Running Doc on why stretching is the key to good Achilles health

Dear Running Doc:

I’m 48 years old and been running since I was 6. My Achilles tendon had begun to ache just a little last week and I went to see my family doctor who told me after an MRI that I had a partial tear but all I needed was heel lifts for my shoes right away and not to rely on stretching. Should I? Can I run? What will happen if I don’t?

Joey M., Port Washington, New York

Joey, any sport that keeps you on your feet and uses a pushing-off motion can produce Achilles trouble. Shoe inserts (orthotics) are sometimes prescribed by a physician but not heel lifts alone because foot motion is changed and the Achilles tendon is shortened leaving it more susceptible to a tear later: a full length orthotic is safer and produces better results. I disagree with the stretching recommendation as well: stretching is always your first defense and the key to good Achilles health!

Running depends on the severity of the tear. You may be able to be run on mircotears with a proper flexible, full length orthotic. A bigger tear may require a cast and a complete tear will require surgery. Understanding Achilles tendonitis and tears may help you.

Any Achilles tendon being pushed beyond its limits can grow inflamed. That’s the tendinitis to which most athletes ascribe pain — and perhaps some swelling — above the upper heel. But every time the tendon gets inflamed, and certainly every time the pain comes from more serious microtears in the overused tissue which can easily be mistaken for tendinitis, the Achilles grows just a little weaker.

What brings the condition on, besides simple overuse? The Achilles is vulnerable to misuse. Designed to do its job of guiding the heel in a vertical plane, it’s intolerant of the inward rolling of the ankle when it pronates, or of any other “deviant” motion.

But a calf muscle routinely loosened by conscientious stretching before and after a workout cuts the tendon some slack, particularly in older, stiffer athletes, reducing the tendon’s role as a shock absorber for which it’s not very well suited anyway.

So on those impatient days when stretching seems too much of a bother, it pays to remind yourself that a neglected and partially torn tendon needs to rest and heal in a cast for about a month unless you like courting a rupture.

And if that tendon does indeed pop? The gulf between the two ends creates a hole you can actually feel. A clock has just started ticking, during which the tendon’s two ends will drift apart. As soon as possible you must decide if you want the rupture re-paired by surgically reattaching the ends — the best choice for most athletes. It involves a cast at first and probably nine months of therapy. The sooner it’s done, the easier the repair. Or you can just go into a cast for maybe eight weeks and accept whatever healing nature is able to provide — probably a weaker result.

Given all this, a couple of minutes of prevention don’t seem like such a bother after all. Do both the gastroc (upper calf muscle) stretch and the soleus (lower calf muscle) stretch whenever you’re near a wall and have the time. You can’t do this too much! As for the Achilles tendon stretch and strengthen, once every other day should do it.

1. Gastroc stretch. Lean into wall, keeping affected leg back straight, heel on floor and turned slightly outward. Stretch should be felt in calf.

2. Soleus stretch. Similar to above with affected leg back but knees slightly bent, lean into wall until stretch is felt in lower calf.

3. Achilles tendon stretch and strengthen. Stand with toes on stair, heels off the edge. Raise up on toes (10 sec hold), then SLOWLY down as far as possible (10 sec hold). Return to starting position. Do five times.

Before deciding to run yourself, get evaluated by a sports medicine specialitst to KNOW how bad your tear is and what the best course of treatment is. One hour may save you nine months of rehab!

Enjoy the ride!

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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

Want your question answered in this column? Write to running doc at runningdoc@nydailynews.com.

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