Achilles tendinitis tends to affect runners more than any other group or athletic population. There is typically a high correlation to the amount of activity and volume performed in relation to biomechanical abnormalities and training errors which lead to Achilles tendinitis or tendinopathy.
The Achilles serves as the conjoined tendon for both calf muscles, the gastrocnemius and soleus muscles. Achilles tendinitis (also called tendonitis) is a serious condition for any athlete as it typically means a significant reduction in training volumes and modification to training routines. A complete stopping of sporting activities may be necessary in severe cases.
Learn the potential causative factors for Achilles tendinitis and how to self-treat this condition so you don’t lose too much time with your training.
15 Tips to Self-Treat Achilles Tendinitis
- Age. The risk of injury increases with age, but on average the injury occurs between 30-50 years old.
- Gender. Males are more commonly affected than females.
Loss of ankle dorsiflexion (the movement of toes and ankle toward the shin bone).
- Abnormal ankle motion.
- Poor calcaneal stability during running. Most commonly seen in runners who over pronate, particularly during the heel strike and full weight acceptance in stance phase.
- Decreased calf muscle strength.
- Training errors including tapering up volume and intensity too quickly, such as a sudden increase in mileage, or increase in intensity.
- Environmental factors like running on very hilly, uneven terrain or very hard surfaces, such as concrete. Cold weather training may also increase your risk.
- Obesity, hypertension, increased cholesterol, and diabetes. These conditions affect the body’s blood flow and its ability to deliver nutrients.
- Certain antibiotics. A reported 6% of cases of Achilles tendinopathy occur after taking the antibiotic, fluoroquinolone.
- Certain forms of arthritis.
- Typically the pain is located to the mid portion of the Achilles tendon from the end of the muscle to the start of the heel (calcaneus).
- Intermittent pain related to exercises or activity.
- Stiffness upon weight bearing after prolonged immobility such as sleeping.
- Stiffness and pain at the beginning of an exercise training session that lessens as exercise continues.
- As the condition worsens, a progression from pain occurring at the end of an exercise session to experiencing pain throughout the duration of the activity.
- As the condition worsens, pain and stiffness in the lower leg and ankle will worsen to the point that even walking can become difficult.
15 Tips to Self-Treat Achilles Tendinitis:
- Ice. Once symptoms develop, initiate an icing protocol. Apply the ice to painful areas of the Achilles and calf muscles. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a cold pack. Individuals with poor circulation or impaired sensation should take particular care when icing.
- Rest. Significantly reduce your training volume and intensity. More severe pain or prolonged pain over many weeks means that you may need to discontinue your activity for 2-4 weeks or longer (depending on the severity and duration of symptoms). Avoid exercises that place undue stress on the Achilles and calf muscles.
- Alter your training environment. Avoid hill training and hard surfaces like concrete. Instead, run on softer surfaces such as grass or a track.
- Initiate a stretching program. Stretching exercises, as demonstrated in Achilles Tendinitis Rehabilitation Exercises.pdf, can reduce pain and improve function in those who experience limited dorsiflexion range of motion. The initial focus is on stretching the calf muscles, but a full lower body stretching protocol should be initiated. Hold each of the following stretches for at least 30 seconds, 3 repetitions per side, 2-3 times a day. These stretches shouldn’t cause more than a mild increase in pain or discomfort.
- Warm up prior to exercise. If you continue with your training, you must focus on a proper warm up. I recommend that you increase your normal warm up time and perform a minimum of 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a foam roller or self-massage tool to roll up and down the calf muscles as part of your warm up (as demonstrated in the rehabilitation exercises in tip #4). Limit prolonged static stretching before exercise because it may worsen performance.
- Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up.
- Self-mobilize the tissue. Soft tissue mobilization can be used to reduce pain and improve mobility and function. Be sure to mobilize the tissue of the calf. For this particular area, you may want to use one of the self-massage tools referenced above as well as a tennis or lacrosse ball.
- Spot Train. Eccentric loading exercises of the calf muscles have shown to be highly effective in the treatment of Achilles tendinopathy and tendonitis. Eccentric means when the muscle lengthens during the exercise. A key exercise is the heel raise. Place your foot over the edge of a block or step. The upward lifting motion is concentric while the lowering downward motion is eccentric. The upward motion can be performed with both legs while the downward motion is only performed on the affected foot. Move slowly for 5 seconds down and repeat up to 30 repetitions. If the pain is severe, initially perform with an exercise band (instead of the block or step). For further instruction, please refer the rehabilitation exercises demonstrated in tip #4.
- Work on the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. This will help to maintain normal gait mechanics during exercise and running. Not only will this help to treat potential weak areas that may have caused altered biomechanics leading to the injury, but it will likely help to prevent the development of other orthopaedic issues (such as hip or knee pain). Please refer to Ankle Resistance Exercises.pdf.
- Improve your lower body mobility. Mobility issues and myofascial restrictions may lead to altered biomechanics in the legs, ankles, and feet. Tightness in the lumbar spine, pelvis, IT Band, buttocks or in the deep hip internal or external rotators as well as poor ankle or foot mobility can be contributing factors to Achilles tendinitis or tendinopathy. Initiate a cross training program that involves yoga (or a full body stretching program) in combination with soft tissue mobilization.
- Consider changing your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. Shoes only last 350-500 miles. If you are nearing those miles, then it may be time to change.
- Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over the counter orthotic such as Superfeet Premium Insoles. In my experience, these types of insoles can last 1,000 to 1,500 miles easily. If the over the counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.
- Add a heel lift as a temporary measure to relieve pressure off of the Achilles tendon. (I only recommend this as an initial treatment option in cases of extreme pain.) If the lift is used too long, then the tendon and muscle can begin to shorten–ultimately worsening the condition. In the short term (typically up to a week), a heel lift can be a helpful method in reducing pain, strain, and inflammation to the area.
- Hydrate more frequently. The human body is primarily made of water, which is critical for all body functions. I highly encourage you to hydrate more frequently during recovery. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Adequate hydration helps insure that much needed nutrients are being delivered to the area.
- Seek Help. If you’re not experiencing relief after a week or two of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing the condition. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. You may need assistance in identifying the biomechanical cause of the condition in order to eliminate the pain. A custom orthotic may be necessary or modalities, such as iontophoresis or low-level laser therapy (LLLT), may be indicated.
RETURN TO RUNNING
Prior to returning to your normal training activities, insure the following:
- Your involved leg is as mobile and flexible as the other (particularly into dorsiflexion, which is flexing your ankle toward your shin bone).
- Your involved leg is as strong as the other leg.
- Your ability to balance is equal in both legs.
- You can jog, run, sprint and jump without pain.
If you are not progressing after 2-3 weeks of implementing these treatment options, please speak to your medical professional so you don’t lose too much time with your training. As you taper back into your running program, follow these guidelines:
- Initially start with level terrain only before progressing to uneven ground and hills
- Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
- Initially start with a slower pace and intensity. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.
- Continue with the rehabilitation protocol until you are performing all of the exercises and running normally without pain.
Achilles tendinitis can be very debilitating and demoralizing, but it can be self-treated if addressed at the onset of pain. Early management is important for a timely recovery. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.