Chris Mallac explores talar dome injury in athletes; how do they occur and how can they be treated? Talar dome injuries such as osteochondral lesions of the talus (OLT) can occur following an ankle injury, resulting in ongoing residual ankle pain and functional disability. Initially, OLT was described and classified as ‘transchondral fractures of the... MORE
7 things to know about treating Masters runners
In the second part of our series on the aging runner, we look at running-related injuries and how to treat them. Masters runners report more injuries, more often, than younger runners(1). These aches and pains are likely to occur in the muscles and tendons of the posterior chain – hamstrings, plantar flexors, and Achilles tendons. In fact, the number one running-related injury in the Master population is Achilles tendinopathy(1). Older runners may suffer from these injuries more often due to decreased stiffness in the muscles and tendons of the leg.
Muscle stiffness has to do with how well muscles store and release energy. Think of the legs as a spring (see figure 1). When you compress a tighter or more resistant spring, it bounces back with more energy and vigor than a looser spring. The same holds true for muscles and tendons. When they are more ‘stiff’ or have more tension, they release more energy, meaning greater movement with less effort.
As athletes age, the natural stiffness in their muscles, as well as their strength, decreases. Stiffness in the Achilles tendon can be up to 17% lower in an older athlete than their younger counterpart(1). Coincidentally, the Achilles tendon stiffness in those with tendinopathy is 20% less than that of healthy individuals(1). When less stiff, the tendon has to work harder to apply the forces generated in the muscle. Therefore, the decrease in tendon stiffness alone likely places older runners at an increased risk of Achilles tendon strain.
Figure 1: Leg stiffness when running
When treating the older athlete with running injuries, keep these seven things in mind:
- Strengthen don’t stretch– Muscle mass and strength naturally decrease with age. A good resistance-training program, however, can combat Mother Nature and lower the chance of overuse injury by 50%(1). Meanwhile, despite intuition, stretching doesn’t prevent or help heal injuries.
- Don’t forget the calf muscles– Those all-important leg muscles rarely get attention in the gym, and yet they bear a significant burden when propelling a runner. Strengthening the plantar flexors, especially the soleus, increases Achilles tendon stiffness and decreases the risk of injury.
- Know your history– The history of the athlete, that is. Fluoroquinolone use increases the risk of Achilles tendinopathy and rupture. Typical effects are usually seen after two weeks, however, the risk remains for six months after stopping the drug. Statin medications, common in an older population, also escalate the risk of tendinopathy.
- Slow and heavy– Tendons respond better to slow and heavy resistance no matter the type of muscle contraction. Therefore, begin with 3 sets of 6-8 reps of significant load. The movement should require enough effort that the subject naturally performs it slowly. Once the tendon improves, add plyometric exercises to increase stiffness.
- Take your time – The old adage that everything slows with age holds true when it comes to collagen synthesis. Older tendons take longer to respond to changes in loading, therefore, strength training may take six months or more to show results.
- Avoid soft and squishy – Running on soft surfaces such as sand or spongy grass, requires more tendon stiffness. Aging athletes should avoid surfaces and modes of running, such as barefoot or minimalist shoe running, hills, interval training, and treadmills while recovering from a tendon injury.
- Include dynamic warm-ups– Once the older athlete resumes a progressive running program, be sure they incorporate dynamic warm-up activities into their routine. Short, quick movements increase tendon stiffness and prepare the muscles for activity, adding both a protective and performance benefit.
- Sports Med Arthrosc Rev. 2019 March;27(1):15-21