Achilles Tendinitis in Runners
The Achilles tendon, a band of durable tissue that joins two muscles in the calf to the heel, has spring-like properties that allow people to produce force off the floor (Maghsoodi, n.d.). Although people can experience Achilles Tendinopathy after a single event of too much external load, it is more commonly caused by overuse, causing slow deterioration in the tendon (Vos, et al., 2021). Achilles tendinopathy is especially common in athletes due to their high activity levels as their tendons absorb repeated stress. The injury occurs most frequently in runners since their tendons are loaded with tension in the full duration of their training. Other common causes in runners include “tight calf muscles, poor ankle range of motion, excessive pronation” (Davis, n.d.), a sudden increase in training workload, and excessive exposure to hills (Runner’s World Editors, 2021). Signs and symptoms of Achilles tendinopathy include mild to severe pain, redness or burning sensation, reduced ankle mobility, and accumulation of scar tissue (Runner’s World Editors, 2021).
Phases of Exercises
While people were often told to take a complete break when you experience pain, studies have shown that tendons prefers load for recovery (Maghsoodi, n.d.). Start with the first exercise and gradually work your way up as you gauge pain or discomfort. Perform five sets for all exercises, holding for 45 seconds and resting for two. When you are ready to start exercising after working through the four phases for weeks, it is crucial to gradually work your way up to the workload that you were used to. For example, if you are used to running five miles, start by running one mile. After recovering and seeing how your tendon feels, slowly progress by increasing a mile over the next few weeks.
Phase 1: Supine Calf Isometric With Band
In a seated position, place a band or a towel slightly over the midpoint of your heel and pull with the hands and push your heel forward. You should feel tension in your calves. Pull and push as hard as you can without pain. (Maghsoodi, n.d.).
Phase 2: Single Leg Heel Raise Isometric Hold
Stand in front of a wall or near an object to grab for balance and raise both heels as high as you can. Keeping your knees straight, slowly transfer your weight to the affected side and lift your other foot off the ground. If you experience too much pain, you can start by raising both heel. (Maghsoodi, n.d.).
Phase 3: Single Leg Heel Raise Weight Shift
Keeping your knees straight, place your hands in front of a wall or on an object and raise your heels off the floor as high as you can. Slowly sway back and forth, focusing on applying your weight on each heel, for the prescribed time. (Maghsoodi, n.d.).
Phase 4: Single leg/Double leg Pogos
Place your hands on the wall or an object with your knees straight and jump up and down. Start with both feet and with a small range of motion, then slowly jump higher, while focusing on landing softly. When you feel ready, take one foot off and perform the movement. (Maghsoodi, n.d.).
How Physical Therapy Can Help:
Physical therapy can help heal from achilles tendinitis in many ways including soft tissue work, joint mobilizations, and adding in progressive resistive and mobility exercises with a focus on running.
Here is a sample video of soft tissue work we perform to help achilles tendinitis in runners:
Not only will soft tissue help, but your physical therapist should also be planning out short and long term goals with you in regards to what you discuss. In this programming there should be a good mix of mobility, strengthening, balance work, and education on how to rehab the achilles without over or underdoing it.
If you or anyone you know who has achilles tendinitis and would like to get back to running, please reach out to us. We are San Diego’s premiere sports physical therapy clinic help runners like yourself each and every day.
References
Davis, J. (n.d.). The ultimate runner’s guide to Achilles tendon injuries. Retrieved from
https://runnersconnect.net/achilles-tendonitis-and-insertional-achilles-tendinopathy-in-runners/
Maghsoodi, A.R. (n.d.). How to rehab Achilles tendinopathy. Retrieved from
https://theprehabguys.com/rehab-achilles-tendinopathy/
Runner’s World Editors. (2021). Sore Achilles tendon? Here’s how to treat it. Retrieved from
https://www.runnersworld.com/health-injuries/a19574249/achilles-tendon-injury/
Vos, R.D., Vlist, A.C.V.D., Zwerver, J., Meuffels, D.E., Smithuis, F., Ingen, R.V., … Weir, A.
(2021). Dutch multidisciplinary guideline on Achilles tendinopathy. Retrieved from https://bjsm.bmj.com/content/bjsports/early/2021/06/28/bjsports-2020-103867.full.pdf
Written by Jun Bae, current student of Natasha Hastings
