A 50-year-old female triathlete preparing for middle-distance events presents with recurrent Achilles tendinopathy, primarily on the right side. Symptoms flare up with increases in training volume or intensity, limiting her ability to train consistently and progress toward performance goals.
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Key Findings
Initial running assessment revealed a low running quality score (38%), with deficits across multiple domains:
- Significant asymmetry in impact loading, with higher loads on the non-symptomatic (left) side
- Increased dynamic instability, particularly on the symptomatic (right) leg
- A likely protective offloading strategy, reducing load on the painful tendon
After a targeted intervention combining progressive tendon loading and stability training, a 3-month retest showed:
- A 26% improvement in running quality
- Restoration of left-right symmetry in both loading and stability
- Improved overall stability and control
- A more balanced impact loading profile
Main Takeaway
Achilles tendinopathy is not only a local tissue issue. Pain often leads to compensatory offloading and instability, which can persist and affect overall movement quality. Addressing both tendon capacity and neuromuscular control is key for sustainable improvement.
Conlusion & next steps
A combined approach of progressive loading and stability training can effectively restore symmetry and running quality. Key next steps include:
- Maintaining tendon loading progression and calf strength
- Continuing stability work to preserve gains
- Monitoring symmetry and impact loading over time
- Introducing higher-speed (incremental speed test) and reactive testing to prepare for race demands
Long-term monitoring ensures that improvements are maintained and that training loads can be safely progressed without recurrence.
