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Traditional Shoes vs. Minimalist Shoes


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness, Run Injuries) by Rick Kaselj on 04-01-2012

Traditional Shoes vs. Minimalist Shoes

In the last few years there has been an ongoing debate in the running industry regarding footwear. At one extreme are the barefoot and minimalist running shoe proponents who argue that no shoes or at most, shoes with minimal structure, are best. On the other end are experts who hold that the traditional thick soled, cushioned shoes are optimal for injury prevention.

Traditional Running Shoes

Until the 1970’s running shoes were manufactured with flat, thin-soles. Indeed the current growth in popularity of minimalist shoes can be seen as a case of old becoming new again.

In the late 70’s and early 80’s running shoe construction began incorporating thicker soles with elevated heels. The rationale for adding cushioning in the midsole and motion control features in running shoes was to absorb impact forces and control movement, specifically pronation, of the foot.

This rationale however was probably misguided. Cushioning materials in shoes actually increases overall leg stiffness (Bishop et al. 2006). Some leg stiffness is beneficial to running well but excessive leg stiffness may be a factor for increased risk of injury (Hewett et al. 2004).

A review study by Richards et al in 2008 concluded that the prescription of “pronation control, elevated cushioned heel (PCECH) running shoes to distance runners is not evidence-based.”

Additionally, a study by Ryan et al in 2010 showed that motion control shoes had the highest incidence of injury in their research group, regardless if the wearer had highly pronated feet or not.

There is good evidence that the shoe construction of the last thirty years or so has not accomplished what it was originally intended to do. Injury rates in runners today remain as high as ever.

Minimalist Shoes

Since Christopher MacDougall published Born to Run in 2009, there has been tremendous growth in the number and styles of so-called minimalist shoes. Virtually every major shoe manufacturer and a number of smaller upstarts now have minimalist shoes.

These shoes were designed to mimic how the foot functions barefoot. Generally, running barefoot will cause a runner to land with a flatter foot (De Wit et al 2000).

In addition, Lieberman et al. (2010) found that if a barefoot runner lands with a forefoot landing there is no impact transient (a very rapid rise in impact forces) as compared to landing heel first in shoes. It should be noted however that Lieberman and his group do not claim that heel striking in and of itself causes injury.

Minimalist shoes share the following characteristics:

  • They’re lightweight.
  • They have a flexible upper and sole.

  • They incorporate less or no cushioning material in the mid-sole.
  • And there is less difference between the heel and forefoot height (also known as heel drop). Traditional shoes have a heel drop of 11 – 15 or more mm while minimalist shoes have a heel drop under 10 mm.

Traditional Shoe 

Heel Drop

Minimalist Shoe Heel Drop

Within the minimalist shoe category are three main sub-categories:

  1. Barefoot-style shoe. This shoe is the most minimal in structure with no cushioning, a zero-drop (heel and forefoot are level) and the thinnest sole. Examples include the Vibram Five-Fingers and the Merrell Trail Glove.
  2. Minimalist shoe. These shoes have some cushioning in their midsole, small or no heel drop and a wide forefoot allowing the toes to be splayed. Examples include the Altra brand shoes.
  3. Transition shoe. These shoes are most similar to traditional running shoes but are lighter, more flexible and have a lower heel drop. Examples include the Nike Free, Saucony Kinvara or the Brooks Pure models.

Take Home Advice

Currently, neither the minimalist side nor the traditional side can conclusively say their method of shoe construction is superior in regards to injury prevention. More and more studies are being done with minimalist shoes and it will be interesting to see the data.

In my opinion as a coach I think most runners could benefit from some amount of running in minimalist shoes. However caution must be taken in how quickly and how much a runner transitions away from a regular, traditional running shoe.

There will be a wide range of individual variability in adapting to a more minimalist style of running. A runner’s experience, ability, strengths, weaknesses, injury history and psychology are all factors to consider.

The choice of running shoe style needs to be part of a well-thought out training program. If a runner has been relatively injury-free and is content with their performance in traditional shoes I see no reason to push them into minimalist shoes.

On the other hand, if a runner has had repeated injuries and setbacks with traditional shoes it may be time to transition to a more minimalist shoe.

My advice would be to first look for a shoe with a wide toe-box to accommodate splaying of the toes during running. This will facilitate proper function of the big toe. Less cushioning and more flexibility are other characteristics to look for. Lighter shoes will help improve running economy.

I would be more cautious in regards to heel drop. Going to a zero-drop shoe for many runners will be put too much strain on the Achilles tendon and lower posterior chain. Look for a 4 – 8 mm heel drop initially.

Use the shoes indoors during strength training sessions first and then try them for short runs and running drills. Build the mileage gradually. Some runners may adapt to where they can run with minimalist shoes all the time. Others may only be able to progress to using them for shorter runs.

But keep in mind that shoes, whether traditional or minimalist, are not a solution by themselves. Runners need to incorporate strength training, multi-planar mobility drills and technique exercises into an individualized conditioning program that includes adequate recovery and sound nutrition.

Vancouver Running Symposium

If you’re interested to learn more about this topic and are in the Vancouver area on January 26, I invite you to attend the Vancouver Running Symposium.

An expert panel consisting of a sports medicine doctor, physiotherapist, pedorthist, coach, shoe designer and a podiatrist will be debating the role of traditional shoes vs. minimalist shoes.

Full details and the RSVP form can be found at Vancouver Running Symposium.

Curb Ivanic
, MS, CSCS is a Vancouver based trainer, running coach and experienced ultrarunner. He is the creator of the Core Running system and has coached hundreds of runners from beginner to elite over the last 12 years. You can contact him through CoreRunning.com .


Big thanks to Curb, that was great.

I very much recommend that you do what you can to make the Vancouver Running Symposium.  It looks great.

If you are looking for a fitness education course focused on working with the recreational runner, you can check out:

If you are looking for resources to help you run injury free, you can check out:


Here are a few other articles on running that may interest you:


Scapular Stabilization Exercises, Jumper’s Knee and Osteoarthritis


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness, Scapular Stabilization) by Rick Kaselj on 13-12-2011

Back to doing research reviews.  This is fun.  It is great to go into the research to see what is new when it comes to exercise and injuries.  In this round of research reviews I found some great research on scapular stabilization exercises, jumper’s knee and osteoarthritis.

Let’s get into the research.

Should I be Wasting My Time with Scapular Stabilization Exercises if I have Shoulder Impingement?

What They Looked At:

The effectiveness of an exercise program on the shoulder with people who have subacromial impingement syndrome.

How Did They Do It:

They divided 40 subjects into two groups.

Group 1 did stretching and strengthening exercises while group 2 did stretching, strengthening and scapular stabilization exercises.

What They Found:

Both groups showed improvement but the second group had greater improvement in muscle strength, joint position sense and scapular dyskinesis.

Take Home Message:

If you or your client has subacromial impingement, make sure to add scapular stabilization exercises to your program, along with stretching and strengthening.

Let me take a minute to explain a little more on why you should do this.

The results above all make sense because in shoulder impingement clients you often see:

  • increased upper trapezius activity
  • decrease in middle and lower serratus anterior activity
  • reduced rotator cuff activity
  • delay in middle and lower trapezius activity with sudden perturbation
Make sure to include stretching, strengthening and scapular stabilization exercises to help improve these dysfunctions.

To get more information, check out: Başkurt Z, Başkurt F, Gelecek N, Özkan MH. (2011). The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173-9.

Also have a look at this one:  Phadke V, Camargo P, Ludewig P. (2009). Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement. Rev Bras Fisioter. 2009 Feb 1;13(1):1-9.

For the program that I use for scapular stabilization exercises, click here.

Want to Improve Osteoarthritis pain? Then Losing Some Weight is the Key.


What They Looked At:

They looked at 111 obese adults.   The researchers performed a baseline MRI and a 12-month follow up MRI to look at cartilage thickness.

Neat Stuff in the Introduction:

  • Obesity is a major health problem
  • The World Health Organization estimates more than one billion people are overweight and 300 million are obese
  • Osteoarthritis is the most common form of arthritis and the leading cause for chronic disability among older adults
  • Weight loss has been shown to decrease knee pain and to improve knee stiffness, function and disability

What They Found:

The average age was 52 years old, a BMI of 37 and average weight loss was 9%.

A decrease in weight led to an improvement in quality and quantity of medial articular cartilage but this was not observed in the lateral compartment.

This improvement in cartilage could lead to a reduction in the need for total joint replacements and decreased the impact on the health system.

Take Home Message:

We don’t talk about it often but with so many conditions in the lower body, an emphasis on decreasing weight will help overweight and obese clients recover from some injuries and prevent future ones.

Thinking beyond just exercise to lifestyle, nutrition and activity – even when injured – is key.

To get more information, check out: Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, Sambrook PN, March L. (2012). Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012 Jan;71(1):26-32.

I go through more stuff on knee osteoarthritis in the course:

What is the Best Treatment for Jumper’s Knee?


What They Looked At:

The effectiveness of an exercise program, ultrasound and transverse friction for the treatment of chronic patellar tendinopathy.

Neat Stuff in the Introduction:

  • Jumper’s knee or patellar tendinopathy
  • common in sports involving jumping and landing, rapid acceleration and deceleration, cutting moves and kicking (basketball, volleyball, soccer, tennis, high jump, long jump, fencing, track)
  • No correlation between intrinsic factors leading to jumper’s knee (malalignment, Q-angle, biomechanics).
  • Principal cause of jumper’s knee is hard playing surfaces, increase in training involving repetitive eccentric movement and tight hamstrings and quads

How Did They Do It:

They had 30 subjects with chronic patellar tendinopathy and divided them up into three groups (exercise, ultrasound and friction). Each group received treatment three times a week for four weeks.

Then they looked at the pain level of each of the subjects at 4, 8 and 16 weeks.

What They Found:

They found the exercise program had better results than the ultrasound and friction.

Yay, exercise.

If you do get treatment for jumper’s knee and have ultrasound and friction performed, don’t discount the exercise. It may be the missing piece that will help you out the most with your jumper’s knee.

What the focus needs to be on is an eccentric exercise program.  I go through that in Achilles Tendinitis Exercise Solution for the Achilles tendon.  In a few weeks, I will be finishing up this month’s, Injury of the Month, which will be Jumper’s Knee.  Watch for it before the end of December.

To get more information, check out:  Stasinopoulos D, Stasinopoulos I. (2004). Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clin Rehabil. 2004 Jun;18(4):347-52.

Hope you enjoyed the research review.

Let me know what you think. Please feel free to share a recent article that you have read in the comment area.

Rick Kaselj, MS


Working Towards 10,000


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness, Knee Injury, Knee Pain, muscle imbalances, muscle imbalances revealed, Shoulder Injury, Shoulder Pain) by Rick Kaselj on 26-10-2011

I get lots of email. Let me answer some of the questions that came in over the last week or so.

What to Do About Bootcampers with Painful Knees?

Brenda found me on Facebook.

“Hi Rick, I’ve got a couple of clients with dodgy knees and a lot of my boot camp has running, which is too painful for them – can you offer suggestions that will give them just as good a workout and that are safe? Thanks, Brenda”

If you are looking for a program to help you out, I recommend this:

Working Towards 10,000

I mentioned this in last week’s questions from readers.  I am working towards helping 10,000 health and fitness professionals help 1,000,000 clients become pain and injury free by 2020.

It is an ambitious goal but you got to have big goals to bring the best out of you.

I think I am on the right track especially when I get emails like this:

“Hi Rick,

Thank you very much for the free gift!

I am just starting out as a personal trainer.

However, I have been involved in physical fitness, getting in shape, nutrition for quite a number of years. Your website is really incredible!  You’ve opened my mind up to things that I did not know about.  This will definitely help me out when I train people.  The last thing I want to do is hurt them when they’re coming to me for help.  The information you provide will definitely help me do that.

I now feel better ‘armed’  to train people properly if they have an injury.  Thanks, Rick.

Thank you so much, Larry. I am glad all the free stuff on the website has helped you and your clients out.

This is what Larry was talking out, yours free.


Yes, free.  Click here to get it.

Even Fit Pros Get Injuries

A few years back, I got chatting with another fitness professional on injuries that fitness professionals have.

After that conversation, I asked other fitness professionals about their injuries.  I was shocked to see how many of them had some little ache and pain that was not forcing them to stop working, but slowing them down a little.

Here is an example.

“I love learning more about how unbalanced I am.

I just ordered the Achilles tendinitis package last night from your site and am going to get started on that right away.

I went out and bought new shoes and that seem to help a bit, but I’m going to work through the exercises so that I can avoid any future problems.

I can’t remember if it was Eric Cressey or Mike Robertson that recommended your site, but I think that’s how I found about you and your site.

I like the name Exercise for Injuries and the concept behind it… I just don’t like being injured.   Thanks for your help,


Thanks EK, let’s get  you uninjured.

Seniors in a Care Home

A neat trend that I have seen over the last 12 years of teaching fitness education courses is more fitness professionals in senior care homes.

This is very cool and exciting.

From talking with the few that are in them, what they do is an activity class, stretch classes, core classes and some personal training.

I know these seniors are getting a lot of benefit from exercise at their age.

One thing that they all said was a big issue for seniors is shoulder injuries and many of them have come to my Exercise Rehabilitation of the Shoulder course.

If you do work with seniors, it may be an idea to come out to the class.

Muscle Imbalances Revealed – Upper Body Edition – Exam


Things are rolling with MIRU and people are getting their CECs and CEUs from it.

I have just got approval from NSCA, BCRPA and BCCMT.

Here is a specific question as it relates to the MIRU exam.

“Hello Rick,

How do I go about in submitted MIUB in order to receive .7 credits through the NSCA?

I won the product a few months ago and I do not have a receipt for them for approval.

What do you suggest?


It is really easy.

The exam is in the membership area in the exam and there are no plans on taking down the membership ares so it is there when you need it.

Print the exam out and fill in the answer sheet.

Send me the answer sheet and I will mark it.

If you get over 80%, I will send you the certificate for NSCA CEUs.

That is it, pretty easy.

Some More Kind Words about MIRU

“MIRU provided a different perspective about movement.

First, because of the different background of each presenter and second was a sort of the “holistic” approach, meaning that, breathing and myofascialtraining aren´t  too common findings in other materials related to exercise.


Luigi Marino Neto
Strength Coach
Sao Paulo, Brazil”


Please do send me your questions via Facebook or email.  I will do my best answering them and please do not be angry if I do not get to it.  I get a few hundred a day.

Plus, here are some more videos that may help when it comes to bootcampers and knee pain:


Foot Injury Exercises


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Ankle Injury, Fitness, Plantar Fasciitis) by Rick Kaselj on 11-10-2011

Awesome post for you on foot injury exercises.


Foot Injury Exercises: How to effectively address issues in the foot, through SMR, mobility, and stability

The foot is a very complex structure for both fitness and health professionals to assess effectively. Bearing weight for the majority of the day it is responsible for absorbing and transmitting forces between a contact point (usually the ground) and the rest of the body.

By far the most commonly diagnosed condition in the foot is plantar fasciitis. While this may be common, many conditions may develop in the foot. Without a proper diagnosis, methods of rehabilitation become blind and often ineffective.

Below are some of the most common foot conditions to keep in mind during your assessment:

  • Plantar fasciitis: Pain is present in the heel or underside of the arch. Pain usually decreases with rest, and is worst during the first few steps after long rest periods (ie: the morning). Heels spurs, or bony growths, may also show up on x-ray to help confirm this diagnosis.  (For plantar fasciitis exercises, check out Rick’s Plantar Fasciitis Relief in 7 Days Program)
  • Severs Disease: Heel pain that presents in children between the ages of 8-14. Pain is similar to plantar fasciitis however, spur development is uncommon. This condition is caused by inflammation of the growth plate in the calcaneus (heel). Pain gets better with rest and is recreated by squeezing the heel.
  • Fractures: Fractures can present with minimal or no swelling. Stress fractures are quite common in toes 2-5. Pain does not decrease with rest, the bone may be tender to the touch and night pain may also be experienced.
  • Neuromas: A neuroma is a benign tumour originating from nerve cells due to regional irritation. Pain is quite localized and is most common between the 2nd and 3rd toe. There may be a palpable nodule that is very tender to the touch.
  • Tendinopathies: Any of the tendons that assist in stabilizing the arch can become irritated due to repetitive strain. Pain may be present at the start of activity, disappear during and resume post activity. Pain presents as a dull ache and may extend up into the calf.  (For Achilles Tendinitis exercises, check out Rick’s Achilles Tendinitis Exercise Solution)
  • Sprains: Impact sprains may happen especially in flat feet. Pain is sharp, tender to touch, and may be accompanied by localized swelling.
  • Peripheral Neuropathies: Nerve entrapments higher up in the leg and back can cause pain in the foot, especially on the medial side (mimicking plantar fasciitis). Night pain may be present and symptoms are paired with problems elsewhere in the body (ie: “calf or hamstring tightness causes my heel to flare up”).
  • Degenerative Changes: The most common arthritic development in the foot happens at the big toe. Pain is localized to the big toe, and may be present at night. There may also be the presence of a bony growth. Bunion formation can present similarly at this joint, however bone growth happens on the inside of the big toe.

#1 – Simple Assessment Foot Injury Assessment

Assess the foot in non-weight bearing first. If a person has an arch while non-weight bearing, you should recognize there is potential for that person to create an arch. Without forces of gravity and load the foot is structurally sound. With optimal function this arch presentation should remain stable upon the foot hitting the ground.

If the arch collapses in assumption of standing, the therapist/coach should start thinking of ways to improve arch stability.In individuals with arch collapse while non-weight bearing, chances of true structural issues are higher. Functional rehabilitation should still be carried out, but without expected progress an orthotic may be needed for full resolution of symptoms. In my experience orthotic prescription is required less if a correct rehabilitation protocol is followed under sound patient compliance.

#2 – Is Self Myofascial Release Good For The Foot?

Pes Planus: The majority of conditions happen because of the foot’s inability to be stable in a gait cycle. This loss of function leads to pronation of the foot or dropping of the arch (also known as pes planus). Pronation of the foot leads to lengthening of the tissues in the bottom of the foot. The result is pain, and irritation due to loss of mechanics.

Self myofascial release (SMR) in these instances creates less tissue stiffness, and greater instability. In cases of forefoot and rearfoot pronation a coach/therapist may be better coaching SMR of the hips and pelvic girdle. Addressing tight fibrotic musculature that maximizes function of the pelvis will certainly create better opportunity for function in the foot.

Read the rest of this entry »

Exercises for Achilles Tendonitis


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness) by Rick Kaselj on 11-07-2011

Now we are onto part 3 of the Achilles Tendonitis Injury and Exercise Report where we will focus on Exercises for Achilles Tendonitis.

I really thank you so much for reading this.

If you missed part 1 and part 2, here they are:

Now off to part 3.

Treatment and Management of Achilles Tendonitis


Acute Achilles Tendonitis


Movements to Avoid

Acute injury involving the Achilles tendon is often effectively managed with conservative treatment.

It is recommended to take a break from activities that involve repetitive and forceful plantar flexion (Coming onto the toes).

Resting can bring about positive effects to the injured tendon. Many times this is enough to do the trick.

Training Tips

If you are an athlete and you want to maintain your fitness level, the best solution is to cut back the intensity of your training and modify activities that involve hill work and speed work. If you are training twice a day, you may change it to once a day. You can also take one or two days off between training sessions per week to maintain your form.  You might shift focus of your training program to activities that decrease the amount of plantar flexion.

The Use of Ice

Application of cold compressions to the affected area is also important.  With acute Achilles tendonitis involving inflammation, it is important to control and decrease that inflammation.

Ice or cold compressions are usually applied 10 to 20 minutes to reduce inflammation, control pain and swelling. Ice is applied every two hours for 48 to 72 hours during the initial injury.

Keep in mind not to apply ice directly onto your skin. You can wrap ice cubes in a towel to avoid skin damage.

Compression Wraps

Application of compression wraps may also help in providing support to the injured tendon during walking or running. It also helps in relieving swelling.

Before applying, ensure that your skin is dry and clean. Apply a wide, firm and elastic compression bandage to cover your ankle and lower leg. Begin by wrapping around all the toes, around the foot and then the ankle.

Application of compression wraps is a useful thing to do during acute injuries, but you must ensure that it is correctly done. It must comfortably wrap around your foot and ankle. Wrapping it too tight can slow down the process of tissue healing.

Other Things You Can do

Elevation of the affected leg drains the excess fluids, helps relieve swelling and assists in decreasing pain.

Pain and anti-inflammatory medications maybe something that helps with inflammation during the initial stages of your injury.

Chronic Achilles Tendoninitis or Tendinosis

The treatment for chronic Achilles tendinitis is quite similar to acute tendinitis, although it is significantly less responsive to intake of non-steroid anti-inflammatory medications and ice applications.  The exercises to perform are different.

Orthotics and Foot Biomechanics

Structural deformities involving the foot may be a risk factor of Achilles tendonitis.

Overpronation, a condition where the foot flattens out, can add a great amount of stress or load to the tendon.

Looked at your shoes to see if they are overly worn out and getting a proper fitting set of new shoes will help with your Achilles tendonitis.


An operative treatment may be considered if the symptoms continue to disrupt your normal routines despite 6 to 12 months of conservative treatment.


Without a doubt, incorporation of appropriate exercises into your treatment regimen can help protect the Achilles tendon from further damage or progression.

In mild cases of acute tendinitis, conditioning may be maintained by modifying your exercises and activities. Cross training, swimming, biking and aqua jogging are recommended (Gottschlich et al., 2009). Again, make sure to avoid activities that require repetitive and forceful plantar flexion.

Include calf strengthening exercises into your exercise program. This is essential.

These exercises will not only provide better support to the Achilles tendon but they may also stimulate the production of type 1 collagen fibers, improving the tendon’s strength and endurance to stress.

After pain has subsided, calf stretches are recommended. These exercises should be done with the knee both in extension and flexion to stretch the gastrocnemius and soleus muscles, respectively.

Recommended Exercises for Achilles Tendonitis



Achilles Tendonitis Stretch

Achilles Tendon Calf Raise

Achilles Tendon Single Leg Calf Raise

If you are looking for an exercise program to help you with your Achilles Tendonitis, I would suggest this one:

Read the rest of this entry »

Heel Drops


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness) by Rick Kaselj on 06-07-2011

Today, I want to go through how to do Heel Drops, which is a common exercise given for Achilles tendinosis.

Heel Drops





Purpose: To strengthen and improve the quality of the Achilles tendon.

This is a specific exercise for Achilles Tendinosis.

Starting Position: Start in a standing position with the balls of your feet on a step.You can use a riser as in the photo above or the bottom stair of a set of stairs.

You will start with the balls of your feet on the step, your heels off the step, your legs straight and hands against the wall in order to eliminate balance.

How to Do the Exercise: Let your heels drop focusing on the movement happening in your ankles.

You should feel a stretch in your calves.

After reaching the bottom o the position, return back to the start.

Progressions: You can progress to doing the exercise, one leg at a time.
Contraindication & Common Mistakes: You should feel a light stretch, and if you feel pain, discontinue the exercise.


Here is a video that will help you out:

Read the rest of this entry »

Achilles Tendon Exercises


Filed Under (Achilles Tendinitis, Achilles tendinosis, Achilles Tendonitis, Fitness) by Rick Kaselj on 04-07-2011

Today I am continuing on with the second part of the Injury and Exercise Report on Achilles tendon exercises.

If you missed it, in part 1 I focused on Achilles Tendonitis and Exercise.

Before I get into the article, let me go through a few exercises you can do for Achilles tendonitis.

Self Massage for Achilles Tendinitis

Double Leg Calf Raise for Achilles Tendinitis

I hope those Achilles Tendinitis exercises help you out.

Now lets get into the article.

What is the Strength of the Achilles tendon?

What do the figures say?

How strong is the Achilles tendon?

The strength of tendons is related to their thickness and collagen content. Tendons with more collagen type I fibers, are more adept to withstand larger loads.

Research indicates that an adult healthy Achilles tendon is capable of enduring about 9 kilonewtons when running (Maffuli et al., 2004). This figure corresponds to about 12.5 times the body weight. When running on your toes, as much as 4 kilonewtons are loaded to the tendon. Maffuli and his team indicated that the Achilles tendon can support a load of about 2.6 kilonewtons during walking and 1 kilonewton during cycling.

How big of a Problem is Achilles Tendinitis?

In the past 30 years, the incidence of Achilles tendinitis has significantly increased. Its escalating incidence is attributed to a greater number of individuals who engage in recreational and competitive sporting activities. In fact, at this time, 10% of Americans are involved in some kind of activity that requires recreational running and other jumping activities, for longer periods of time than in the earlier generations (Hargrove & McLean, 2009).

The exact data are not known, but there are reports indicating the incidence of Achilles tendinopathy in the population.

Hargrove and McLean estimated that Achilles tendinopathy affects between 7 and 18% of club runners.

In the United States, more than 200,000 patients are treated each year for Achilles tendinitis and tendinosis.

What Increases the Risk of Achilles Tendinitis?

Achilles tendinitis is commonly associated with athletes, especially runners. It was estimated that this injury has a 7 to 18% incidence among club runners. The figure is not so surprising knowing that the Achilles tendon loads about eight times your body weight during running.

Its incidence is also on the rise in individuals involved with raquet sports, track and field, volleyball and soccer. The number of Achilles tendinitis cases among ballet dancers has also become a growing concern.

Achilles tendinitis is by no means limited to athletes. Almost one-third of patients with the diagnosis did not even participate in any form of vigorous physical activity. This condition has also been seen in people who live a sedentary lifestyle.

Age is possibly one of the most significant factors associated with Achilles tendinitis. It more commonly occurs in older and more sedentary athletes than in younger and well-conditioned athletes.

In addition to repetitive microtrauma, this condition is significantly influenced by the declining number of tough collagen fibers as you age. As an result, the Achilles tendon becomes more susceptible to injury.

One problem with Achilles tendon damage is that healing may be slower than the usual due to the limited supply of blood. The problem turns from bad to worse as you age since an Achilles tendon injury does not usually heal appropriately when physiological changes related to aging set in. If the athlete is poorly conditioned, overfatigued or insufficiently prepared, the risk further increases.

As an interesting side note, rupture of the biceps tendon is strongly linked to smoking. However, no study has adequately proven that smoking is related to Achilles tendon rupture. In spite of the lack of evidence, smoking should be avoided. Its chemical components can inhibit or slow down the process of tissue healing, which can certainly worsen the tendon damage.

What Causes Achilles Tendinitis?

The exact root cause of Achilles tendinitis is not fully understood. Although more information is needed to fill in the gaps, initial findings suggest that Achilles tendinitis is associated with overuse, improper training, aging of the tendon, gait abnormalities due to structural deformities, or improper footwear (Dubin, 2005).

As a main starting point, an injury involving the Achilles tendon occurs when the force applied to the tendon exceeds its ability to withstand the load. It may occur in a single episode or more frequently, over a period of time, such as repetitive microtrauma.

Certain activities and improper body mechanics may also weaken, tire or tighten the supporting muscles in the lower extremity, such as the gastrocnemius, quadriceps and hamstrings. When they tire out, trauma is most likely to occur. When the strength of calf muscles is maintained, the Achilles tendon sustains its ability to endure the load.

Excessive outward turning of the foot increases the tendency to walk on the inner border of the foot. This places a great amount of stress on calf muscles and Achilles tendon.

Trauma is also caused by premature increase of the intensity, duration and frequency of an exercise program.

Also, training on improper surfaces increases the risk of its occurrence. The foot has to have a stable ground contact to efficiently absorb the shock and transfer the load evenly to the supporting structures.

Your footwear may also increase the risk of Achilles tendinitis. Frequent wearing of high heels shortens the tendon and calf muscles,  leading to Achilles tendinitis and high heel pain.

Signs and Symptoms of Achilles Tendinitis

Achilles tendinitis may be acute or chronic. Acute tendinitis is mainly manifested by signs and symptoms of inflammation. You may experience localized or burning pain in the Achilles tendon area or around the back of the ankle, specifically from the calf to the heel during or after an activity. During the earliest stages of the injury, the pain and tenderness are usually resolved within 24 hours with conservative treatment. Activities and exercise are not usually disrupted.

When acute Achilles tendinitis is inappropriately managed or untreated, chronic tendinitis ensues. This condition is more difficult to treat, necessitating more aggressive interventions to resolve the symptoms. Pain continues to be the major complaint. The onset of pain may occur all throughout an activity, with decreased activity or at rest. A great number of patients with this condition complain of increased severity of pain in the morning. Unresolved by conservative treatment, pain in the Achilles tendon may begin to interfere with your speed and overall performance. It may get so severe that you may be unable to tolerate your usual training session, especially if it involves walking up hill or up the stairs. Activities of daily living become intolerable as it further goes into progression.

Individuals with chronic tendinitis report a sensation of fullness or the development of nodules at the back of the leg, about 2 to 4 centimeters above the heel. This occurrence signals tendinosis, which involves degenerative changes in the Achilles tendon. Creaking sounds upon movement of the ankle joint or upon pressing the tendon with your fingers may be noted.

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