Achilles Tendonitis
You’re Grounded!
Achilles Tendonitis is an injury that I see across most athletic endeavors. This is an injury that, if allowed to fester, can sideline you for months at a time. If ignored, the rehabilitation process can take months. However, if you acknowledge and treat this condition when you first begin to notice it, you may not even have to stop doing your thing at all and you may be able to avoid seeking help from a skilled clinician.
The Achilles’ tendon is that big cord of connective tissue between your heel and calf. In fact, the Achilles’ tendon is the tendinous end of both the soleus and gastrocnemius muscles that comprise the calf muscle. The two muscles merge into a tendon about 2/3 of the way down your calf and then insert into your heel. The gastrocnemius muscle originates above the knee joint, while the soleus originates below the knee joint. As such, any Achilles’ tendon rehab must include exercises with both a bent and straight knee. More on that later.
The literature around this injury points to many risk factors. Clinically speaking, I see this in patients that have tight posterior leg musculature (calf, hamstrings), patients with excessive weight, patients that have started exercising after a prolonged sedentary period, or patients that have had a sudden increase or change in their current physical activities. The common theme here is that Achilles tendinitis arises when your calf musculature cannot buffer the stress of your activity level. In this context of overuse the tendon begins to break down and it lets you know about it in the form of pain.
Achilles pain can be anywhere on the side or posterior heel, up through the body of the tendon itself. If you feel pain in this region at the beginning of your walk, run, ride, etc. that is Achilles tendinitis, even if the pain goes away as you warm up. In fact, pain in the Achilles that dissipates as you exercise is one of the hallmarks of the injury. If in doubt of this diagnosis, try giving your Achilles a vigorous squeeze. Take your thumb and forefinger and pinch the tendon, starting at the bottom of your heel, working your way up to the calf muscle. If your pinch causes pain, it’s Achilles Tendinitis.
If you have determined you have this injury, you don’t have to schedule an appointment with me immediately, although I will be happy to have you visit my clinic. However, you do need to start treating this yourself as soon as possible.
Calf Mobility
Begin with improving the extensibility of the calf and Achilles tissue. This is done with pressure, not stretching. Grab a foam roller and get on the floor. Take the painful leg and rest it on the foam roller at your heel. Put you non-involved leg on top of the painful leg and press down. Now roll your lower leg back and fourth, perpendicular to the foam roller. Then gradually move the foam roller up your Achilles and calf repeating the rolling motion until you are just below the back of your knee. Plan on spending 3-5 minutes daily doing this.
This injury is one of few conditions that require exercise whilst it is still painful to do so. The most effective exercise you can apply is the eccentric heel raise. I suggest doing these in both a standing and seated position, to address the soleus and gastrocnemius muscle fibers that merge into the tendon itself.
Standing Eccentric Calf Raises
Stand on a step or similar solid object such that your weight is on the balls of your feet, while your mid-foot and heel are hanging off the edge. Rise up onto the balls of your feet, then lift up the non-involved foot, balancing on the painful one. Now, slowly (to a 5 count) lower your heel down until it is below the level of the step. Return your non-involved foot to the step and rise back up onto the balls of your feet. Repeat. Perform this exercise for 2 sets of 12 repetitions, every other day for a minimum of 2 weeks.
Seated Eccentric Calf Raises
Now sit on a chair and place your forefoot on an object that elevates your heel similar to the standing position described above. Now rise up onto the balls of your feet using just your involved foot. Balance and hold a 15-30lb weight on top of your thigh, near the knee. slowly (to a 5 count) lower your heel down until it is below the level of the step. Remove the weight and rise back up onto the balls of your feet. Repeat.
If you have spent a few weeks consistently using the foam roller and doing eccentric calf raises without improving or your progress is too slow, consider scheduling an appointment with me. I use a combination of trigger point therapy, blood-flow restriction therapy, pneumatic compression and progressive mobility/exercises when treating this painful condition. Once we have reduced the pain, we can take a closer look at the underlying causes of the tendonitis and work on preventing it from returning. I spend a full hour, one-on-one with every patient for every visit. This approach allows me to consistently reduce my patient’s painful Achilles symptoms while addressing the underlying cause of the injury. While the Achilles pain is what initially got your attention, movement dysfunction at both the ankle and hip is often what precipitates this injury. Ultimately, you may require a program of comprehensive exercises addressing the entire lower extremity.