I’ve been continuing the program outlined above. I have also found a more effective PF stretch, which is basically a standing soleus stretch with your toes on a board to force them into extension.
I have been doing one high and one medium intensity bounding session per week on the unaffected leg over the last six weeks or so. About 50-70 foot contacts per session. My standing 10-hop test for the unaffected side improved from 26.5 to 31.5m over over this six-week period.
More recently, I have also done a little bit of lower intensity bounding on the affected leg. I have done very little running during this time. I started a bit of tempo running two weeks ago and some easy sprints one week ago.
On Friday, I tested my 10-hop distance for both legs, and interestingly, I got 32m on both sides, which means the affected side improved as much as the unaffected side even though I only trained it at low intensity and low volume.
I also did some flying sprints on Fri and noticed that my speed had not suffered despite the fact that I had done no running except two low volume tempo sessions and one session which included four 50m run throughs over the last four weeks.
Using bounding on my unaffected leg as the only high intensity stimulus for the last month was thus sufficient to improve my bounding performance on both legs and to maintain or even slightly improve my sprint performance.
My heel was a bit sore after the Friday workout, but I was fine the next day, so I think I can tolerate this type of training now.
Btw: While this is counter-intuitive, research suggests that running on a harder surface is better for PF and achilles tendinopathy than running on a soft surface. I was silly enough to ignore this fact over the last few months and did all my training on grass. Tried a track workout for the first time yesterday and the post exercise soreness was a lot less than what I have been experiencing after my grass workouts.
How did I train without interruption and continue to progress?
You MUST stay off the injury as much as humanly possible, trouble shoot ( I think I discuss this in the blog) and save the most critical speed work/ sessions ( and keep it short if possible) for using your feet.
Almost everything else you can work around. You need to be creative. Watch the lifting too because a common mistake is most people want to lift more to make up for less running. Part of that makes sense but you need to work at healing and getting better so if the gluteus and hams and calves become tighter than normal for more than usual lifting then the shock absorbing qualities are not protecting the feet.
As a general rule it’s a good idea to increase your recovery methods to improve your bodies natural healing ability. [/b]
Acute and overuse injuries correlated to hours of training in master running athletes.
Knobloch K, et al. Foot Ankle Int. 2008.
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Abstract
BACKGROUND: The goal of the study was to determine the rate of running-associated tendinopathy in light of the amount of time training and other risk factors.
MATERIALS AND METHODS: 291 elite runners (average age 42 +/- 9 years) who ran an average of 65.2 +/- 28.3 km/week were included with an overall distance of 9,980,852 km (34,416 km/athlete). Descriptive statistics with Chi2-Test, Fisher-Exact-Test and Mann-Whitney-Test were used to calculate relative risks (RR).
RESULTS: The overall injury rate was 0.08/1000 km (2.93/athlete). Overuse injuries (0.07/1000 km) were more frequent than acute injuries (0.01/1000 km). Achilles tendinopathy was the predominant injury (0.02/1000 km) followed by anterior knee pain (0.01/1000 km), and shin splints (0.01/1000 km). Achilles tendon rupture was rarely encountered (0.001/1000 km). At some time, 56.6% of the athletes had an Achilles tendon overuse injury, 46.4% anterior knee pain, 35.7% shin splints, and 12.7% had plantar fasciitis. Mid-portion Achilles tendinopathy was more common (0.01/1000 km) than insertional (0.005/1000 km). An asphalt running surface decreased mid-portion tendinopathy risk (RR 0.47, p = 0.02). In contrast, sand increased the relative risk for mid-portion Achilles tendinopathy tenfold (RR 10, CI 1.12 to 92.8, p = 0.01). Runners with more than 10 years experience had an increased risk (RR 1.6, p = 0.04) for Achilles tendinopathy.
CONCLUSION: Achilles tendinopathy is the most common running-associated tendinopathy followed by runner’s knee and shin splints.
Achilles tendon injury risk factors associated with running.
Review article
Lorimer AV, et al. Sports Med. 2014.
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Abstract
BACKGROUND: Research into the nature of overuse Achilles tendon injuries is extensive, yet uncertainty remains around how to identify athletes susceptible to Achilles tendon injury.
OBJECTIVE: To identify the strength of evidence for biomechanical risk factors associated with Achilles tendon injuries.
RESEARCH METHODS: SPORTDiscus, CINAHL, Web of Science and PubMed were searched for Achilles tendon injury risk factors and biomechanical measures which are altered in runners with Achilles tendon injuries, excluding ruptures. Fifteen articles were included in the analysis.
RESULTS: Two variables, high vertical forces and high arch, showed strong evidence for reduced injury risk. High propulsive forces and running on stiffer surfaces may also be protective. Only one biomechanical variable, high braking force, showed clear evidence for increasing Achilles injury risk.
DISCUSSION: Gait retraining to direct the centre of mass further forward to reduce high braking force could be useful in decreasing the risk of Achilles injury. The majority of biomechanical risk factors examined showed unclear results, which is likely due to the multifactorial nature of Achilles overuse injuries. Many risk factors are related to how the athlete’s body interacts with the environment during gait, including ground reaction forces, muscle activity both prior to landing and immediately post ground contact, and joint motion throughout stance.
CONCLUSION: Multiple risk factors have been associated with the development of Achilles tendon injuries in running athletes but most effects remain unclear. Advice for athletes recovering from Achilles tendon injuries could include avoiding soft surfaces and reducing the pace of recovery runs. Orthotic intervention could assist athletes with low arches but modification of pronation should be viewed with caution. Strength training and gait retraining could be beneficial for reducing injury risk.