Achilles tendinitis / tendon pain, correctly know as achilles tendinopathy, is one of the most common injuries in runners. As with almost every running injury, is usually due to overuse. Achilles tendinitis is usually defined by a pain in the back of the heel and is often aggravated by running, walking up hill or up stairs, as well as when stretching your calf.
There are 2 types of achilles tendinitis / tendinopathy, insertional (pain close to the heal) or mid-portion (pain in the middle of the tendon). Both are managed similarly except for one important exception which we will talk about.
Being physiotherapists, we have read the literature and have 5 quick tips that are easy to implement and will get you back out on the trails.
1. Avoid running two days in a row
The achilles needs time to synthesis collagen in order to repair itself! This can take 24-36 hours after a running or strength session! Try doing strength exercises and running on alternate days, giving your achilles time to rest. You can reintroduce running two days in row once the initial painful stage is over.
2. Strengthening exercises for Achilles Tendinitis
To improve your achilles ability to handle load, you need to improve the strength of your calf muscles. The achilles tendon needs load to heal, as it has a poor blood supply and the movement of the tendon during exercise helps it get the nutrients it needs.
Key strength exercises for Achillies Tendon Pain:
- Calf Raise: Complete calf raise exercises using pain as a guide (see tip 5). Start 3 x 8-12 repetitions with double leg calf raises on the flat ground, adding progressions as they become easier. Progressions from easiest to most difficult include: Double leg calf raises on a step, single leg calf raises, single leg on a step, single leg (quick on the way up, slow on the way down). Try these with a straight leg and a bent leg to target the gastroc and soleus muscle respectively.
- Tip Toe Walk: Holding a weight in your arms (start with a light weight and increase as tolerated). Walk on your tip toes until fatigue. Repeat 3 times in a row with rest breaks
- Skipping: Skipping with skipping rope is great way to begin plyometric training. Aim to build up to 6 minutes of continuous skipping without pain.
3. Avoid speed, uphill and sand running
In the initial stages, excessive load will aggravate your achilles pain. Speed, uphill and soft sand running all put extra force through the achilles complex, when compared to running on the flat. These types of running can slowly be reintroduced after the initial painful stage has passed.
4. Avoid stretching your calf!
Stretching puts compressive forces through your achilles. These compressive forces often aggravate achilles tendinopathy and will make your pain worse over the long term. This is more important in insertional Achilles tendinopathy as the insertional aspect of the tendon is easily compressed when the ankle is bent.
5. Use Achilles Tendinitis pain as a guide
Pain is a pain in the ass. But pain is a great guide for determining if you are doing too much or too little. When running or strength training, try and keep your pain below 3/10 on a 0-10 scale (10 is the worst pain you can imagine). Also take note if your pain is worse the day after running or strength training. If your pain is getting above 3/10 or is worse 24 hours after, you may need to take a step back with your running or strength training loads. If you continue to run with significant pain, you’re running pattern will change to compensate for the pain. This will cause overload of other tissues, resulting in another injury and setting you back further.
If you are getting no pain at all when running on the flat, Great! It’s time to increase your running load by running two days in a row or adding in speed or hill work.
Remember that the achilles loves to be loaded! Resting and avoiding any running or strength work will make your achilles tendon feel better in the short term but it will do nothing to help it heal in the long term. So whatever you do, keep moving!