Recently I’ve came to terms with the fact I am now a masters athlete. I wanted to learn about perfecting my recovery, my training and the injury risks of this age bracket. I also want to avoid the ever occurring achillies tendon irritation. In clinic I see a lot of masters runners. Always looking to provide a greater depth of knowledge, I wanted to brush up my skills in managing and preventing injury in this athletic population.
There are many resources which I have used including: – Brad Beer, Rich Willy and Trang Nguyen. I have looked into their work and borrowed some of their pictures and information for this blog. Have a further look at these resources to understand your pathology. Enjoy the rabbit hole, I loved all their work.
Starting with the podcast The Physical Performance Show. The Expert Edition: Prof Peter Reaburn – Maximising Health & Performance of the Masters Athlete. This led me towards the recent journal by Rich Willy 2019 on the masters athlete (journal). The information discussed was interesting and I wanted to share some of the thoughts here.
Definition
The masters athlete is defined as older than 35 years. They train for or takes part in athletic competitions often specifically designed for older participants. Many of these athletes are experienced competitors who continue their athletic pursuits after their sports careers have ended. They can also be individuals who return to sport after extended periods of inactivity or simply participate and train sporadically.
Tayrose et al. 2015
What Changes in the Masters Athlete and its affect on the achillies tendon?
So what are the major changes between a masters runner and that of a younger runner? Firstly there was higher reporting of injury in the masters runner (49% versus 45%). The masters runner was more likely to have more than one injury occurring at a time (30% versus 24%). To understand why I looked a recent journal by Rich Willy 2019. They looked at the profile of a masters athlete. It was interesting the findings which make the masters athlete more susceptible to injury.
The masters runner was more likely to endure muscular and tendionous injuries. This type include Hamstring, plantar flexors, achillies tendon injuries. Whilst the younger athletes injuries were compiled of knee and lower limb including ITB and medial tibial stress syndrome. The thought behind the masters profile of injury was the added stiffness to the muscle tendons.
Achillies tendon injuries can be directly linked to the training load being too much for the capacity of the tendon. This means that the load going through the tendon is too much for it to accept. Therefore the tissue will not react positively to this load. When this happens the capacity is further reduced and can lead to pain and irritation of the tendon.
The stiffness of the achillies tendon also reduces when masters are compared to younger runners. The reduced stiffness results in a greater strain being put through the tendon during plantar flexion. This increases the risk of tendon micro trauma.
Treatment of the Masters athlete’s Achillies tendon.
What is the answer? Runners with a high capacity of plantar flexion and good strength are less likely to injure the achillies tendon. Runners who have the increased plantar flexion strength and those who can generate more propulsion during running have a reduced risk of developing achillies tendon issues. Increased propulsion comes from the use of the whole chain including the foot. Incidentally this is where the highest percentage of muscle loss comes from in masters runners). The research suggests that reduced gastorocnemius and soleus complex strength and also a rear foot contact strike increase the risk of achillies tendon injury. With a fore foot strike you are continuously loading the tendon which increases the capacity
Individuals with achillies tendon issues hop with a reduced stiffness. This is important as running is basically a series of hops. Inefficiency in hopping generally translates to a reduced efficiency in running. Add soft surfaces to this and you further increase the risk of achillies tendon irritation by up to ten times. The reason is because hopping or running on soft ground requires the body to produce more stiffness. If the body is producing more stiffness or the requirements exceed the capacity of the body, the tissue will breakdown. So avoiding soft surface running may be important for the masters runner.
Strength training what should I do?
The biggest question a lot of my clients ask – how do I reduce the risk of achillies tendonitis? The answer is simple – the stronger the plantar flexion strength -> the greater the stiffness -> the reduced risk. Strenghen the plantar flexors – Soleus, Plantaris, and Gastrocnemius. A recent study concluded that stretching had no protective effect against injury. Resistance training’s shown to reduced overall injury risk by 50%. It would therefore suggest that masters runners should prioritise strength over stretch in their non running exercise.
The recent unlace the brace program has has resounding feedback for reducing pain. It has also increased the stiffness and capacity of the plantar flexor group through targeted exercises. The book is available through the landing page to this website (www.physiorun.net) or here.
The research recommend 3-4x 6-8 reps 2-3 times a week for the plantar flexors (calves and in particular soleus). This results in increased tendon stiffness and increases running performance. The higher the repletion count the more negligible the tendon stiffness effect that occurs. Skipping or low level jumping can also compliment the strength training. This increases tendon stiffness but doesn’t build cross sectional area which the strength training does. So wouldn’t be sufficient enough to do only, hence running can maintain strength but doesn’t built it.
Lastly – tendon adaptation takes a long time. The older you are the longer it takes. The inclusion of strength training in the plan should be for over 6 months with slow progressions to allow adaptations.
Whilst recovering from achillies tendon injuries it is important to reduce the exposure to exercise that increases the demand on the muscles. The journal cite minimalistic shoes, soft surfaces, hill running and speed work / treadmill work as being the main risk to the injury rehabilitation.
Are you a masters runner having achillies tendon pain? Have you introduced long slow heavy loading? How is your rehabilitation going?
Thanks very much for reading. I have put in the resources as links where used but main resources were the PDF journal below and @running.physio infographic.
Run Long and Prosper
James