Over dinner this weekend, a friend of mine asked for my professional opinion.
A couple of weeks ago, he had changed his running shoes and then went out for his regular run. He came back with pain at his inner arch. This hurt with walking for a week, so he took the week off running until his walking improved. He returned back to his normal run but the medial arch pain came back.
He wanted to know what was happening and what should he do?
Based on details over dinner and without pulling his shoe off, it seemed like he had a tibialis posterior tendinopathy.
Tibialis posterior (or tib post) tendinopathies are common running injuries. They are often caused by sudden changes to running volume.
The tibialis posterior is a muscle that sits deep in the calf complex, and its tendon attaches to the inner side of the ankle near the arch. The tibias posterior’s main job is to keep the foot and ankle stable and balanced during walking, running and other standing activities.
A sudden increase to exercise volume, changes to footwear or poor choice of footwear can cause the tendon to become overworked and painful. Pain for this injury normally presents itself above the medial arch.
So what did I advise my friend about his injury?
He had done the right thing to rest from the aggravating activity for 1-2 weeks. He could have also used soft tissue massage at the calf and worn supportive shoes to help reduce his pain.
What he should have done when he tried to return to running after his rest period was reduce the distance from what he normally runs. This is to prevent overloading a recovering tib post tendon. If this was successful, then he could have increased his distance by 10% each week.
Since my friend’s symptoms have continued to persist despite an appropriate rest period, I have recommended that he works with a physio to review his biomechanics and start a specific tendon strengthening programme in order to get him back happily running in the next couple of months.
How is your prep going for city to surf? Does my friend’s injury sound familiar to you or someone you know? Maybe our physio team can help.
