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Achilles Tendon Problems in Cycling

The silly season has ended and the serious cyclist is back in the saddle.
And while you may be rearing to go, let's keep 2011 injury free!
With the emphasis usually on hip and knee alignment, the calf and Achilles tendon are liable to being overlooked.

This article highlights the role of the Achilles tendon and possible damaging mechanisms. Normal tendons consist of tight parallel bundles of collagen fibres. Injuries to tendons generally occur at the point of least blood supply, with the Achilles tendon this is usually 2cm above the insertion of the tendon.

The function of the Achilles tendon is to stabilise and optimise the function of the gastrocnemius (calf) muscle.  Mostly, injuries to the Achilles tendon occur when running and jumping. However during prolonged hill climbing, like you would be doing during a multi-day cycling event you can overextend the tendon and cause some serious damage which may result in inflammation.  As well as being very painful, if the inflammation is severe enough you lose the ability to laterally rotate your foot freely.  This means that you will not be able to unclip - not an impressive sight when you want to come to a graceful stop in front of your best mates and adoring fans!

The two most common problems associated with tendons are a partial tear, which is characterised by sudden onset pain and localised tenderness, and tendinopathy.  Tendinopathy refers to the disease process of the tendon brought on by training through an acutely strained tendon. The tendon will start to thicken which is partially responsible for the damage to the collagen fibres and subsequent degeneration. In this case, the tenderness is also localised to the affected area and thus differentiation may be tricky. Occasionally ultrasound scans are required to distinguish between the two injuries.

Also be aware of the design of your cycling shoes. They may be digging into your Achilles tendon, especially when your toe is pointed on the down stroke.
Research indicates that direct pressure or shear forces on a tendon is more damaging to it than even overstretching.

If untreated the Achilles will become weaker leading to a possible rupture of the tendon, which usually requires surgical intervention.

Tips to avoid Injury:

Achilles problems in cyclists aren't due to one explosive wrench that injures the tendon. Instead, they're caused by repetitive movement. 

• Is your saddle high enough? Your body may recompense for a low saddle by bending the ankle too much at the top of the pedal stroke, which in turn puts strain on the Achilles.
• Are you concentrating too much on pulling through at the bottom of the stroke? It's good to work on this skill occasionally, but in normal riding it shouldn't be a conscious act. Overemphasis could conceivably cause Achilles strain.
• Are you doing a lot of climbing? Short, steep hills can bring on a case of Achilles tendinopathy if you push too hard on hills at a low cadence.

The key to avoiding such an injury is proper cycling technique and bike set-up.

Eccentric Achilles tendon exercises have been consistently shown by research studies to provide the most effective treatment for Achilles tendinopathy.
An example of an eccentric exercise for the calf would be standing on tip toes then slowly lowering the heels to the floor.

For further advice please do not hesitate to contact me so that we can ensure elite performance and winning cycling style!

www.centreforsportsmedicine.co.za

Tarryn Graham BSc Physiotherapy (Stell)
Physiotherapist
Centre for Sports Medicine, Umhlanga

031 5605557 or info@centreforsportsmedicine.co.za