Running injuries

In late February, a fellow Maltese-Canadian came to see me at Physica Health. An avid runner who loves running in Victoria, 70 year old guy, who presented with pain in his achilles tendon and with the hope of running a marathon in May 2020. At first thought, I realized this could be hard, but with a very motivated patient I thought there could be a chance. He calls himself Crazy Legs for a reason :) 

Upon further examination, it seemed he had an inflammation of the tendon sheath in his achilles tendon, a common condition known as Achilles tendinopathy. At Physica Health, our work is based on evidence-based Physiotherapy and we follow the work of Tim Gabbett and Jill Cook very closely. These clinicians are pioneers in tendon rehabilitation. 

Most of our rehab at the clinic, when it comes to return to sport involves 4 phases:

Stages of Rehab

Phase 1: Mobility/Activation Phase

Phase 2: Strengthening phase (Isometrics, Isotonics, Concentric, Eccentrics)

Phase 3: Energy storage loading/Plyo work

Phase 4: Return to Sport drills.

Now Joseph’s case is very interesting. He had full mobility in his ankle, knees and hips. There was some tightness in his posterior calf muscles

We started with very gentle calf and soleus stretches, just minimal holds and minimal number of reps. This is part of a simple program that I like to use as a warm-up and we added some foam rolling drills to release some fascia. Research on foam rolling is not great, but we like to use it as part of a mobility program.

Strengthening - The program emphasized a number of different exercises that worked on soleus and gastrocs strengthening, We started on isometrics, advanced to isotonics and eventually worked on eccentric work. strengthening is a key component in all rehabilitation plans at Physica. Below are some ideas of a few of the exercises that we implemented.

I only saw Joseph over 2 sessions, then we continued progressing the exercises via email. He was diligent and added his own core work too.

We also discussed the return to running program. I love Christopher Johnson’s work (zerenpt.com) and I gave Joseph a Run/Walk program that enabled him to slowly increase his loading capacity on his tendon.

At Physica, we love treating running injuries and Physiotherapy for runners is a big component of what we do in the clinic here in Victoria!

Final thouhgts

Joseph’s injury surprised me as he healed very fast. He managed to continue his marathon training within 3 weeks since I started seeing him. I spoke to Joseph quite a few times in the last few weeks, and I wonder if his diet has helped him accelerate his healing. He mentioned that he was a vegan for the last 3 years, and continues to take Vitamin B12 and Iron as supplements. He did tell me his wife Dorothy has been very patient with him over the years :) An interesting study can be seen here. A high carbohydrate diet can affect inflammation in tendons, so this probably is quite interesting, but more research is needed in this area and not my expertise.

Well done Joseph, was a pleasure treating you, and hope you continue to have a healthy running and ‘crazy’ career!