Achilles tendon pain frequently occurs in active people when the tendon is exposed to high or unusual loads. Initial inflammation of the Achilles tendon can quickly progress into the breakdown of the tendon tissues. This is known as tendinopathy, which can be a disabling condition which often takes a long time to recover from.
Early recognition of Achilles pain may prevent significant deterioration of the tendon.
There are many treatment strategies that can be helpful to alleviate this condition. The effectiveness of these methods will depend on the individual and the factors which led to them developing tendon pain in the first place.
Where is the Achilles tendon?
Your Achilles tendon is formed by the gastrocnemius and soleus muscles to form one tendon that attaches into your heel bone (also known as the calcaneus).
What does the Achilles tendon do?
The Achilles tendon is essential for many activities, namely walking, running and jumping. The power generated through the gastrocnemius and soleus muscles is transferred through the tendon to the heel and foot allowing for forwarding propulsion through plantarflexion (whereby you flex your foot or point your toes). This movement is essential for toe-off during walking and running.
How does one develop Achilles tendon pain?
Achilles pain or tendon changes are often the results of repetitive or intense strain on the Achilles tendon.
This includes increased loading of the tendon due to changes in movements strategies (for walking, running, jumping activities) whereby there is a significant load placed on the tendon over a period of time or in a given moment.
If one tends to favour one leg while running and this increases during the activity, this may put increased strain on the tendon over time.
In extreme circumstances, the Achilles tendon can rupture.
What types of exercise increase the risk of Achilles pain?
- Walking, running, jumping on hard surfaces
- Any exercise in improper footwear, eg. hard shoes, shoes that are old
- Switching to minimalist shoes from a standard grade shoe too quickly
- Any new or unusual exercise done in high volume or intensity too quickly
What are the most preventative steps to avoid Achilles tendon pain?
Anyone can develop Achilles pain under the right circumstances - particularly those that don’t allow the calf muscles and Achilles tendon to adapt to the loads placed up them.
- Apply the principle of Progressive Overload: Load any tissue (muscle, tendon, ligament, bone) too much or too quickly and it has the potential to fail.
- When taking up new activities, build up your volume and intensity of training gradually.
- Check your shoes! Depending on the type of exercise you do, footwear should be changed regularly. And make sure you have the right shoes for the particular activity you are doing.
- If moving to minimalist or barefoot footwear do this gradually by decreasing the grade of your footwear over a period of time. This can be done with advice from your local shoe store specialists.
What are the best stretches for the Achilles tendon?
There are many ways to stretch your calf or Achilles tendon. These are all best done by either:
- Fixing your whole foot to the floor and moving your body forwards (e.g. standing lunge calf stretch)
- Fixing your forefoot to the floor and letting your heel sink down to the floor (e.g. downward dog type stretch).
- Fixing your foot on the edge of a step and letting your heel drop.
When stretching, start by taking the stretch to the first point of resistance, hold for 15-60 seconds, then progress gradually to the next point of resistance. The principle of progressive overload can be applied to stretching as well! Too much too soon can lead to pain or discomfort.
The top 3 Achilles tendonitis exercises you can do before or after running
- Achilles stretch - pick one of the above.
- Heel raises. These can be done sitting or standing, depending on your level of pain/discomfort. Used both for re-training movement and building strength.
- Eccentric heel drops. The standard protocol includes both a straight-knee and bent-knee version, aiming for 3 sets of 15 repetitions.
It is important to note that there can be many influences on one’s loading strategies through their foot such as altered control through the trunk, pelvis or knee which can lead to overloading the Achilles tendon. If the above exercises aggravate your Achilles pain, please consult with your Physiotherapist.
Foods to Heal Achilles tendon PainAchilles tendinitis is actually a misnomer and the more up-to-date term would be tendinosis or tendinopathy. The inflammation can quickly lead to break down of tendon tissue known as collagen. For any connective tissue, a diet that includes healthy proteins and amino acids (including collagen) and healthy fats are ideal for creating an optimal healing environment for tendons.
Cook, J. L., Khan, K. M., Purdam, C. Achilles tendinopathy. Manual Therapy 2002; 7(3): 121-130.
Cook, J. L, Purdam, C. R. Is tendon pathology a continuum? A pathology model to explain the. clinical presentation of load-induced tendinopathy. British journal of Sports Medicine. 2009; 43(6): 409-16.
Scott, A., Huisamn, E., Khan, K. Conservative treatment of chronic Achilles tendinopathy. CMAJ 2011, 183(10): 1159–1165.