The Achilles heel for runners and walkers!

We know how important it is to keep active (see our information on ‘recommended weekly exercise’) this can be anything from running 10K’s, hill walking or keeping up with your 10,000 steps using a health pedometer.

A problem that affects a great deal of people and limits ability to exercise is a condition called Achilles tendinopathy. It presents as a discomfort and often a lump in the Achilles tendon just above the heel. The Achilles tendon is the thick band like structure that connects your calf muscle with your heel.

What is a tendinopathy?

Tendons are made up of thousands of tough, elastic fibres. These fibres are subject to stress or load when our muscle contracts to move our joints and especially when we use our muscles to absorb shock. Stress to the tendon causes multiple micro tears to the small fibres and our body then rebuilds the tissue. This is a state of equilibrium where an almost equal number of fibres breakdown then repair maintaining the status quo. The problem arises when the breakdown outweighs the rebuild and then the tendon structure changes and becomes less efficient at dealing with the stress this is what is termed a ‘tendinopathy’. For more detail on the different stages of tendinopathy please see our section the conditions section.

Symptoms

Initially you may start to feel Achilles tendon ache after a long walk or run and one of the most common times to feel this is when your first start walking as you get out of bed in the morning. The discomfort usually disperses as the tendon warms up but can return again after long periods of inactivity in the day. When you squeeze the tendon it is common to feel tenderness and often there is a hard nodule.

The nodule is nothing to worry about and is a collection of fluid that seeps into the tendon when increased breakdown in the fibres occur. As your body tries to repair this problem a new blood supply is created around the nodule and with a new blood supply comes a nerve supply which causes an increase in sensitivity and therefore pain. As the condition progresses it takes less and less load to aggravate the tendon and the discomfort felt can become more constant.

Managing an Achilles tendinopathy

Reactive tendon: It is common to feel Achilles discomfort following and increase in activity or training. If this happens you will have just caused a mild increase in micro tears in the tendon due to the overload. Firstly reduce the load on the tendon by avoiding high impact exercise for 7-10 days. You may also want to avoid long walks for a few days. Once you return to exercise or walking it is important that you leave further exercise for 24 hours as tendinopathy discomfort tends to be worse he day after.

Tendon Disrepair: If the problem starts to become more persistent for more than 2 weeks this problem might not settle by just reducing the load. The tendon micro tears will be more extensive and there will probably some swelling or a nodule to the tendon. If this happens you need to make sure the tendon starts to repair in the most efficient way. This can be achieved by doing 2 exercises.

1. Calf stretches:

Stand facing a wall a good stride length away with both feet together and both feet facing forward.

Lean forward to place your hands on the wall then step one foot forward towards the wall. Bend the knee of your front leg and keep the back leg straight with your heel flat on the floor.

You should feel the stretch in the calf of the back leg.

Hold this stretch for 30 seconds and repeat 3 times twice per day.

1. Calf strengthening:

To allow the tendon to repair successfully it is now accepted that graded load needs to be put through the tendon.

Exercise 1: Isometric calf raises

Stand with your hands against a wall for support. Push up on to your tiptoes to the maximum height possible. Hold this position for 10 seconds then slowly lower back down. Try to build up to 20 repetitions of this twice per day.

Exercise 2: single leg lowering

Repeat the first part of exercise 1 but instead of holding the maximum height calf raise with 2 feet transfer all your weight onto the affected leg by lifting the non-affected foot off the floor. Hold this for 5 seconds and then lower down slowly. Repeat again this for 3 sets of 15 repetitions twice per day.

Exercise 3: Single leg calf raises

Stand on one leg and slowly raise up to your maximum height and hold for 5 seconds then slowly lower down. Repeat again this for 3 sets of 15 repetitions twice per day.

Important note: Remember you are loading a sensitive tendon so you will expect some discomfort when performing these exercises.

Pain relief: You can apply Ice for 20 minutes up to 4 times a day to reduce discomfort. This should be applied with the ice in a damp towel to avoid ice burning.

If the problem persists after 6 weeks or if the problem worsens then come and see us at the Performance lab and we can perform a full assessment to look for biomechanical issues that may be contributing to the problem. We can also provide more specialized treatment such as kinesiology taping, compex muscle stimulation, acupuncture and manual therapy.