Achilles tendinopathy in the summer runner: recognising it before it becomes chronic

Summer is one of the favourite seasons for anyone who loves running. Longer days, favourable weather and the chance to train outdoors lead many runners, beginners and experienced alike, to increase both mileage and training frequency. It is precisely in this season, however, that the risk also rises of developing one of the most common problems among running enthusiasts: runner's tendinopathy, often located at the Achilles tendon.

In Lugano and across the canton of Ticino, many people make the most of the lakeside, the trails and the hillside routes to stay in shape. Small signals ignored at first can nevertheless turn into a persistent problem capable of costing weeks or even months of sport.

Recognising the first symptoms of runner's tendinopathy means being able to act quickly, reducing the risk that the irritation develops into a chronic tendinopathy that is far harder to treat. Understanding how the problem arises, which mistakes encourage it and which strategies to adopt makes it possible to keep running safely while protecting the health of the tendon.

The Achilles tendon is the strongest in the human body, but also one of the most heavily loaded during running. It connects the calf muscles to the heel bone and allows every phase of the push-off to take place.

With each stride this tendon stores elastic energy and releases it in the next phase of movement, helping to improve running efficiency. During a single training session it can be subjected to thousands of consecutive loading cycles.

When those loads increase too quickly, or recovery is insufficient, the tendon tissue can start to show signs of strain.

It is at this stage that runner's tendinopathy can appear, initially with very mild symptoms that many athletes tend to underestimate.

The summer season brings many changes to training habits.

Many runners:

• suddenly increase their mileage;
• take part in summer races;
• run on routes with more climbing;
• alternate between tarmac, gravel and trails;
• use shoes that are worn out after the winter.

High temperatures also affect how the muscles behave. Feeling looser can lead to a shorter warm-up, while dehydration alters the properties of connective tissue, making it less efficient at withstanding repeated stress.

Taken together, these factors create ideal ground for runner's tendinopathy to develop.

One of the most common mistakes is waiting until the pain becomes significant before asking for a physiotherapy assessment.

In most cases the first signals are far subtler.

Early symptoms may include:

• stiffness on waking;
• pain during the first steps of the day;
• discomfort in the first minutes of a run that seems to ease with movement;
• slight tenderness when the tendon is palpated;
• a feeling of tension in the calf;
• mild localised swelling.

Many runners read these symptoms as simple muscle fatigue.

In reality they often represent the early stage of runner's tendinopathy, the point at which acting is considerably easier than in the advanced stages.

There is a very typical feature of Achilles tendon problems.

At the start of training the pain is there.

After a few minutes it seems almost to disappear.

At the end of the run, or in the hours that follow, it returns more intensely.

This pattern misleads many athletes into believing the problem is resolving on its own.

In reality the tendon continues to be loaded beyond its capacity to adapt.

Carrying on training without changing the load increases the risk that runner's tendinopathy will turn into a chronic tendinopathy.

Every runner is different, but some mistakes come up particularly often.

Among them are:

• increasing mileage too quickly;
• consecutive training sessions without recovery;
• sudden changes of surface;
• shoes that are no longer suitable;
• reduced calf muscle strength;
• limited ankle mobility;
• an inefficient running technique;
• returning to training after a break without building up.

Very often the tendon is not the real cause of the problem.

The cause may lie in the biomechanics of the whole lower limb, involving the hip, the knee and the foot as well.

This is why a global assessment is one of the most important parts of the rehabilitation process.

We now know that the term "tendinopathy" describes only part of the problem.

In the early stages an inflammatory response may be present, but when the problem persists the tendon undergoes genuine structural changes.

The collagen fibres become less organised.

The capacity to bear load decreases.

The tendon loses part of its elasticity.

This is precisely why limiting treatment to ice or anti-inflammatory drugs is rarely a lasting solution.

Runner's tendinopathy requires a treatment pathway that genuinely restores the function of the tendon.

A physiotherapy consultation makes it possible to understand not only where the pain appears, but above all why it has appeared.

The assessment examines many aspects, including:

• ankle mobility;
• calf strength;
• balance;
• foot contact;
• hip control;
• any compensations while walking and running;
• load distribution.

Every detail helps to build a personalised programme.

Two runners with the same pain may in fact have completely different causes.

In recent years research has shown that the treatment of Achilles tendinopathy rests mainly on progressive exercise.

The tendon needs an adequate stimulus in order to recover its functional capacity.

Naturally, not all exercises are equal.

The choice depends on the stage of the problem, the intensity of the pain and the person's sporting goals.

The programme is built gradually, increasing load only when the tendon shows it tolerates it well.

It is precisely this controlled progression that allows runner's tendinopathy to improve without encouraging relapses.

This is one of the questions runners ask most often.

The answer is not the same for everyone.

In some cases running has to be suspended temporarily.

In others it is possible to carry on while adjusting:

• distance;
• pace;
• training frequency;
• type of terrain;
• the intensity of climbs.

The aim is not to remove movement altogether, but to find a level of load compatible with the tendon's capacity to recover.

This strategy often makes it possible to maintain good fitness without making the problem worse.

Once the painful phase is over, many runners make the mistake of returning immediately to their previous training.

It is precisely at this point that many relapses occur.

Prevention includes:

• a gradual increase in mileage;
• strength exercises maintained throughout the season;
• adequate recovery between sessions;
• replacing shoes regularly;
• paying attention to the signals the tendon sends;
• planning races properly.

A tendon that has already shown strain needs more attention, even after the pain has completely gone.

Many runners live with minor discomfort for weeks, hoping it will disappear by itself.

Unfortunately this attitude is one of the main factors that allow the problem to become chronic.

Acting within the first weeks often significantly shortens recovery time and limits the interruption to sport.

When the pain becomes constant even in everyday life, rehabilitation tends instead to take longer.

This is why any persistent symptom at the Achilles tendon deserves a professional assessment, especially for those who run regularly.

Lugano offers outstanding routes for anyone who loves running, from the lakeside to trails through the greenery. To keep practising this sport safely it is essential to listen to your body and not ignore the first signs of overload.

Runner's tendinopathy does not appear out of nowhere: in most cases it sends small signals long before the pain becomes disabling. Recognising them means protecting the tendon, avoiding long periods off and returning to training with greater awareness.

If you feel pain in the Achilles tendon, stiffness in the morning or discomfort that returns during or after a run, the Ti-FISIO team can help with a thorough physiotherapy assessment and a personalised rehabilitation programme. Through an analysis of the causes, specific exercises and correct management of training load, it is possible to address the problem before it becomes chronic and to return to running safely on the routes of Lugano and the canton of Ticino. Contact Ti-FISIO to book a consultation and receive a programme built around your sporting needs.

+41 91 940 10 20

info@ti-fisio.ch

Via Ceresio 42, Pregassona.

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+41 (0)91 229 69 80

mendrisio@ti-fisio.ch

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