Popular wisdom around running is always shifting, especially when it comes to best practices for healing injuries. The philosophy on tendon health has evolved over the past few years, especially concerning how to heal one of the peskiest running injuries in the books–Achilles tendonitis.
Lauren Roberts is a Toronto-based physiotherapist who says that runners should consider loading their injuries as opposed to hammering out lots of sets. “For many years rehabilitating injuries was all about doing multiple sets of many reps with little to no load. Now we’re in the midst of a philosophy switch that’s suggesting, especially for tendons, that less reps and higher weight is better for healing.”
Roberts says that the bulk of the research has been done on tendon injuries. “We used to prescribe runners 50, 60, 70 reps of calf raises but now I suggest doing five to eight at 70 per cent of their maximum load. We’re seeing faster recovery with this style of rehab.”
My top 3 2019 key rehab themes:
1. Greater awareness of RED-S is needed- athletes can be stable weight but in energy deficit
2. In a data driven world -many of the best athletes /coaches keep things simple
3. When rehabbing injuries tissues respond to load not # reps+sets
— Running.Physio (@Brad_Beer) December 28, 2019
What are you fixing with loaded exercises?
Tendonitis (acute) or tendinopathy (chronic) happen when a tendon thickens. “Think of a healthy tendon as smooth parallel lines and an unhealthy (or injured) tendon as having a bunch of tangled knots. The million dollar question is how to untangle those knots.”
Finding maximum load
Roberts says that the one tricky element of the equation is finding what maximum load is for every runner. “This is hard to figure out on your own and has a high margin of error. If you lift too much, you risk doing more damage than good. Proceed with caution if you’re trying to self-treat a tendon injury. You need to find that magic middle zone where you’re encouraging growth without also encouraging inflammation.”
To find this sweet spot, a physiotherapist will most likely do a calf capacity test where they will ask you to stand on the affected leg and do calf raises to fatigue. “Once you have pain or fatigue, that’s considered your maximum load.”
Injuries need PEACE and LOVE
The British Medical Journal suggests two new acronyms to help runners heal soft tissue injuries: PEACE and LOVE. PEACE stands for protect, elevate, avoid anti-inflammatory modalities, compress and educate, and these steps should be taken immediately after an injury is sustained. LOVE stands for load, optimism, vascularization and exercise, and is for ongoing treatment of an injury. The LOVE acronym, which includes loading, is a recent update that suggests that an active approach to recovery with movement and exercise benefits more runners with musculoskeletal disorders.