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June 6 2024

How to properly train the Achilles for injury prevention

Did you know that 75% of recreational sports Achilles ruptures occur in active people ages 30-50? Repair surgeries cost thousands of dollars, and rehabilitation for return to play takes more than 6 months. While no injury can be completely prevented, fitness professionals can help clients avoid the sidelines by training them for Achilles injury prevention.

Dispelling the Myths

Clients often self-design parts of their workout based on popular media. The self-designed workouts become habits. Habits determine risk factor exposure. Fitness professionals can help clients maximize their activity participation while minimizing risk factors by helping clients dispel myths.

Myth 1: Stretching before workouts or sport will prevent Achilles injuries.

Fact 1: Lack of ankle flexibility decreases safe zones of movement. Daily calf stretching for 30 seconds each day (for both the gastrocnemius and soleus) can improve ankle flexibility. However, static stretching reduces power and speed for an hour post-stretching. Achilles injuries typically happen with fast movement as the nervous system mis-judges the force direction and speed. Therefore, dynamic warm-ups involving gradually increasing speeds, ranges of motion and direction changes would be more effective pre-workout. Post workout including both gastrocnemius and soleus stretches for 30 seconds most days of the week can add to the available range of safe movement possibilities.

Myth 2: Jumping will cause Achilles ruptures.

Fact 2: Think about the number of people that run and jump every day without having any Achilles issues. As people age, the Achilles becomes less springy due to cellular level changes. Avoiding certain activities simply makes the zone of possible movements smaller. Instead of avoiding jumping, focus on risk factor minimization. Educate clients on the right footwear for each activity, gradually build intensity and volume and include tendon-specific strengthening exercises in their programs. For clients looking to start high-intensity activity, start with a basic return to running walk-jog program before aiming for jump rope duration or number of box jumps.

Myth 3: People will experience Achilles tendinitis or tightness before a rupture.

Fact 3: Many people that experience Achilles ruptures have no warning symptoms or injury history in the area. Common modifiable risk factors include avoiding cortisone injections to the Achilles, selecting appropriate footwear for the activity, including a dynamic warm up, planning low intensity days to alternate with higher intensity days, avoiding pushing through fatigue and keeping distractions to a minimum to maximize concentration on the sport or activity at hand.

Prevention Exercises

Dispelling myths helps build Achilles wellness habits. Clients can build on their strength with prevention exercises. Prevention exercises do help minimize injury risk when used together with program design to control fatigue and attention levels, careful attention to the workout surfaces and proper nutrition and hydration.

Fitness professionals can teach clients to strengthen the Achilles, which helps build greater capacity for a variety of activities. Think of capacity like risk margin. Building a larger risk margin allows more room for movement in all directions at all speeds. While the prevention program can be performed at any age, those over 30 years old have an increasing need to counteract natural tissue age-related changes.

Help your clients learn this eccentric tendon-strengthening program now:

Exercise: Eccentric calf raise

1. Stand with the knees straight and balls of the feet on a step
2. Use both feet to do a calf raise
3. Lift one foot off of the step
4. Lower on a single leg
5. Take 3-5 seconds to lower
6. Repeat 10x before changing to the other leg
7. Repeat the process for a second set with the knees slightly bent
8. Progress: Either take longer to lower, or add a light external weight

Common eccentric calf raise mistakes

1. Skipping the bottom of the motion. Most injuries happen at end range. The tendon will only have capacity at end range if it is trained at end range.
2. Progressing sets and reps instead of eccentric load. Tendons strengthen with eccentric load. Increasing sets and reps can improve endurance, but ruptures are typically a load (not endurance) problem.
3. Doing too much. The Alfredson Achilles tendon rehab program has become quite popular. It requires 180 repetitions per day for 12 weeks to realize benefits. For most people, this is either too time consuming or too high-volume to be realistic. Next steps If you train active adults over 30, use the pearls above to help educate clients for maximal enjoyable activity participation with minimal Achilles rupture sidelining risks.

Dr. Meredith Butulis, DPT, OCS, CEP, CSCS, CPT, PES, CES, BCS, Pilates-certified, Yoga-certified, has been working in the fitness and rehabilitation fields since 1998. She is the creator of the Fitness Comeback Coaching Certification, author of the Mobility | Stability Equation series, Host of the “Fitness Comeback Coaching Podcast,” and Assistant Professor the State College of Florida. She shares her background to help us reflect on our professional fitness practices from new perspectives that can help us all grow together in the industry. Instagram: @doc.mnb