by Shana-Lee Bownes

Lockdowns that had us all cooped up in our homes for over a month seems to have sparked a greater appreciation for exercise in us all. Who can forget how ironically crowded the Cape Town beach front walkway was on the 1^st May 2020 with walking folk and runners eagerly tottering about with mask-concealed smiles.

Running is arguably one of the most accessible forms of exercise and a popular choice adopted by many trying to stay fit and get outside, especially during the hard lockdown. A survey conducted by De Jong and colleagues (2021) about running during the pandemic found a small but significant  increase in running mileage of 1,4km per week (great) but also a 1,4 times the injury risk compared to before the pandemic (not so great)(DeJong, Fish et al. 2021).

Here’s the story: We dust off out running shoes and hop on the road. The first few training sessions are rough, but then they get easier and that’s when the bug bites. Suddenly you’re up at 5am on a Saturday for your long run and posting a snap of your coffee #postrunfeels. But that little niggle in your knee that gradually builds up as you run is still there and often when niggles are ignored they have the potential to turn into more serious injuries. When looking at the studies published in running injuries van der Worp and colleagues found that injury was reported between 19,8-25% in men and 79,1-79,5% in women who run (van der Worp, ten Haaf et al. 2015).

Research on running injury prevention has unfortunately been somewhat inconclusive. Messier and colleagues have undertaken a very important step to improve research in this area by unpacking all of the different factors that contribute to developing running injuries. Over a two year period they followed 300 runners, testing running specific, physical and psychological characteristics. During the study 66% of participants sustained injuries in the two year period. Expressing more negative emotions, being a female and knee stiffness was associated with injury, this is unsurprising considering knee injuries were most commonly reported. Knee stiffness, especially in those weighing 80+ kilos, significantly increased the chances of developing one of those pesky overuse injuries (Messier, Martin et al. 2018).

So, where to from here? Hopefully with this knowledge we can focus our efforts on discovering the mechanisms by which these risk factors contribute to injury. Hopefully by addressing these risks we can come up with strong preventative measures. Measures will translate well into the running community and when implemented – will protect us against injury.

Until then in the wise words of Dean Karnazes: “Run when you can, walk if you have to, crawl if you must; just never give up.” (Meuller 2020)

References

DeJong, A. F., P. N. Fish and J. Hertel (2021). “Running behaviors, motivations, and injury risk during the COVID-19 pandemic: A survey of 1147 runners.” PLOS ONE 16(2): e0246300.

Messier, S. P., D. F. Martin, S. L. Mihalko, E. Ip, P. DeVita, D. W. Cannon, M. Love, D. Beringer, S. Saldana, R. E. Fellin and J. F. Seay (2018). “A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS).” Am J Sports Med 46(9): 2211-2221.

Mueller, S (2020). “60 Inspiring and Motivating Running Quotes” [online] Planet of Success. Available at: <http://www.planetofsuccess.com/blog/2017/motivating-running-quotes/&gt; [Accessed 11 April 2021].

van der Worp, M. P., D. S. ten Haaf, R. van Cingel, A. de Wijer, M. W. Nijhuis-van der Sanden and J. B. Staal (2015). “Injuries in runners; a systematic review on risk factors and sex differences.” PLoS One 10(2): e0114937.

by Ashleigh Thomas

If you’ve heard or experienced an achilles tendon rupture, you’ll know exactly what the title is alluding to. If you don’t know, an achilles tendon rupturing sounds like a gunshot, and it’s as painful as it sounds. Researcher Gregory Hess, in his 2010 review of “Achilles Tendon Rupture” in the Foot and Ankle Specialist Journal, writes that the number of sporting injuries is increasing with the increase in sport participation. The most common injury; achilles tendon injuries. This begs the questions: how can we avoid them (and the months of no sport participation and gruelling rehab) and who is most vulnerable?

Schepsis, Jones and Haas (2002) comment that the increase in sport-related achilles tendon injuries as going from 2 to 12 cases per 100 000 in less than 10 years. Typically, this occurs in males during their 4^th and 5^th decade of life (Schepsis et al., 2002). The injury also appears to occur most commonly in racquet sports such as tennis, squash, and badminton (Schepsis et al., 2002:298). It appears that this injury is the achilles heel of middle-aged male squash players.

It is important to understand the mechanisms of this injury. Hess (2010) explains that 53% of reported cases are due to the push-off mechanism (off the weight bearing leg with the knee extended). Other mechanisms include unexpected ankle dorsiflexion and violent dorsiflexion of a plantar flexed ankle during running/jumping/agility activities/activities involving eccentric loading/explosive plyometric contractions (Hess, 2010).

The achilles’ structure and function are also pieces of the puzzle. The achilles is an extension of two independently moving muscles, the gastrocnemius and soleus muscles, and it attaches to the posterior heel bone. The tendon is primarily composed of collagen which forms cross-links that allow it to resist high tensile forces (Hess, 2010). Forces stretching the tendon beyond 4% result in some of these cross-links failing and stretching beyond 8% is likely to result in a rupture (Hess, 2010).

Additionally, defects in the tendon’s structure could result in a rupture as it has a poor nutrient and blood supply (Hess, 2010). A rupture is also likely if degeneration and overloading occur repeatedly over extended periods of time (Hess, 2010). Therefore, it makes sense that the proposed processes for achilles tendon degeneration and rupture are tendinosis and chronic tendinopathy because these conditions cause an imbalance between tendon degeneration and repair (Hess, 2010).

How can we identify individuals who may be at risk of experiencing such excruciating pain? Through research, a number of intrinsic and extrinsic factors which predispose individuals to sustaining a rupture have been identified. The presence of these can increase the likelihood of a rupture. These factors, as described by Hess (2010), are seen in Figure 2.

Individuals exhibiting these factors should take extra precaution as Hess (2010) writes that a combination of these factors reduce the tensile strength of the tendon and contribute to faulty biomechanics and compensatory mechanisms which can evolve into a tendon rupture. A key factor that Schepsis et al. (2002) emphasizes, and which Hess (2010) agrees with, is the degenerative effect of natural ageing on the tendon resulting from decreased blood flow, decreased collagen tensile strength and increased tissue stiffness (Schepsis et al., 2002). These aging effects reduce the tendon’s ability to handle stress, predisposing it to injury.

All is not lost; there are things you can do to try to prevent this from happening. A rupture could be prevented by avoiding degenerative changes in the tendon by doing regular physical activity, and by allowing adequate rest following tendon injury (Hess, 2010). Eccentric strengthening of calf muscles has also been linked to prevention of rupture (Hess, 2010). However, we still have many questions to answer before we can say for certain what the best method of prevention is. This also speaks to the gap in this area and research going forward should focus on the implementation and the effectiveness of prevention programs.

References

• Hess, G., 2010. Achilles Tendon Rupture. Foot & Ankle Specialist, 3(1), pp.29-32.
• Schepsis, A., Jones, H. and Haas, A., 2002. Achilles Tendon Disorders in Athletes. The American Journal of Sports Medicine, 30(2), pp.287-305.
• de. 2021. Achilles tendon – anatomy and importance. [online] Available at: <https://www.medi.de/en/health/the-body/tendons-and-ligaments/achilles-tendon/&gt; [Accessed 9 May 2021].