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For Achilles injuries, 'everyone is vulnerable'

Achilles tendinopathy - the breakdown of the tendon - is a common overuse injury for athletes who run, jump, or make quick turns.

Eleanor Beason, a runner who has dealt with Achilles tendinopathy, trains at Lindenwold Memorial Park.
Eleanor Beason, a runner who has dealt with Achilles tendinopathy, trains at Lindenwold Memorial Park.Read moreAKIRA SUWA / For The Inquirer

Eleanor Beason of Lindenwold has run nearly 24,000 miles — that's almost the circumference of the planet.

Beason, 61, has competed in 1,000 races since 1999, when she first entered the Susan G. Komen Race for the Cure.

Pounding that much pavement hasn't been without injuries. Beason has dealt with the painful foot condition plantar fasciitis, a torn hamstring, and a stress fracture to her sacrum, the triangular bone in the lower back located between the hips. Since March, she has been battling pain and stiffness in one of her Achilles tendons.

The Achilles tendon is the largest tendon in the body. It connects the calf muscle to the heel.

Roughly two adults out of every 1,000 will suffer an Achilles injury. Achilles tendinopathy — the breakdown of the tendon — is a common overuse injury for athletes who run, jump, or make quick turns, said Karin Grävare Silbernagel, an assistant professor of physical therapy at the University of Delaware. It can occur in the tendon or where the tendon attaches to the heel bone.

The injury can creep up on an active adult. It often starts as morning stiffness. Activity is still possible but, over time, there may be a thickening in the tendon that can be painful to the touch.

Achilles tendinopathy affects professional athletes and recreational exercise enthusiasts alike.

For recreational runners such as Beason, the affliction accounts for about 6 percent to 18 percent of all injuries seen, according to a study by Silbernagel.

"It's disappointing," Beason said. "Every time I think I am OK and I'm not having any issues, something seems to happen."

For professionals such as Philadelphia Union defensive midfielder Ken Tribbett, the injury is frustrating.

Tribbett first mentioned the morning stiffness he had been experiencing to the training staff during the preseason.

"I thought maybe it was the shoes I was wearing," he said. He changed his footwear and felt better, but only for a while. Then the stiffness returned, walking was difficult, and he took longer to warm up than other players.

"I wasn't as quick, I wasn't as fast," he said about his playing time. "With our level you have to be quick and sharp and react. I was feeling like I couldn't do that anymore."

An MRI on Aug. 21 found a tiny tear in one of Tribbett's Achilles where the tendon joins the heel bone.

"It is an equal-opportunity injury," said Pat Corrigan, a physical therapist and doctoral student at the University of Delaware, adding that "everyone is vulnerable."

Silbernagel, Corrigan, and other colleagues at the University of Delaware have been working to keep athletes on course. The researchers are currently recruiting for two studies on the Achilles tendon. One study is to better understand tendon recovery after a rupture, the other is to learn more about a person's function and ability to be active with an injury.

Risks for Achilles tendinopathy include weak calf muscles, increased or decreased dorsiflexion — backward bending — of the foot, and excessive pronation, the inward or outward roll of the foot. Runners who strike the ground on their toes are more at risk than those who strike on their heels.

Tendons take longer than muscles to properly heal because they don't have the same rich blood supply. Achilles tendinopathy can take up to a year to fully recover, and there are no shortcuts.

Taking anti-inflammatory drugs might offer temporary relief but will have no effect on the injury. The same goes for other treatments such as extracorporeal shock-wave therapy, a noninvasive treatment involving pressure waves, or platelet-rich plasma injections, using the patient's own blood to try to heal the injury, Silbernagel said.

"None of those work without doing rehabilitation," she said. Silbernagel advises anyone with tendinopathy to get treatment earlier rather than later.

The good news is you can continue to run, jump, and be active while undergoing treatment, Silbernagel said.

A return to a sports-training program might start with a short-distance run early in the week, followed by a low-impact exercise such as swimming and rehabilitation midweek, then another short run later in the week. The program should take into consideration the athlete's pain level and stress load on the tendon, as well as the intensity and duration of the workout, Silbernagel and Corrigan said. The athlete could gradually increase the running distance over time.

And just because the symptoms have subsided, it doesn't mean the tendon has fully recovered, Silbernagel said. Patients need to continue with their program or the injury could get worse, she said.

"We see heavy reinjury in soccer players," said Silbernagel. With such a short recovery time between the schedule of games, about 27 percent to 44 percent of players will suffer another Achilles injury, she said.

Tribbett's current recovery plan includes a short rest and rehab with his training staff.

"And try to get back as soon as possible so I can help the team," he said.

Beason, who continues to train for a marathon in Baltimore and recently completed the Philly 10K with a time of 1:01:38, has been doing stretches to lessen the pain in her Achilles.

"I'm not expecting this to be a great marathon, but I know I can do it," Beason said.

Tips for staying healthy

  1. Strengthen the calf muscle. Heel raises should be a part of any workout routine.

  2. Strengthen the hamstrings, quadriceps and gluteal muscles so you are not putting added pressure on the calf muscle.

  3. If you take time off from running, start back slowly and gradually build up your mileage. Don't expect to jump back into the same distances and times right away.

  4. When changing a running routine, such as going from flat terrain to hills or hard surfaces to soft sand, decrease the load on the tendon by pulling back on the distance.

  5. If you do experience symptoms, seek help early. Physical therapy can help minimize the length of the recovery.