How to banish Achilles tendinopathy forever: a fast, effective runner's guide

Achilles tendon injuries are common in runners and non-runners alike, and can be a nightmare to fix.

How to banish Achilles tendinopathy forever: a fast, effective runner's guide

It’s often characterised by pain in the tendon, usually at the beginning and end of exercise, pain and stiffness first thing in the morning or after sitting for long periods.

Luckily, there's much that can be done to speed up healing and prevent occurrence, so we asked the guys over at PhysioMed to give us their best tips on how to treat and prevent Achilles tendinopathy.

What is Achilles tendinopathy?

Your Achilles tendon is the fibrous band that connects your calf muscles - the muscles which create the force needed to push your foot off the floor when walking and running - to the muscles in your heel.

Achilles tendinopathy, previously known as Achilles tendonitis, is thought to be a combination of inflammation, injury from overuse, and degeneration of the thick Achilles tendon at the back of the ankle.

Causes and how to prevent it

  • Poor footwear or a sudden change in training surface, e.g. sand, makes the calf work harder.

Wear suitable shoes for the right activity. Take account of the surface you are exercising on and if soft and unstructured like sand or loose soil reduce the intensity / duration or take a short break or reduce any load you are carrying into smaller loads until you become conditioned to it.
  • An abrupt increase in the duration or intensity of an activity.

Graduate or phase the increase in the activity and only increase one aspect, either time, intensity or load. If you know in advance that your work schedule or exercise programme is increasing in such a manner, plan ahead and phase the increase in activity in advance.
  • A sudden introduction or escalation in hill/stair activity.

 Graduate or phase the increase in the activity. If this is not possible within a work environment, make use of escalators/lifts where possible and reduce over time to create the phased approach.
  • Weakness of the calf muscles.

If you feel this is an issue, strengthen your calf muscles so they are strong enough to cope with any of the above issues.
  • Calf tightness and reduced range of movement at the ankle. 

If you feel that this is an issue, ensure adequate length of the calf muscles and good range of movement at the ankle by undertaking a regular stretching programme.
  • Poor foot control – flat feet or feet rolling inwards causes increased twisting strain on the tendon.

If you feel that this is an issue for you please visit your GP, chartered physiotherapist or podiatrist to receive an expert opinion and appropriate intervention.
  • Wearing high heels constantly, which shortens the calf and tendon. 

Wear high heels for a limited time. Compromise may be found in wearing flat shoes on the way to and from the venue or work. Wearing flat shoes or nothing on your feet while at home is helpful. Also undertake a regular calf stretching programme.

Symptoms and treatment

Pain usually occurs either in the middle portion of the tendon (1-2 inches above the heel) or where the tendon attaches into the back of the heel. This area is often thickened or swollen and tender to the touch.

Your calf might also feel tight and there may be stiffness in the ankle joint.
Pain will normally be reproduced during the ‘push-off’ action of walking, climbing stairs or running.

At-home recovery

Achilles tendinopathy is often slow to heal, especially when compared with other injuries, mostly because of the poor blood supply to this area.

The body’s tissues need a good supply of the oxygen and nutrients carried in the blood to repair, so measures such as ice, heat, massage and gentle stretching of the calf and tendon can help to promote blood flow.

In order to reverse the degenerative aspect of Achilles tendinopathy, rehabilitation needs to include loading and strengthening of the tendon at the appropriate time, alongside stretching.

Follow these at-home recovery tips:

  • Self-massage of the tendon and the calf. 

This may be painful initially, but will increase blood flow and help healing of the tendon, and should become easier as you go. Remember to give yourself time with the massage, as the tissue needs time to relax and let go as you massage the knots away. 

This could be done while at lunch, sitting during a tea break at work, or watching a favourite programme at home. Gentle heat on the Achilles (10-20 minutes) will also help to relax it and increase the blood flow. When using heat, this should be a mild heat and never feel hot.

  • Self-massage of the bottom of the foot. 

This area is connected to the Achilles tendon, therefore can affect healing if it is not kept supple. Place a tennis ball, rolling pin or something similar on the floor with the affected foot on top of it. 

Roll the foot over the tennis ball or rolling pin from heel to toe. 

Gently press on the tennis ball or rolling pin as you do the movement. 

Start by doing this for 1-2 minutes and build up gradually to five minutes on either foot.

  • Maintain the ankle range of movement with large foot circles, and pointing and flexing the foot, especially when getting out of bed in the morning or after sitting for long periods.
  • Wear shoes or use an insole that provides good arch support and shock absorption. 

Trainers or rubber-soled shoes are good options. Choose footwear that does not put pressure on the Achilles tendon and avoid shoes which do not fasten securely to your feet, such as flip-flops or sandals without a heel strap/support.

  • Relative rest, especially from high-impact or repetitive exercise involving the ‘push-off’ action of the foot. This may include modifying your work duties for a determined period of time (with the agreement of your manager), to include short periods of sitting down where possible or using a trolley/vehicle to reduce the load you are carrying.

Please remember to use this advice under the guidance of your physiotherapist. For more tips and advice, visit PhysioMed online.

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