Treating an Achilles with Tyler Pennel

Dr. Brian Fullem practices at Elite Sports Podiatry in Clearwater, FL. He ran 14:25 for 5K while at Bucknell University. This is the continuation in a series of articles by Dr. Fullem, educating us about injury care, injury prevention & other health topics for athletes at all levels of performance.

On June 4th, 2015 Tyler Pennel of Zap Fitness became the 443rd American to ever break 4 minutes for the mile.  All the more remarkable about this feat is the fact that Tyler is also the 2014 U.S. Marathon Champ in 2:13:33.  In between those two great accomplishments he suffered from a bout of Achilles tendinosis and his prudent treatment allowed him to return to training much faster than if he had chosen to try and train through this injury.

Tyler Pennel pulling away from the field in the 2014 USA Marathon Championships. Photo: Paul Phillips/Competitive Image

Tyler Pennel pulling away from the field in the 2014 USA Marathon Championships. Photo: Paul Phillips/Competitive Image

The Achilles’ tendon is the largest tendon in the human body. Studies have shown that up to 18% of runners will develop an injury to the Achilles. If an athlete has a swollen and painful Achilles’ tendon then that is one of the rare instances where I may recommend not running. The biggest issue with this injury is that after two weeks the tendon is no longer just inflamed but actually starts to degenerate, so time off is not the only solution and continued training on an injured tendon may lead to compensatory injuries as well as a potential rupture.

Studies have shown that up to 18% of runners will develop an injury to the Achilles. If an athlete has a swollen and painful Achilles’ tendon then that is one of the rare instances where I may recommend not running.

When Tyler Pennel began experiencing pain in the mid portion of both Achilles he was able to have three sessions with a shockwave therapy device known as EPAT. The device sends a sound wave deep into the Achilles to help the tendon heal. Shockwave has been proven to produce new blood vessels in the area, the medical term is neovascularization. The full effect may take up to 20 weeks and one study with the same device I use in my practice showed a 78% success rate in the Achilles treatment of athletes. (https://www.researchgate.net/publication/50398377_Extra-corporeal_Pulsed-activated_Therapy_%28EPAT_Sound_Wave%29_for_Achilles_Tendinopathy_A_Prospective_Study)

Shock wave was just one element of Tyler’s treatment plan. He also exhibited some weakness in his gluteal muscles, which leads to his trunk dropping down instead of going forward, so that weakness not only places more stress on structures such as the Achilles but it also may impede performance.  A core strengthening routine was developed for Tyler by my wife Annemarie who is a Physical Therapist and I with an emphasis on functional, closed chain strengthening. Videos of some of the exercises that help a runner develop a stronger core can be found here.

Annemarie Fullem, PT examining a runner at home

Annemarie Fullem, PT examining a runner at home

Custom orthotic devices were fabricated and used by Tyler until his pain was gone and then discontinued. The devices can be utilized in the future depending on if Tyler develops any injuries related to his foot function, when an athlete is flying from out of town I try cover all the bases whereas with a local patient with a similar makeup as Tyler I would normally see how the rest of the treatment plan works before considering custom devices. Zap fitness has an Alter G treadmill, so that is usually the best way to progress back to running sooner.  Tyler recovered faster because of several factors: extremely fast and prudent treatment and he stopped running (it is much better to take a few days or weeks off up front than cause the tendon to degenerate leading to a chronic state and have to miss months). Tyler has very little injury history and excellent biomechanics. Tyler also takes an extremely professional approach that all the Zap athletes follow, being a professional athlete and acting in a professional manner are not the same thing. I had the opportunity to be at Zap this summer and will write soon about my experience at the place I call Runner’s Nirvana. Tyler recently battled for the win at the U.S. 20K road championships in New Haven, CT finishing 5th in a sprint finish in 59:40.

Related: The Achilles: What You Need to Know
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