Achilles Tendon Pain:
Summer in Melbourne. It’s BBQs, cricket, beaches, and Thongs. But for some its Achilles pain, Plantar Fascia pain, foot, and ankle pain. So what can be done?
What Is My Achilles tendon?
Your Achilles tendon is the big thick tendon that connects your calf ( this is the muscle of the lower leg, (just below the knee ) to your foot. Injuries to this tendon are one of the most common in running and jumping sports. The repetitive nature of the activities gradually irritates the tendon causing pain and micro-trauma. And at worse – rupture! Damage can take a few forms: 
- Inflammation of the Tendon – Tendonitis**
- Swelling of the tendon
- Micro tears of the Tendon – Tendinosis
- Complete Rupture
**Through research we know now, that this is rarely the cause of your pain. And we are now referring to this type of injury as a Tendinopathy, avoiding the “itis”
What Can Cause Achilles Tendon Pain:
- Over-training “too much too soon” – Poor build up and load tolerance.
- Change in training surface / Load – e.g. grass to bitumen
- Poorly footwear.
- Hill running.
- Excessive calf Tightness / Weakness
- Poor Ankle foot biomechanics
How do I best manage my Achilles tendon pain?
When it comes to managing tendinopathies of the Achilles tendon, there are two types: insertional, and mid-portion.
- Insertional tendon pain occurs where the Achilles tendon inserts into the heel bone (calcaneus).
- Mid-portion Achilles tendon pain is experienced in the ‘mid-portion’ of their Achilles tendon. Pain of this type may be one-sided (ie the inside or outside of the tendon), or over the belly of the tendon itself.
Go Beyond Exercise For Achilles Pain.
While it is extremely important to be doing the correct exercises for Achilles tendon rehabilitation. Exercise prescription is not the sole treatment for Achilles tendon pain. Manual therapy for initial pain management is also important. It is therefore essential to address the contributing factors in the treatment plan. Addressing aspects such as running/walking mechanics. And attempting to minimize training errors are vitals. As is selecting appropriate running footwear. Not to mention avoiding footwear which provides no support. Such as Havaianas
Shockwave Therapy has also been shown to dramatically improve the pain, associated with Achilles tendon pain and kick start the healing process.
The 3 Key Stages of Achilles Rehabilitation:
- Isometric loading: Achilles tendon holds
Isometric tendon loading has been found to have pain-relieving effects on tendons. As a result, it will also maintain some baseline strength. It is a paramount exercise to begin with for Achilles tendinopathies. And can be performed with either double legs or a single leg. Depending on the type and severity of the injury. For highly irritable (reactive) Achilles tendons double leg holds, of often shorter duration, and fewer repetitions may be performed.
- Isotonic loading: calf raises
These exercises can be commenced once the tendon’s irritability has reduced. There are no ‘hard and fast’ rules for when to start this loading phase. I tend to commence clients on graduated isotonic loading once:
- Pain levels are about 5/10 pain on repeated single leg calf raises. And their reported morning tendon stiffness has reduced.
- Energy Storage loading: plyometric exercises
A crucial last stage of rehabilitation is the commencement and execution of ‘energy storage’ tendon exercises. These exercises involve highly explosive jumping and hopping exercises. We do this to test the ability of the tendon to cope with the load of the exercise.
Closing Thoughts:
Carefully managing all Achilles tendinopathy rehabilitation, whether for a reactive or degenerative tendon is essential. Tendon rehabilitation is far from ‘straightforward’. Tendon adaptation to the loads outlined above will take time.
Adequate recovery time between rehabilitation sessions needs to be considered. When to increase the load. When to decrease load. We are constantly assessing the choice of exercises. Ensuring you are getting adequate adaptation, without further irritation. Our aim is to get you back on track as quickly as possible. BUT as safely as possible. Your long term health and well being is our ultimate goal.
Any Questions?
If you’re having trouble with your Achilles Pain. Or have just started a running program and feel you may need a little extra help. We are here. Let the Osteopath’s at Equilibrium Sports and Spinal Clinic in Glen Iris guide you to a stronger body without pain and irritation, so you can enjoy your summer exercise program and life without the niggles’ aches and pain.
Feel free to email us at info@equilibriumsas.com.au if you have any specific questions.
