Pilates for runners with Achilles

tendonitis

Melinda van Tonder

September 2018, Basi CTTC

Pretoria

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Abstract

Running is a great form of exercise with many health benefits. Some of its benefits

include improving cardiovascular strength, promoting healthy bone density, creating

strength in lower extremities, and clearing the mind.

However, running has some potentially serious disadvantages and can create a lot

of imbalances in the body, particularly in the lower extremities, that can lead to many

injuries. Imbalances in runners can lead to tight hips, lower back pain, knee pain,

difficulty in keeping their balance, and stiffness in the thoracic spine.

Pilates is a great form of cross training for runners and provides rehabilitation from

various injuries. Doing Pilates on a regular basis can have the following benefits for

runners:

Improved lung capacity;

Proper breathing control;

Core strength, which gives an upright posture during the run;

Postural faults and imbalances are corrected;

Reduced injury time; and

Increased endurance and flexibility.

The selection of proper Pilates exercises can help runners to have a more efficient

and sustainable running practise.

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Table of Contents

Title Page............................................................................ …………………………... 1

Abstract ...................................................................................................................... 2

Table of Contents ................................................................ …………………………. 3

Anatomical Description ........................................................………………………….. 4

Case Study ..........................................................................………………………….. 7

Conditioning Program ............................................................………………………… 9

Conclusion ............................................................................................................... 22

Bibliography ..............................................................................................................23

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Anatomical description

I believe it’s really important to have at least a basic understanding of our running

anatomy as it can help in so many ways.

The movement of the leg while running happens as follows: the leg is pulled forward

by the hip flexors while the quadriceps is responsible for extending the knee. The

foot action of being flexed and placed on the ground originates from the tibialis

anterior. The leg is then pulled back by the gluteal as well as the hamstrings.

There are many joints involved when it comes to running, but for the purpose of this

research paper I will look at the larger joints of the lower limbs which are most

commonly affected by running; the hip; knee-; and ankle joints.

1. Hip joint anatomy

The hip joint is a ball and socket joint formed by the head of the femur (thigh

bone) which is the ball part and the socket – known as the acetabulum – on the

lateral, lower pelvis.

Injuries around the hip area tend to be muscular. There are a lot of muscles

around the hip joint which can be grouped together as follows:

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The hip flexors- raise the leg in front. These muscles are found at the front

of the hip joint, passing from the pelvis down on to the femur, or even the

tibia below the knee.

The adductors- groin muscles which move the leg inwards and across the

body. The adductors attach to the inner pelvis and either to the inner

femur, or the tibia just below the inner knee.

The gluteal - perform movements such as abduction (moving the leg out to

the side, away from the body); extension (moving the leg backwards) and

both medial and lateral rotation. They all attach superiorly to the iliac crest

and / or sacrum and pass laterally and downwards, across the buttock to

the two trochanters (bony lumps) at the top of the Femur.

Injuries to the muscles and tendons of the hip joint are the most frequent type of

injury in runners due to the massive demands on these muscles, not only to move

the joint forwards, but also to stabilise the pelvis and control frontal plane (sideways)

and rotational forces.

2. Knee joint anatomy

The knee joint itself is a hinge joint formed between the femur (thigh bone) and

the tibia (shin bone). Some basic muscles that affect the knee joint are

The quadriceps (straightens the knee);

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The hamstrings found at the back of the thigh (extends the hip joint and

flexes the knee).

The adductors;

The gastrocnemius is the biggest muscle found in the calf (plantar flexes

the ankle).

The popliteus (small muscle found at the back of the knee joint).

3. Ankle joint anatomy

The ankle joint allows the up and down movement of the foot – known as

dorsiflexion (pulling the foot up) and plantar flexion (pointing the foot away).

Muscles which affect the ankle joint tend to be found in the lower leg and pass a

tendon across the ankle joint to attach to one or more of many foot bones.

The plantar flexors or calf muscles: These are found in the back of the lower

leg, and are known as the gastrocnemius. This is the largest and most

superficial of the calf muscles which originate above the knee joint on both

sides. Underneath this is the soleus muscle. Soleus is a little smaller and less

well known but still very important in ankle function. It originates lower down on

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the tibia bone. These two muscles meet to form the Achilles tendon, the

biggest tendon in the body.

The dorsi flexors or shin muscles: The largest of the dorsi flexors is the tibialis

anterior muscle. This muscle is found at the front of the lower leg, with a

tendon which passes across the front of the ankle. Its function is to dorsi flex

the foot and to assist tibialis posterior in inverting it.

The peroneus muscles: Also called the fibularis muscles are found on the

outside of the lower leg. Their function is to evert the ankle (turn it so the sole

faces outwards).

Case study

Since my early school years I have been a passionate dancer and long distance

athlete. I continued running after school, doing half marathons and training almost

every day. A few years ago I developed Achilles tendonitis, due to over training

errors such as not stretching enough and not strengthening important muscles used

when running. Achilles tendinopathy is a condition which involves inflammation

and/or tendon breakdown from excessive loading. It is characterized by point

tenderness on the tendon and pain with forceful plantar flexion or extreme

dorsiflexion. It is often a persistent injury that may be related to underlying

biomechanical problems, such as tight calf muscles, over pronation, tight hip flexors,

muscle imbalances, and training errors (Study guide, Comprehensive Course. Body

Arts and Science International, 2000-2013).

A hump formed at the back of my right heel where the tendon started to thicken and

my hips and calves became very tight. As the time went on the hump became

bigger and more painful. Activities like walking in the shops or standing for too long

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became challenging, my balance also got affected and I could not balance on my

right leg.

In 2017 my Pilates journey started and I also went for physiotherapy. They

recommended exercises where the muscle focus is to strengthen my gluteus medius

and hip adductors and stretching my hip flexors; calves; quadriceps and hamstrings.

In my conditioning program I will focus on strengthening and stretching these

muscles. I will also focus on strengthening my core muscles and stretching my

upper body to create a better running posture.

This conditioning program is designed for six weeks with three one hour Pilates

sessions per week, but continued Pilates sessions on a regular basis will deliver

better long term results as Pilates is not a quick fix.

I started doing this program after I had a good understanding of the fundamental

exercises and principals of Pilates.

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Conditioning Program (runner with achilles tendonitis)

Weeks 1-2

BASI block Exercise(s) Desired results

Warm Up Fundamental warm up:

pelvic curl, spine twist

supine, chest lift and chest

lift with rotation.

Thoroughly warm up

the spine, deep

abdominal muscles

and oblique

abdominal muscles.

Warm up the

hamstrings (pelvic

curls).

Bring awareness to

body and

powerhouse.

Establish pelvic and

lumbar stabilisation.

Foot Work Footwork series on the

Cadillac (medium/heavy

setting).

Hip Opener (light/medium

setting).

Stretch and

strengthen the

hamstrings and

knee extensors.

To correct foot

alignment and to

get feedback.

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The calf raises and

prances strengthen

the foot plantar

flexors and helps

with control of foot

stabilisers.

The hip opener will

stretch the

adductors.

Abdominal Work Abdominal work on the

Pilates arc: chest lift;

reach; overhead stretch

and teaser prep.

Abdominal work on

the arc will

strengthen and

stretch the

abdominals which

will help with a

stronger core and

better posture while

running.

Exercises like the

reach and overhead

stretch will stretch

the thoracic spine

and shoulders

which gets tight

from running and

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everyday activities

like sitting at the

computer.

The teaser prep will

add some

challenge and build

hip flexor strength.

Hip Work Single leg supine : frog;

circles down and up; hip

extension and bicycle

This series works

great for the

imbalances in my

hips as I find it

difficult to control

both springs with

the basic leg

springs series.

Hip work focuses

on hip

disassociation while

keeping a neutral

pelvis; this helps

the hip to work

more smoothly

while running.

Spinal Articulation Monkey original (medium

resistance).

This exercise will

stretch the spine;

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hamstrings and

calves which gets

very tight from

running. It will also

help with abdominal

control and spinal

mobility.

Stretches Ladder barrel: shoulder

stretch 1 and 2; gluteals;

hamstrings, adductors;

and hip flexors.

These stretches will

increase flexibility

and improve my

running in the long

term if done

regularly.

Full Body Integration F/I Thigh stretch with RUB

and kneeling cat stretch

(medium resistance).

The thigh stretch

with RUB will

strengthen and

stretch the

quadriceps, which

will improve running

and help prevent

common injuries.

The kneeling cat

stretch will

strengthen the back

extensors and

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abdominals while

also stretching the

shoulders.

Arm Work Shrugs and triceps press

sit (medium resistance).

These arm

exercises will bring

some focus to

improved posture.

Full Body Integration A/M Tendon stretch on the

reformer (light resistance).

The tendon stretch

will stretch out my

calves which will

help with the

achilles tendonitis.

It will build

abdominal strength.

Leg work Gluteals side lying series

and adductor squeeze.

These exercises

will strengthen the

gluteus medius and

hip adductors which

becomes weak

from running.

It is also done in a

supported position

which helps if you

have imbalances in

your hips and

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struggle with

controlling the hips

and pelvis if too

much weight is

added.

Lateral Flexion /rotation Side lift on Pilates arc. Stretch the lateral

flexors and

strengthen the

oblique muscles.

Back extension Prone 1 and 2. Strengthen the

back extensors

which help with a

better posture.

Prone 2 have the

added benefit of a

shoulder and chest

stretch.

Weeks 3-4

BASI block Exercise(s) Desired results

Warm Up Fundamental warm up:

pelvic curl, spine twist

supine, chest lift and chest

lift with rotation.

See weeks 1-2.

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Foot Work All footwork on the

reformer (medium/heavy

resistance).

Using more

resistance will help

to strengthen the

hamstrings and

quadriceps.

The calf raises and

prances will stretch

the calf muscles

while strengthening

the ankle plantar

flexors.

Prehensile is added

for a foot stretch.

Abdominal Work Abdominals legs in straps

(light resistance): double

leg; and double leg with

rotation.

These exercises

will strengthen the

abdominals, oblique

and hip flexors

(when drawing the

legs in towards the

fore head.)

Hip Work Hip work on the reformer

(medium/light resistance):

frog; circles up and down;

and openings.

Strengthen and

stretch the hip

adductors.

To help with knee

extensor control

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and neutral pelvis.

Spinal Articulation Short spine and long spine

(light to medium

resistance).

The short spine will

stretch the

hamstrings.

The long spine will

help to strengthen

the gluteals,

hamstrings, and

quadriceps, as I will

have to use these

muscles to keep my

legs at a 90º angle

when rolling up and

down.

Stretches Kneeling lunge (light

resistance).

Gluteal stretch on the

ladder barrel.

The kneeling lunge

will stretch the

hamstrings and hip

flexors which is

important for

running.

Full Body Integration F/I Knee stretch series (light

resistance): scooter; round

back; and flat back.

This series will

strengthen the

hamstrings,

quadriceps and

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abdominals.

It will help with hip

and knee extensor

control.

Arm Work Rowing series (light

resistance).

To create better

shoulder mobility,

trunk stability and

control.

It will add flow and

challenge to the

routine, which is

great being a

dancer also.

Full Body Integration A/M Tendon stretch on the

reformer (light resistance).

See weeks 1-2.

Leg work Gluteals side lying series

and adductor squeeze.

Add more

repetitions than in

the first two weeks.

These exercises

will strengthen the

gluteus medius and

hip adductors which

becomes weak

from running.

Lateral Flexion /rotation Side stretch on chair Lateral flexor

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(extra light/light

resistance).

stretch.

Teach abdominal

and oblique control

if the ribs tend to

thrust forward.

Back extension Swan prep with magic

circle.

Strengthen the

shoulders and back

extensors.

Strong back

extensors will

improve running

posture.

Weeks 5-6

BASI block Exercise(s) Desired results

Warm Up Fundamental warm up:

pelvic curl, spine twist

supine, chest lift and chest

lift with rotation.

See weeks 1-4.

Foot Work All foot work on the chair

(medium to heavy

resistance).

To strengthen the

hamstrings and

quadriceps.

To develop hip

flexor control, as

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the legs move up

and down while

keeping the upper

body stable.

The calf raises will

stretch the calves

and hip flexors,

strengthen the

calves and help

with correct foot

alignment.

Abdominal Work Torso press sit (extra light

resistance).

Control the hip

flexors (keeping the

legs stable and

parallel to the floor).

The position of the

arms will stretch the

shoulders and

chest.

Hip Work Supine leg series on the

arc: openings; scissors;

helicopter; bicycle and;

bicycle reverse.

Stretch the

hamstrings and hip

flexors, and

develop control of

all muscles

surrounding the hip

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joint.

Stretch and control

hip adductors.

Maintain abdominal

support.

Spinal Articulation Tower on the Cadillac

(medium resistance)

To improve

hamstring and

lower back

flexibility.

Maximize the

stretch of the calves

and hamstrings

when the feet are

dorsiflexed.

Stretches Ladder barrel: shoulder

stretch 1 and 2; gluteals;

hamstrings, adductors;

and hip flexors.

These stretches will

increase flexibility

and improve

running in the long

term if done

regularly.

Full Body Integration F/I Reverse knee stretch (light

resistance)

To strengthen the

abdominal muscles

and hip flexors.

Strong abdominal

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support is needed

as the hip flexors

pull the legs

backwards.

Arm Work Arms standing series:

chest expansion; hug-a-

tree; circles; punches and;

biceps.

Full Body Integration A/M Saw To stretch the

hamstrings and

chest.

Leg work Squats To strengthen the

quadriceps and

core.

To develop knee

control.

To improve

alignment.

Lateral Flexion /rotation Side over on box To strengthen the

abdominals with

special emphasis

on the oblique

muscles.

Back extension Breaststroke prep (light

resistance)

To strengthen the

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back extensors for

better posture.

Conclusion

Over the course of my Pilates program, I started noticing more flexibility in my hips

and calves. The range of motion in my ankles improved and the swelling and pain at

the back of my heels was reduced. After a few months of Pilates I could continue

with my running without any foot or hip pain. Pilates also made me more aware of

how I run and my running posture. Although I still avoid steep uphill running and

running on very uneven surfaces, I noticed a great improvement in my running. Due

to all the foot work, hip work, leg work and stretching my legs feel more weightless

when I run and I can also run more comfortably. Pilates is a great form of cross

training for any athlete as it can be tailored to each specific need and can bring

balance to the body to avoid many overuse injuries.

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Bibliography

Perfect Pilates, http://www.perfectpilates.co.za/pilates-for-runners.html

Leg muscles used during running, https://adventure.howstuffworks.com/outdoor-

activities/running/training/leg-workouts-for-runners1.htm. Sited 18/08/2018.

The pros and cons of running, https://www.drweil.com/health-wellness/balanced-

living/exercise-fitness/the-pros-and-cons-of-running/. Sited 18/08/18.

Running injuries, https://www.webmd.com/fitness-exercise/guide/running-injuries-

causes-prevention-treatment#3. Sited 18/08/18.

Running Anatomy, http://www.rehab4runners.co.uk/running-anatomy/. Sited

19/08/2018.

Complete guide to mat work and apparatus exercises. Pilates second edition. Rael

Isacowitz, 2014.