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 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)
- 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 position. Here’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,
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