Achilles tendinopathy is an overuse injury that is especially common to runners and jumpers. It’s the repetitive loading that can cause micro-traumas in the tendon and subsequent pain. Over time, these microtraumas can result in degeneration or changes to the structure or composition of the tendon, so it’s best to get in and manage the niggle early.
I’ve experienced Achilles issues on my left side for a few years now, on and off. The pain can vary from mild to severe, AKA ‘just a niggle’ to screaming stabbing pain when simply walking. Either way, it totally sucks as it limits your potential and performance.
My natural first response to healing it was to simply stop, rest and wait for the pain to go. Oh, how wrong I was. Resting, in fact, made the condition worse. My Achilles got weaker and the pain hung around like a bad smell.
Over time I tried and tested a number of different fixes given to me by physiotherapists and what I’ve come to learn is that the source of the ‘overload’ can vary greatly between each individual. For some, it is simply that their training schedule had increased too quick too soon, for others it is running gait and biomechanics. It could be a weakness in other muscles (glutes or hamstrings), resulting in the Achilles doing more work than it should, or a motor control issue. Or it could simply be poor footwear.
But what’s really important is getting to the bottom of the root cause of YOUR Achilles pain.
But before we go on, this article is about MY journey with Achilles tendon pain. I’m an everyday runner with a love for long distances. I’m also a qualified fitness instructor with a passion for movement. I’m not a doctor and I’m not a physiotherapist. But in my journey, I have spoken to and been treated by multiple sports clinicians. Not only have I listened carefully to what they have had to say, but I’ve tried all their therapies and can comfortably say that I can evaluate them all.
What I encourage you to do it remember is that a) everybody is different and b) having your pain assessed by a clinician will fast-track the healing process.
In saying that, here are my thoughts on solving the riddle for the dreaded Achilles tendinopathy.
What is a tendon?
A tendon is a band of connective tissue that connects muscle to bone. The Achilles tendon is the largest tendon in the body. It attaches the calf muscles to the heel bone and helps you to walk, run, jump or stand on tiptoe.
What makes the Achilles tendon grumpy and painful?
- Over-training – “too much too soon”
- A sudden change in training surface – e.g. grass to road
- A sudden change in training type – e.g. easy runs to sprint/speed running
- Flat (overpronated) feet
- High foot arch with tight Achilles tendon
- Poorly supportive footwear – e.g. constantly wearing high heels
- Tight calves, hamstrings, glutes and/or lower back muscles
- Weak calves, hamstrings, glutes
- Poor eccentric strength
- Low cadence when running or poor running gait
What kind of pain is it?
The pain can vary from moderate to severe and it feels like a sharp pain in the heel or back of the ankle. It’s generally most painful first thing in the morning and in the first 10-15mins of a run, it then eases off during the day. In severe cases, the pain can be debilitating.
What happens if I ignore it?
In my experience, if it’s not managed properly the pain just gets worse, it becomes chronic and it starts to impact on everyday life. Simply walking can be an issue. I’ve heard of severe cases where surgery was the end result.
How do I heal it?
The first step toward a pain-free Achilles is figuring out the cause (see above) and then correcting the dysfunction. For me it was a little bit of trial and error…
Resting completely made the condition worse for me. My Achilles got weaker. But easing back off the training and cutting out the sprints (temporarily) definitely helped.
After a run session, applying ice packs for 20-minutes per hour during the acute stage was really helpful in reducing any inflammation and fast-tracking the healing process. I personally get great results from cold therapy. But whilst ice gives temporary relief of pain, it doesn’t fix the root cause of the problem.
#3 Non-steroidal anti-inflammatory drugs
Over the counter anti-inflammatory drugs is a very short-term band-aid solution for the pain and does not address the root cause of the issue. Drugs may silence the screaming pain in your ankle but the problem still exists. I personally didn’t even bother with taking drugs, as I was worried it would give me a false sense of security and the ice was just as good.
#4 Mobility Training
Tight calf muscles and hamstrings can lead to poor ankle mobility, and this can often lead to the AT doing more work than it should. This is where stretching and foam rolling can really make a difference. When tested, my ankle and hip mobility were actually fine, in fact, I’m a little too flexi. But my lower back and glutes were fired up. Even tightness in the lower back can have an impact down the chain. Remember, everything in the body is connected. I recommend having a physio test your mobility. I am committed to daily foam rolling and ball release work on both my glutes and lower back.
#5 Stability Training
If you have ruled out any mobility issues, then it’s time to ensure that you have adequate stability through hips, knees and ankles. How much wobble do you have on single leg deadlifts? Are your hips doing a hula dance every time you run? A physio identified some motor control issues on my left side and I’m committed to daily stability exercises to ensure I iron out the asymmetry.
#6 Strength training
Only once you’ve got optimal mobility and stability should you progress to adding load and throwing around weights and kettlebells. If you’ve still got pain, I personally think it’s better to work on stability for a bit longer. Most physios I saw recommended eccentric strength exercises for my calf muscles. An example would be single leg heel rises. The idea is that if you can strengthen your calf muscles the AT won’t have to pick up the slack and it won’t be overused. But if your calf muscle is already strong and tight you may be exacerbating the issue. This is where a full individual assessment really helps.
#7 Run/Walk Interval Training
My pain didn’t start from a sudden increase in my running schedule or change to the training surface. But I did back off the running and change my training schedule slightly. Interval style training involving a run-walk pyramid was really helpful.
#8 Foot mechanics
Everyone has different feet (flat or high-arch) and different foot issues (arthritis, bursitis, previous ankle sprains etc). Have a podiatrist assess your feet for any issues. I have friends who found orthotics really helpful.
#9 Running gait assessment
This is probably where I got the biggest bang for my back. My running cadence was too slow causing me to overstride and the load wasn’t being transferred through my body very well. In other words, my Achilles tendon was doing far more work than it should. By increasing my cadence, my foot strike is now under my hip rather than in front and the load is better distributed through the joints.
#10 Shockwave Therapy
Because tendons don’t have a great blood supply healing can be a little slow. Shockwave Therapy is a non-surgical therapy designed to speed up recovery by encouraging blood flow to the injured site. I tried it and it ‘s actually quite painful. It sounds and feels a bit like a jackhammer and Physios say that 2-3 treatments are needed to see improvement. I’m not convinced of the therapy, as it’s still not addressing the root cause of the issue.
So there you have it, for me addressing my running gait, ironing out particular tight muscles and working on single leg and hip stability were the big solutions for me. But it could be a different case for you. Find a clinician who can help you pinpoint what the REAL cause is and you’ll be able to fast track the healing.
Good luck and happy running!