Resuming running after an Achilles tear

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Sarah asks: Last year while training, I tore my Achilles tendon but didn't know it for months. It wasn’t until I felt a sharp, shooting pain in the back of my foot that I went to the doctor. After six weeks in a boot and months of physiotherapy, I'm ready to start running again. But I'm nervous about training. I don't want to permanently damage the Achilles. How do I put this fear behind me?

Achilles tendon tears are relatively common, both partial and complete, especially in men around age 40. These injuries also occur in women, as you know. I do not have all the details of your injury, your running history, or your health, so my advice will be on the general side. I am going to assume your physiotherapist has the joints in your feet, ankles, knees and pelvis moving well with no restricted movements. I am also going to assume that you have maintained your core strength, which you will need to return to running. (If not, I recommend this core strengthening programme from Mike Fredericson M.D. of Stanford University.)

If your doctor or physiotherapist has released you for running, clearly you cannot pick up where you left off when you sustained the injury. For your peace of mind, it may be best to start like a brand-new beginner runner with a walk-run program. Pick an exercise duration that you feel you can complete comfortably with good walking form and no limp. For example, 10 or 20 minutes of continuous walking while maintaining a good gait and minimal pain in your Achilles tendon. Use an out-and-back course from your home.

If that is successful, add a minute or two each day and build up to 30 to 40 minutes of walking. Then begin to walk a block or two and run a block, repeat this for your workout.

If you have no pain, you can advance the next day with more time or more of the time spent running and less walking. If you have pain, take a day off and do not advance the amount of running or the total time the next time out. Remember that it does take 48 hours to recover from a workout, so do not be afraid to take rest days as you progress.

If you have problems with this gradual return, you should check in with your doctor or physiotherapist.