Achilles Tendinopathy and Rupture – Practical Prevention Strategies for the Crossfit Population

We recently released a podcast episode with Pat Byrnes going in depth about Achilles Tendinopathy and Rupture.  If you missed it you can check it out HERE: Here’s a...

We recently released a podcast episode with Pat Byrnes going in depth about Achilles Tendinopathy and Rupture.  If you missed it you can check it out HERE:

Here’s a list of the key points we discussed in the podcast.  I also wanted to make a checklist of strategies for those of you out there looking to reduce your risk of Achilles problems.   You could implement them directly into your own programming or into your client’s programming.  Pat and I are currently working together to try and reduce the likelihood of injury at Crossfit Tribe and these are the methods we’re using.

I want people to understand that the health of our entire body, especially the Achilles Tendon is directly related to the way we train ourselves and our clients.  Let’s do what we can to prevent these injuries before they side line us.

Before I start I want to let everyone know that this article is about preventing injuries before they occur.  If you believe you’ve already got an issue with your Achilles tendon please go see a professional.

Achilles Tendon Rupture

  • Most Common in Men in their 40’s and 50’s.  Keep in mind that it happens in younger people too (Pat did it in his 20’s)
  • Accounts for 40% of all surgical tendon repairs. (It’s very common)
  • 5:1 ratio of injuries from male:female (Sorry guys)
  • Occurs mostly in individuals who are largely sedentary and then decide to start an activity without adequately conditioning their body. (Sounds like the weekend warriors to me)
  • 90% of injuries occur with an acceleration/deceleration movement. (Jumping, landing, cutting, changing direction – pick up games)
  • Only 15-20% of men reported any sort of posterior heel pain/tendinosis before the injury.  (It usually occurs without warning)
  • 50% of men who have an Achilles Rupture had tissue degeneration before the injury.  (If tissue quality was better would these individual’s have gotten the injury?)
  • Typically occurs 30 minutes into an athletic endeavor (Fatigue possibly plays a role)
  • Biomechanics of the foot, knee and hip probably all effect your likelihood of injury.  (Overpronation, genu-valgus etc. as described above)

Achilles Tendinosis:

  • Frequently caused by: Recent increases in running frequency, volume or intensity or addition of hill or interval training
  • A pronated (flat foot) foot decreases the Achilles’s ability to handle force and can lead to tendonitis.  Pronation creates excessive rotary forces (not good) and tension to the medial side of the tendon.
  • Those with tendinosis typically have decreased calf flexibility.
  • Risk factors: Active Lifestyle, slightly under middle age, cortisone injection in the area

Where we see problems in Crossfit:

  • High rep box jumps
  • Double Unders (High Volume)
  • Running (Forces to the Achilles Tendon are 6-8 x body weight during certain phases of running)
  • Jumping exercises
  • Too much volume of these exercises overall or a period where the volume of these exercises is increased suddenly.

Solving the Problem:

  • Technique:  We make sure our clients squat and deadlift properly which is definitely important but running and jumping should be taught as well.  Its particularly important to make sure that you or your clients are landing from box jumps with solid biomechanics.
  • Proper programming:  Adding in high rep box jumps out of nowhere in your programming is probably a bad idea.  Remember a large cause of Achilles rupture is introducing a high stress stimulus when your body isn’t conditioned to it. (Remember the weekend warrior and pick-up games).  The same thing goes for things like double unders and running.  Keep your Achilles in mind when programming for the week/month.
  • Condition your Achilles:  We try to regularly add in exercises into the warm-up throughout the week that help to condition the lower leg without overly fatiguing it (Remember that fatigue plays a role in Achilles rupture so we don’t want to overdo it in the warm-up).  Things like running drills, jump rope, pogo jumps, agility ladder and frequency drills are fun additions to the warm-up that help prevent injury.
  • Stretch the Gastroc/Soleus (Calves) routinely.  Also stretch the plantar fascia since it is continuous with the Achilles tendon.
  • If you haven’t bought new shoes in some time, it may be time to.  Get the correct shoes for your feet.  For some discussion about what shoes are best for you check out this podcast episode.
  • Soft tissue work for the calves.  We all know how to foam roll the calves.  I really like this variation from Kelly.  If you’re a thrill seeker you can even try that same bone saw technique while performing the plantar fascia stretch outlined above.
  • Prophylactic strengthening of the Calf.  Heel raises and eccentric strengthening fit the bill here.  Remember that 50% of ruptures had degeneration going on with a majority of the individuals having no symptoms before injury.  Its safe to say that there are plenty of people in crossfit that have Achilles degeneration and are at risk but don’t know it.
  • Fix pronation.  We’ve been introducing barefoot balance exercises and trying to emphasize the short foot positionHere’s a video demonstration of the short foot posture.  We also do a ton of hip external rotation and abduction work.  Remember that the glutes are strong external rotators of the hip and can really help reduce foot pronation and promote normal biomechanics during running and jumping.
  • If you have Achilles pain, avoid exercises that cause pain and seek a professional to help resolve the issue.  Remember that 50% of all ruptures occur in those that have existing Achilles degeneration.  If you’ve got pain it may be a sign there is some degeneration and you may be risking a rupture.  (Rob and I outlined some rehabilitation strategies in the podcast but I highly recommend seeking a professional before self-treating)

Before we end this I want to say that I’m taking information from my own experience training myself and others coupled with what the research is showing to come to these conclusions.  Its by no means a definitive guide but rather some sort of brainstorming as to how we can help prevent Achilles problems.  If anyone one else has some ideas please share them in the comments below!

An Achilles Rupture would really sideline my dreams of becoming a professional dancer,

Dan Pope

References:

Schepsis, A. A., Jones, H., & Haas, A. L. (2002). Achilles tendon disorders in athletes. The American Journal of Sports Medicine, 30(2), 287-305. Retrieved from http://ajs.sagepub.com.libproxy2.umdnj.edu/content/30/2/287.full

Categories
Achilles TendonfootInjury PreventionUncategorized
12 Comments on this post.
  • Fitness Pain Free Episode 6: Special Guest Pat Byrnes – All About Achilles Tendonosis and Achilles Rupture Prevention and Treatment | FITNESS PAIN FREE
    19 June 2012 at 10:26
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    […] FITNESS PAIN FREE A Campaign for the Crossfit and Strength Athlete Who Wishes to Enjoy Their Sport Pain and Injury Free Skip to content HomeAboutDan’s Training JournalWho is Dan Pope?Body PartElbow/BicepsFoot and AnkleHamstringKneeLower BackShoulderThe Nervous SystemExercise MasteryBench PressDeadliftPull-UpSnatchSquatPodcastRecommended MaterialsEssential Reading ListRecommended Blogs, Websites and PodcastsRecommended Equipment ← Dan’s Training Journal: Deload Week, Crossfit for Hope Achilles Tendonopathy and Rupture – Practical Prevention Strategies for the Crossfit Populatio… […]

  • Using the Joint by Joint Approach for Performance and Injury Prevention in Crossfit Part 2: The Squat | FITNESS PAIN FREE
    24 October 2012 at 10:26
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    […] (No offense to the boss in the picture to the left snatching a house).  As we discussed in an earlier podcast and article this position is also implicated in achilles tendon […]

  • 4 Easy Progressions of the Short Foot to Provide Knee and Foot Pain Relief | FITNESS PAIN FREE
    6 December 2012 at 10:26
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    […] A flatter foot is linked to both knee and heel pain.  Excessive pronation is also linked to achilles tendon pain and rupture.  Achilles tendon ruptures suck.  Just ask Pat Byrnes.  You can listen to him talk all about his achilles tendon rupture doing box jumps HERE:  The high incidence of achilles pain and rupture during running and doing high reps box jumps has led me to create a list of practical ways to prevent achilles  problems that you can READ HERE. […]

  • Leandro
    23 January 2013 at 10:26
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    I was wondering if you ever thought of changing the structure of your
    site? Its very well written; I love what youve got to say.
    But maybe you could a little more in the way of content so people could connect with it better.
    Youve got an awful lot of text for only having one or two pictures.
    Maybe you could space it out better?

  • Why Does My Squat Technique Fall Apart When the Weight Gets Heavy? | FITNESS PAIN FREE
    27 January 2013 at 10:26
    Leave a Reply

    […] a position of stability but it isn’t healthy for the foot, particularly the plantar fascia or the achilles tendon.  You’ll finish the lift in this position, but your body suffers the […]

  • High Rep Box Jumps Are Stupid | sexyasfuck
    14 March 2013 at 10:26
    Leave a Reply

    […] here. And here. And here. And here. And here. And here. And here. And here. And here. And here. And here. And here. And here. And here. And […]

  • www.seoorganics.net
    6 May 2013 at 10:26
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    You’re so interesting! I do not believe I have read a single thing like this before. So great to find another person with original thoughts on this subject. Seriously.. many thanks for starting this up. This site is one thing that is needed on the web, someone with some originality!

  • Camille Perkins
    15 August 2013 at 10:26
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    Great read! I’ve had chronic achilles pain for over a year. I love CrossFit and have been at it for a few years. Been scaling, resting, etc. and seeing a Doc. Would love to get it resolved! Hopeful that I will soon! Thanks for writing this!

    • djpope
      16 August 2013 at 10:26
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      No problem Camille! Good luck in your rehab. Let me know how it goes and if I can help.

  • Dan
    18 November 2013 at 10:26
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    Thanks for the article. I did a 10 mile run in April with no running training other than very short distance stuff in CF. Good news is that my endurance was awesome from CF (I ran a faster sustained pace than I ever did when i was running 4x – 5x per week and doing long distance events) even though I hadn’t run in almost a year. Bad news is that because I hadn’t been running, I messed up my Achilles :-/ and it hasn’t been the same since (now mid November). I have really tried to take it easy, roll, stretch, no box jumps, no double unders, very minimal running, and it just won’t get better :-(. Planning to call up a PT today as I felt it tweak again this morning doing Snatches. Any suggestions? Questions I should ask the PT? Is a PT the right person to start with?

  • Marc Thibeault
    26 March 2015 at 10:26
    Leave a Reply

    Hi,
    I’m a crossfitter, 51 years old. Doing it 4-5 times a week. I’m having chronic Achilles pain when doing double unders and sometimes running. While I focus on warming up and stretching, it always come back. Would Calf Compression Sleeve help contain the area and avoid pain build up?

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      Haven’t heard of that as an evidence based treatment for achilles issues. There are some ideas I would choose over the sleeve in the article. As always it would be best to get evaluated by a competent professional before trying anything.

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