.3!


Please help with some guidance on the suggested clothing for the event. For example, should I swim in a costume and wetsuit, should I stay in my costume and just throw on some cycling shorts? And for the run, can I stay in my costume and just replace the cycling shorts with some running shorts? If I do decide on a tri-suit, does one swim, cycle and run in the suit? And are we allowed to wear cycling shoes with clips during the cycling leg? – ALIDA KOTZE


ANSWER
It is fantastic that you have taken up the Tri-Challenge; I hope the training is going well. Personally I prefer to race in a tri suit that you swim in (under your wetsuit) and then ride and run in. These garments are made specifically for doing all three events: they are tight-fitting, which prevents chafing, and also have padding that prevents saddle soreness.


However, the 70.3 is a relatively long race, which means you have enough time to do each event with sports-specific clothing. If you prefer, you can change into cycling kit after the swim, and then running kit for the run. Irrespective of what you decide, I would advise socks for both the ride and run, and cycling gloves for the ride. You are allowed to wear proper cycling shoes with clips for the ride.


Lastly, remember sunscreen, sunglasses and a cap for the run. Hope you have a great day at the 70.3!

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