The Achilles tendon is the big tendon in the back of your lower leg attaching the calf muscles to the heel bone. There are two main sides that runners and walkers feel Achilles pain: the insertion where the tendon attaches to the heel bone, and the mid portion which is 1.50″ or 1.90″ up from the heel bone. (pic arrow 1 2). This is important because the tow areas respond differently to treatment.
Pain in the Achilles tendon used to be called Achilles Tendonitis, but because it’s largely a degenerative process and only a limited inflammatory component, it’s now being referred to as Achilles Tendinopathy.
You can either continue reading the article or read our articles of the best shoes for Achilles Tendonitis.
Best shoes for Achilles Tendonitis for women and men
Best running shoes for Achilles Tendonitis (including Asics Gel-nimbus Achilles Tendonitis shoe)
Best walking shoes for Achilles Tendonitis
Healthy tendons are composed mostly of tightly packed parallel bundles of Collagen fibers. Recent research by physiotherapy tendon experts Jill Cook & Craig Purdam has identified three stages to Achilles Tendonitis/Tendinopathy:
The Reactive Stage. During this stage, the tendon swells but the Collagen Matrix is intact.
The Dysrepair Stage. The Collagen starts to break down a bit like a fraying rope.
The Degenerative Stage. There’s severe breakdown of the tendon matrix and the blood vessels and nerves start to grow into the spaces between the Collagen fibers.
The onset of Achilles Tendonitis/Tendinopathy can be sudden, but runners and walkers usually describe a gradual onset in pain and stiffness in the tendon during or after running. At first, the problem may occur only after intense hill track or interval sections, and in the early stages the pain may reduce as you begin to warm up on your run or walk. Stiffness in the tendon first thing in the morning is a frequent finding in the early stages. Gradually, the pain becomes more frequent and you can feel it throughout the full duration of runs, even slower and less intense sessions. Eventually, you may experience pain just walking.
In the early reactive stage, the whole tendon may be swollen. Later on in the degenerative stage the tendon may feel thickened with lumpy nodules. So what causes Achilles Tendonitis/Tendinopathy?
In runners, it’s usually caused by the accumulation of excessive mechanical load on the tendon. That could be from:
an increase in your usual mileage.
excessive hill sprint or track sessions.
change in your usual running surface.
the addition of extra runs to your usual schedule.
joining the barefoot or minimalist craze and overdoing it a bit.
new shoes pressing on the back of your Achilles.
biomechanics. Maybe you’ve had an injury elsewhere so now you’re running differently and it’s throwing more strain onto your Achilles.
On the other hand it’s possible that the loading of the tendon is the same as normal but that the tendon has become weaker after a break from running / walking or after a period of enforced rest after different injury. Alternatively, there are other factors that have been shown to contribute to Achilles pain such as:
a stiff ankle.
weak or tight calf muscles.
lack of warm-up.
All these are possible factors in the development of Achilles Tendonitis/Tendinopathy. Hopefully, one or two will ring true for you because identifying those factors is stage one in curing the problem.
Reactive Achilles Tendonitis/Tendinopathy
First, I’m going to give you some tips for acute management for the Reactive Achilles Tendonitis/Tendinopathy. So let’s say that the morning after a tough hill session you feel pain and swelling in your Achilles, what can you do?
First off, avoid running and reduce the amount of walking you do for three or four days. You can use a five-millimeter heel raise to take pressure off your Achilles, and in a severe case, you may want to wear an air cast boot for a couple of days. You can take maximum dose of Ibuprofen for three days if you’re medically fit to do so. Check with your GP or pharmacist if you’re unsure. It’s worth saying that although inflammation isn’t a big part of Tendinopathy, there’s good reason evidence to show that Ibuprofen helps in this reactive stage. Additionally, many top athletes now take high-dose Omega 3 Tablets and drink Green Tea for Reactive Tendinopathy.
Static calf muscle exercises, otherwise known as asymmetric exercises can be started after three or four days. If you respond well, normal training can often be resumed soon after. So what about treatment for a chronic grumbling degenerative Achilles Tendinopathy?
Treatment for Degenerative Tendonitis/Tendinopathy
You will usually still need a period of relative rest from the activity that’s been causing the problem. That might mean avoiding the problematic hill sessions or track sprints, or it might mean avoiding all running depending on how severe the things are. You can do some cross training such as swimming or cycling to keep up your general cardio-vascular fitness and to help bring oxygen to the healing tendon. Even better, try something specific to running such as aqua jogging or the Elliptigo.
While resting from running, you need to build up the strength of the tendon. And for the Degenerative Achilles Tendinopathy, exercises to gradually load the tendon are seen as the gold standard treatment technique. Eccentric exercises such as the heel drops originally pioneered by Professor Hakan Alfredson have been popular over recent years. There’s good evidence they work well for chronic mid-portion Achilles Tendinopathy, especially in athletes. Some of today’s tendon experts believe that concentric eccentric exercises such as a standard up and down heel raiser work just as well as eccentrics and they’re even easier to perform. Whichever exercise you go for, you need to build up the loads on the tendon gradually. Usually that involves going slowly with low resistance to start with and gradually building speed and resistance. Eventually, you’ll want to build up to doing dynamic exercises such as hopping and skipping.
Stretching of the calf muscles can be useful if those muscles are tight and ice packs can be useful after runs or activities that might cause a reaction in the tendon.
If you’re still struggling having tried some of those home treatments options, it might be time to visit a Physiotherapist. Firstly, a Physio will help you to accurately diagnose your problem and rule out other problems which require a different treatment approach. They will also help to determine the stage of the pathology which guides the best treatment approach. The Physio will perform a physical examination to help evaluate which areas are stiff, tight and weak both in the tendon and calf and also along the whole of the connective chain. They can use various hands-on techniques to loosen stiff and tight areas and teach you specific exercises to improve strength and movement control.
Make sure you visit a Physio who either walks a lot, runs, or treats lots of runners because you need to see someone who will understand your training plan and your running objectives and who will link this to your medical and training history and to your current levels of conditioning strength and flexibility. They might also evaluate your running style to work out if there are any biomechanical factors that contribute to your Tendinopathy problem. A good physiotherapist is going to be like a coach who takes you through all stages of rehabilitation.
Treating Achilles Tendinopathy effectively is largely about stressing the tendon the right amount at the right time, and a good running Physio will help guide you through that process. They might also use adjuvant therapies such as Kinesio taping, acupuncture, shockwave therapy, or ultrasound to help healing of the tendon.
I hope this has been a helpful guide to Achilles Tendinopathy. Good luck and happy running.