Achilles Tendonitis is a common niggle in runners, particularly distance runners, that can turn into a more serious injury if not addressed appropriately.
What does Achilles Tendonitis Feel Like?
Achilles Tendonitis feels like a dull pain in the back of the heel, where the thick tendon (a strong band of tissue) connects the calf muscles to the calcaneus (the heel). This injury can also be referred to as Achilles tendonitis or Achilles tendinopathy. The Achilles Tendon is inflicted to a lot of load each day - whether you’re running, jumping, standing on your toes or wearing heeled shoes. This is because when the calf muscle is engaged, the achilles tendon will pull on the calcaneus.
Essentially, Achilles Tendonitis is caused by repeated load, provoking inflammation of the tendon. Often the pain will manifest in the heel, or at the ‘pinch’ of the tendon. Luckily, because this is a common niggle for runners, methods of treating Achilles Tendonitis are not few and far between.
Where is the Achilles Tendon?
The Achilles tendon is the thick rope like tendon at the back of the heel, attaching the calf muscles to the top of the heel bone. It is the largest tendon in the human body. If you know anything about tendons, they don’t tend to have the best blood supply - this is especially true for the achilles tendon due to its location in the body. This can make it harder for the tendon to recover from significant injury.
How to Cure Achilles Tendonitis Fast
Most runners want to cure achilles tendonitis fast so they can get back to their consistent training load (regular mileage and intensity). It’s really important to find a balance between strengthening the muscles up the chain of the leg, particularly the calf muscles, and keeping them free of excess tightness/tension.
The first stage of treatment for achilles tendonitis should be the RICE method - Rest, Ice, Compress, Elevate. Often it is recommended to do this 3x 20 minutes a day.
Check Your Running Shoes!
Check your footwear to make sure they aren’t worn out, and also ensure that they suit your particular foot structure. Having worked in the running footwear and biomechanics industry, as well as seen my fair share of podiatrists and biomechanics analysts (for my own running form!) - you have no idea how many runners I see wearing shoes that are totally unsuited to their foot type. There is something to continual foot pain with no explanation….
I’ll discuss strength and conditioning for this injury further on in the article.
When to Start Running After Achilles Tendonitis - The Plan
When to start running after achilles tendonitis can be a tricky question. If the injury was suspected to have risen from a series of poor training choices, then it is essential that the same choices aren’t repeated. Some of these poor choices include:
- Running in worn out shoes, that have extended their lifetime. Foam does have a lifespan, and if you’re lucky enough to wear a shoe with a carbon plate, this does wear down too. Replace your shoes every few hundred miles, to minimize injury risk, especially to the lower limbs including the feet and toes. If your shoe can easily bend and flex, rips are starting to form, and the traction is wearing down significantly - it’s probably time to invest in a new pair of running shoes.
- Not warming up properly in cold weather. Tendons don’t do well when exposed to sudden load in cold weather. It’s better to start off easy and progressively get faster into a run.
- Increasing mileage too quickly, or intensity too suddenly. If you go from running 10km a week to suddenly running 30km, you put yourself at a higher risk of injury. This one is simple.
- Running on hilly terrain without proper adaption. Make sure you increase the amount of hills you run (or elevation) each week gradually, otherwise it might be a shock to your achilles tendon. Remember, it needs time to repair and adapt for the next training session.
- Keep your intercostal muscles loose (the muscles between each rib ring of your ribcage), because they will determine how well you load each leg from a ‘form’ or biomechanical perspective. I keep this loose by running a foam roller up and down the side of my ribs, and with intentional thinking of”‘wide and open”.
If you no longer have pain when you walk, can do 3 sets of 20 calf raises on each leg, comfortably, you should be able to gradually start increasing your running mileage again.
Achilles Strengthening Exercises for Runners
The most important things to target are the calf muscles. If these aren’t working as they should when we run, other areas of the body will begin to compensate, resulting in overload and unnecessary overuse. I’m talking about the Achilles tendon here!
Exercises should be eccentric - meaning that the calf should be loaded whilst it is in a lengthened position. Calf raises are perfect for this. Use one hand for balance, find a ledge (step, box etc) and slowly lower your heel down and up again. Eventually you’ll want to progress to 20-25 x 3 sets of calf raises, potentially weighted to prevent injury recurrence.
Talk to your physiotherapist or physical therapist for specific exercise prescriptions in this area. Remember, everyone and everybody is different!