Running Injury Series: Achilles Tendinitis

With the beginning of summer right around the corner, more people are going to start doing activities outdoors. One of the most popular outdoor activities is jogging. While jogging is a great way to increase your cardiovascular fitness, sometimes you get the aches and pains of starting a new exercise regimen. This will be the first post of the running injury series. We will discuss a variety of topics including iliotibial band friction syndrome, shin splints, and runner’s knee. 

The Achilles tendon is located on the bottom of the calf. It connects the two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneous). Achilles tendon pain usually starts with a sudden increase in activity or load, which can cause the tendon to become painful. Previously tendon pain was thought to be caused by inflammation (that’s why it’s called tendinitis). Newer research has suggested that tendon pathology is not caused by inflammation, but instead by disorganization of the tendon structure. This has changed the way Achilles tendon pain is managed. 

Symptoms of Achilles Tendinopathy 

Achilles tendinopathy is characterized by dull or sharp pain located above the heel. The pain is usually associated with movement, but can persist after an intense workout. The most painful movement is typically standing up on your toes. 

What Causes Achilles Tendinopathy 

Achilles tendinopathy is usually caused by an acute overload of the tendon. An increase in how hard, how often, or how long you run can all trigger the onset Achilles tendinopathy. A change in running environment can also lead to Achilles tendinopathy. This can include an increase in uphill running or a change in running shoes.

Running mechanics can also increase the forces on the Achilles tendon, leading to a tendinopathy. Poorly controlled pronation (inside arch collapsing) will increase the forces on the inside portion of the Achilles. Tight calf muscles have also been suggested to increase the risk of Achilles tendinopathy. Tight calf muscles decrease the force they can absorb, therefore, the force on the Achilles tendon increases. 

How to Prevent Achilles Tendinopathy 

The primary method to prevent Achilles tendinopathy is proper load management. If you are experiencing pain, you will need to decrease your running load to where it is comfortable again. Remember that how fast you run, how often you run, and how long you run all increase the load on your body. Therefore, balancing these factors when returning to your running program is essential. It is recommended that you increase by no more than 10% every two weeks to decrease your risk of injury. 

Self-myofascial release to your calves can help decrease the tightness. Using a foam roller, roll your calves for about 30 seconds. Make sure to rotate your legs inside and outside so that you are rolling the whole calf. If two legs on the foam roller is too easy, you can try crossing one leg over the other to increase the pressure. 

To strengthen the Achilles tendon, heel lifts can be performed. Eccentric exercises (heel drops) were a popular treatment option, however, the effectiveness has been questioned in the research. Concentric/eccentric exercises may be more beneficial for returning to play. To perform this, slowly stand on your toes then slowly lower your heel to the ground. This is commonly performed for 15 reps, 3 sets. 

Getting Treatment for Achilles Tendinopathy 

For cases that do not resolve on their own, treatment may be necessary to accelerate the healing process. Conservative treatment options include manual therapy, Graston therapy, and corrective exercise to stimulate tendon regeneration and tendon organization. Other treatment options include medications and injections, however, these have not been shown to alter tissue organization. Therefore, manual therapy, Graston therapy, or exercise therapy should accompany these treatment options to prevent re-injury. 

An examination by a professional can also identify any biomechanical dysfunctions that are contributing to the Achilles tendinopathy. Altered movement patterns in the foot or hip can lead to increased stress on the Achilles tendon. 

Surgery can be an option for those that do not respond to conservative care. Before seeking surgery (unless you have a complete rupture), you should try to exhaust your conservative options first and always get a second opinion. 

In summary, Achilles tendinopathy is a common injury experienced by runners. The most common cause is increasing your running too quickly. Therefore, decreasing your running to a comfortable amount can be very beneficial in treating Achilles tendinopathy. When your condition fails to get better, seeking treatment can help get you moving in the right direction. If you are struggling with Achilles tendinopathy, schedule a free consultation with Velocity Sports Rehab to see if we can help.