Biomechanical assessments for runners with midportion Achilles Tendinopathy issues

Article By : Auptimo (Systems for Gait & motion analysis)

With an injury rate of 2.35 per 1000 in the adult population (de Jonge et all, 2011), the Achilles tendon is one of the most commonly injured tendons, especially in athletes involved in running and jumping sports/activities (Kvist, 1994) (Wilson, 2005)

As per studies, the loading on the Achilles tendon during running increases to 12 times the body weight. This is much higher as compared to walking (upto 3.5 times body weight), or cycling (close to body weight) (Komi, et al., 1992).  Such loading rates when combined with improper running biomechanics can be detrimental to Midportion Achilles Tendinopathy issues in runners.

A gait analysis, whether observational or through a video based system, is an excellent way to identify any biomechanical faults in the runner. A biomechanical fault can be as a result of either a physical limitation in the body or a technical error in the running form.  

In this blog, we will discuss various biomechanical faults that are associate with excessive loading on the Achilles tendon.

BIOMECHANICAL FAULTS ASSOCIATED WITH INCREASED ACHILLES LOADING

FOOT STRIKE PATTERN

Running with a rear footstrike pattern is considered to load the Achilles tendon less than running with a forefoot-strike pattern (Komi, et al., 1992). As per recent studies, running with a midfoot- or forefoot-strike pattern, as opposed to a rearfoot-strike pattern, added an additional load of 48 times body weight for each mile (1.6 km) run. (Almonroeder, et al., 2013)

ASSESSMENT OF FOOT STRIKE PATTERN

Achilles Tendinopathy_Foot Inclination Angle

Foot strike pattern can be determined by measuring the foot inclination angle. 

The foot inclination angle is the angle between the running surface and the sole of the runner’s shoe and allows for the determination of foot-strike pattern.

Heel StrikeRearfoot strike Midfoot strike Forefoot strike 
(Landing on the posterior aspect of their heel)(Landing on the anterior aspect of the heel, with FIA <10 degrees)(Rearfoot & forefoot making contact nearly simultaneously, with FIA near 0°)(Forefoot landing with FIA <0 degrees)

Within the context of return to sport, to control for overall loading, a runner who runs with a forefoot-strike pattern would not be allowed to run as far as a runner with a rearfoot-strike pattern. (SILBERNAGEL & CROSSLEY, 2015)

OVERSTRIDING

Overstriding is found in 60-70% of amateur runners and is associated with the runner extending the knee excessively at Initial Contact. Although this strategy increases performance by increasing stride length, it compromises shock absorption & increases braking forces on the body.

A systematic review found that a high breaking force during running may be a risk factor for Achilles tendinopathy. (Lorimer & Hume, 2014)

Typical overstriders hugely benefit from cadence retraining, a method that promotes shorter and faster steps instead of longer steps.

This ensures the same performance and reduces the excessive load on hamstring.

Refer to this link by Stanford Health for some drills. 

ASSESSMENT OF OVERSTRIDING

Overstriding

Overstriding can be picked up when reviewing the video taken in the sagittal plane. 

The term simply means that the runner is landing excessively ahead of the center of mass of the body (COM can be approximated at the center of the pelvis). Doing this often increases the stride length of the runner, hence the name ‘overstriding’. (Souza, 2016 )

OVERPRONATION

Recent studies have linked excessive subtalar eversion with excessive Midportion Achilles Tendinopathy. In a study comparing running mechanics of runners with Achilles Mid-Portion Tendinopathy with healthy runners, The Achilles Tendinopathy Group displayed significantly greater sub-talar joint eversion displacement during mid-stance of the running gait.  (Ryan M, 2009)

Exercise programs for arch strengthening etc along with foot orthotics can be helpful in reducing excessive calcaneal eversion and reducing the load on Achilles tendon loading.

ASSESSMENT OF SUBTALAR EVERSION

Rearfoot_Eversion

Subtalar eversion can be assessed by measuring the rearfoot angle in the posterior view. Rearfoot angle is defined by the midline of the heel relative to the midline of the lower leg.

Any running gait analysis software like GaitON can be used to do a comprehensive running analysis of the runner. All you need is the software and the slow motion video feature of your mobile phone to start.

EXERCISE AS A TREATMENT

Exercise therapy is consistently supported with the highest level of evidence, and eccentric exercise is the most investigated type of exercise therapy. (Kingma, et al., 2007) It is recommended to initially treat all patients with exercise therapy for at least 3 months prior to considering other treatment options.  (Alfredson, 2003). 

Mentioned below is a progressive Achilles tendon–loading strengthening program that promotes exercise once daily and uses concentric/eccentric exercises.

Excercise_ Midportion Achilles Tendinopathy

REFERENCES

  1. Komi, P., Fukashiro, S. & Järvinen, M., 1992. Biomechanical loading of Achilles tendon during normal locomotion. Clin Sports Med..

2. Alfredson, H., 2003. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med.

3. Almonroeder, T., Willson, J. & Kernozek, T., 2013. The effect of foot strike pattern on Achilles tendon load during running. Ann Biomed Eng..

4. de Jonge, S., van den Berg, C. & de Vos, R., 2011. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med..

5. Kingma, J., de Knikker, R., Wittink, H. & Takken, T., 2007. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med.

6. Kvist, M., 1994. Achilles tendon injuries in athletes. Sports Med.

7. Lorimer, A. & Hume, P., 2014. Achilles tendon injury risk factors associated with running. Sports Med..

8. Ryan, M. et al., 2009. Kinematic analysis of runners with achilles mid-portion tendinopathy.. Foot Ankle Int..

9. SILBERNAGEL, K. G. & CROSSLEY, K. M., 2015. A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. Journal of Orthopaedic & Sports Physical Therapy.

10. Silbernagel, K., Thomeé, R., Eriksson, B. & Karlsson, J., 2007. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med..

11. Souza, R. . B., 2016 . An Evidence-Based Videotaped Running Biomechanics Analysis. Phys Med Rehabil Clin N Am, 27(1), p. 217–236.

12. Wilson, J., 2005. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician.