Return to Running From a Tendon Injury
This blog is specifically discussing tendon type injuries. That includes tendonitis, tendinosis and plantar fasciitis. In podiatric medicine, we treat plantar fasciitis as a tendon injury.
Let say you go for a hard workout, sometimes you do not feel the injury during or after the run. Then all the sudden, you wake up and feel pain. This is sometimes how tendon injuries present.
Managing An acute injury
An acute injury is when most of the pain and swelling occurs and usually lasts 1 week long. This must be treated with rest, ice, compression and elevation. This phase is important to ween back. What can be done for exercises in this stage is gentle range of motion and very light isometric exercises that does not irritate the tissues/ cause more pain. Anti-inflammatories can also help in this phase. You only want to completely rest the foot for a short amount of time . Too much rest can be detrimental to the tendon health, unless there is a tear or rupture , which brings us to the importance of loading the tissue in the next phase. Remember, exercise is the best form of medicine.
The Subacute Phase
This is after an acute injury . There still may be swelling and throbbing in this phase. This is where strength must be initiated to help load the tendon to become stronger. However, it must be catered to the individual pathology and not too difficult. If it is too difficult it can relapse to the acute phase. Here it is not suggested to run yet.
Exercises that may be done in this phase are again, range of motion but more specifically isometric exercises. This allows the tendon / injury to be loaded but in a manner that does not provoke pain. Certain movement that may provoke pain are fast movements or up and down. It is important to strengthen the injury in a movement specific order as particular movements will aggravate the area more. Isometrics can be done each day for 4 sets .
After a week of isometric movement, slow heavy eccentric movements are suggested. That can be done every other day with the isometric movements in between them.
As pain diminishes it is good to start implementing the spring like capabilities of a tendon. Tendons have this ability to allow us to jump and release and store energy. So this needs to be trained especially before running. This can be done by doing 2 footed hops say 5 x 1 min with 1 min rest. Wait 24 hours. If there is pain , or increases stiffness in the morning or next day, then that was too much load. What can be done is cutting the load in half by then trying to do 3 x 1 min the next time. These movements can be done every 2 times so there is plenty of recovery time in between.
Once double leg hops is achieved then one moves on to single leg hops with the same protocol. If that is fine, then one can move onto a return to running program.
Here is an example of the layout.
During the time of return to run, one may not want to forget the importance of strengthening the tendon and loading it properly. Hopefully one can remember the importance of strengthening so one does not succumb to injuries that can sideline them.