Achilles may have been a hero in Greek mythology, but any athlete who has been plagued by Achilles tendinitis will tell you there’s nothing to celebrate when it comes to an Achilles injury. Achilles injuries are among the most common for runners, although athletes from all disciplines are susceptible.
The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles to the heel bones and is used to walk, run and jump. Despite its strength, the Achilles tendon can come under various athletic stressors that manifest in painful tendinitis.
Common Causes & Consequences
“Achilles tendinitis is on the rise as a condition, mainly because of the growing popularity of ballistic exercises like jump squats, box jumps and jumping rope,” says Dr. Kevin Sherman, a sports chiropractic physician and Active Release Therapy practitioner.
When it comes to runners, the tide of Achilles injuries tends to rise whenever a new trend in running shoes prompts runners to try a new, popular shoe without fully understanding the consequences and stresses it can place on the Achilles tendon. Supportive footwear is key.
“The fallout from the barefoot running trend is still with us today,” Dr. Sherman says. “And now, a lot of people are training on low-rise shoes (those with a 4mm or less drop), which can place additional stress on the Achilles.”
Dr. Sherman also sees the condition among swimmers, especially triathletes. “The athletes who do explosive flip turns off the wall can cause repetitive micro trauma to the tendon that can lead to Achilles tendinitis,” he says. Triathletes also have the additional stresses of biking and running to contend with.
Form & Function
How you move your body matters when it comes to Achilles tendinitis. Paying attention to proper form when running, swimming, playing tennis, or any sport is critical.
As an example, Dr. Sherman points to runners whose foot strike is on the front of the feet. That forefoot strike can place added stress on the Achilles tendon. “A mid-foot strike can reduce your risk, but I’m still a big fan of a natural heel strike. For the vast majority of runners, heel striking is OK,” he says.
Also, an increase in intensity or volume of training will up the ante for Achilles tendinitis injuries. Uphill training – think hill repeats – can aggravate the Achilles if it is prolonged and repeated.
For the ladies, if high-heeled shoes are your footwear of choice during the week, watch out when you switch to flats on the weekends. The shift in tension from a contracted to an extended state of the tendon can invite Achilles pain.
Just Sore or More?
The first sign of Achilles tendinitis is heel pain first thing in the morning that usually improves as the day goes on, says Dr. Sherman, who treats 1-2 cases of Achilles tendinitis daily. If ignored, the condition will simply worsen.
“Eventually, it’s going to get worse,” he explains. “You will start to see swelling on the tendon, and it will become exquisitely tender to the touch.” In many cases, the sponge-like sheath that surrounds the tendon is inflamed, rather than the tendon itself, he explains.
If left untreated for an extended period of time, the tendon will begin to degenerate and weaken to the point where it may rupture. “An Achilles rupture often requires surgical repair,” Dr. Sherman says, explaining the recovery process is long and arduous.
Self-Care for Achilles Injuries
When it comes to self-treatment, there are important guidelines.
- Cool the injury using an ice pack from the refrigerator that is above 32 degrees Fahrenheit. Directly following activity, it is permissible to use an ice cube to gently massage the area for 1 minute, and then switch to the cold pack.
- Switch to an athletic shoe with a slight rise. Standard training shoes for runners generally feature a 10-12 mm rise versus low-rise minimalist shoes.
- Wear compression socks (not calf sleeves) to help squeeze the fluid out of the tendon. Wear for at least 2-3 hours a day and take them off before going to bed. Do not sleep in compression socks.
- Take ample time to warm up and stretch out before exercising.
- For women, consider switching to a mid-heeled shoe during the day for work. The slight lift can help relieve tension and stress on the tendon during the day.
- Silicon heel lifts in both shoes also can be helpful. These can be found a nearly any drug store or big-box store such as Target or Wal-Mart.
Don’t Do This:
- Never use ice directly on the tendon, due to the risk of frostbite. Instead, use a cooled ice pack from the refrigerator that is above 32 degrees.
- Never perform a conventional calf stretch against a wall when you have Achilles pain, as it can lead to more damage. “For people with Achilles tendinitis where the tendon is truly inflamed, stretching will perpetuate the injury,” says Dr. Sherman.
- Never use devices that stretch the toes back during the day or overnight. The tendon does not need to be stretched, but rather treated for inflammation.
There are several other strategies you can employ to encourage healing of Achilles tendinitis injuries. First and foremost, be patient as this type of injury can take longer than most to heal.
Use a foam roller to gently push fluid up and out of the area, says Dr. Sherman. When rolling, do not roll directly on top of the tendon. Rather, gently roll over the area on both sides of the calf.
Additionally, eccentric heel drop exercises can be helpful. While standing on both feet, rise up on both heels, pause, and slowly lower on the injured side. Do two three sets of 10 reps at least once a day to build strength in the area.
Consider cross-training while allowing the injury to heal. If you work out in a gym, switch from a treadmill to an elliptical trainer. If you’re a runner, check out cycling or swimming as alternatives during the healing phase.
When to Seek Clinical Treatment
When left to its own devices, Achilles tendinitis can become debilitating and lead to a ruptured tendon and surgery. As soon as self-care measures aren’t helping, seek the advice of a doctor.
A physician trained in Active Release Therapy will generally begin with treatments designed to break up thick myofascial adhesions. The number of treatments will vary depending on the patient.
“With ART, we soften the developing scar, push fluid out of the injured tissues, and we start to lengthen some of the contracted fibers of the tendon,” Dr. Sherman explains. ART therapy may also be accompanied by Graston Technique therapy, which uses stainless steel instruments to treat the injured area.
The good news is that with proactive self-care in conjunction with clinical treatment, Achilles tendinitis generally can be healed.