In the first article, we looked at the causes of Achilles pain and what tendinopathy is. To read it click here.
Now we look at how you can help yourself.
Step 1 – Load Management
Can I carry on running? The answer is potentially, yes. First establish how severe your pain is, using the Pain Measurement Scale to monitor your pain:
Up to a 4 should be a comfortable/normal training zone and should not aggravate the symptoms as long as you don’t go mad! If you are finding it hard to settle your symptoms down, then 1-2 weeks rest from activities that aggravate your symptoms may be a good idea.
24 Hour response to tendon load
Remember tendons can take 24 hours to respond to load, so monitor the response of your exercise. Above a 4/10 pain, then your exercise might have been too much! If this is the case, try resting for a few days then try again if the pain has settled.
If you plan to keep running or exercising, try to keep your pain levels in a comfortable zone. Note how far you can run or exercise before the pain comes on or gets worse. 0-4/10 pain should be your marker for this. Above this zone, it’s probably a good idea to rest a little longer or switch to non-aggravating exercise such as swimming or cycling.
With insertional tendinopathy, you may be able to keep exercising by avoiding the compression element to the Achilles i.e. switch from hill running to flats.
Step 2 – Pain Management
Anti-Inflammatory medication can be useful in the reactive stage of the injury. Medication such as ibuprofen can be useful as it reduces pain and decreases tendon swelling. Before considering any medication, please consult your GP or pharmacist first.
Ice may be useful, especially in the initial stages of the injury or after exercise. Try using an ice pack and placing the painful point directly onto the pack with the weight on the lower limb resting on the ice for 10-15min. Watch out for ice burns! Try using a light towel over the ice if you’re sensitive to this.
Kinesiology tape can be a useful way of managing pain and can help you to exercise with less aggravation. Rocktape and KT tape are the best brands – cheaper options in my opinion don’t seem to work as well. Kinesiology tape works by creating less compression on the painful area and helps the Achilles tendon feel protected, providing sensory feedback to the brain. When using this tape at Sundial here in Brighton, patients will often return saying, “I have no idea how this stuff works but it really helped”. Placebo can be a powerful healing tool, so if it works for you, don’t knock it!
Achilles Self Tape Technique Video to follow soon
Step 3 – Self Management
Footwear can make a big difference to anyone suffering from an Achilles tendinopathy. Making sure you have a supportive shoe that also provides you with cushioning will improve your gait and potentially cause less aggravation to your Achilles tendons.
Having a gait analysis if you’re a runner can also be a great way of identifying areas of weakness and poor running technique that could lead to injury. Here at Sundial, we offer a gait analysis session at our Kemptown clinic, so if this is something you’re interested in, please get in contact with us.
Reducing muscle tension
Reducing muscle tension in the structures around the Achilles can be a great way of creating less tension which could impact on your symptoms. Using a foam roll or tennis ball to self-massage your calf muscles and plantar fascia under your foot will help to reduce tension and help to prevent further injury.
Increase ankle joint range of movement
Often reduced ankle range of movement on the non-affected side can be contributing factor to Achilles tendinopathy. The inability to push off from one foot can lead to muscle imbalance and overuse on the other side. Reduced ankle range of movement is very common after an ankle sprain, which is why improving ankle range of movement is an important part of any physio rehab programme for Achilles tendinopathy.
Strength
A study with 26,610 participants by Lauersen in 2013 looked at the effectiveness of exercise interventions to prevent sports injuries. It found that overuse injuries could be almost halved with strength training alone. This study, along with lots of other research, is why exercise is the number one treatment modality used by physiotherapists all around the world.
I believe that most overuse injuries such as Achilles tendinopathy can be overcome with some simple strength and conditioning exercises. Below is a list of videos designed to help you manage and prevent this condition. However, it’s important you select the right exercise for your type and phase of your Achilles tendinopathy.
Achilles tendinopathy exercises
Do these exercises daily at least once. If you skip a day, don’t worry. Don’t do double the next day as this can overload the healing tendons and muscles.
Easy Achilles Tendinopathy exercises
If you have a suspected Achilles tendon pain then start with these easy exercises. These simple exercises use isometric muscle contraction to gently load the Achilles tendon to stimulate repair. If you go to the more advanced exercises before you are ready you can easily make things worse and slow down your recovery. If your pain is 4 or more on doing these exercises you are not ready for these. See me and get some physiotherapy.
Intermediate Achilles Tendinopathy exercises
This series of progressively harder exercises use slightly harder eccentric muscle contraction exercises to accelerate healing and build strength in the tendon. Don’t do these if you cannot do the Easy ones without your pain going above a 4. Don’t cheat by skipping this step!
Advanced Tendinopathy exercises
This video has a range of progressively harder advanced exercises consisting of concentric and eccentric muscle contractions to gain maximum benefit. You should be able to do the intermediate exercises without pain above a 4 on the scale above. If you have a pain level of 4 or more then you are not ready for these exercises and could hurt yourself more.
Physiotherapy
If in doubt…best to get it checked out! Physiotherapy will help you to understand the root cause of your symptoms. Often with Achilles pain, there is more than one issue leading to your injury. During the first consultation, we will assess your functional ability looking at balance, strength, flexibility and range of movement. From this assessment, we can formulate a treatment plan specific to your needs and goals.
During your initial assessment, you have the option to have treatment such as massage, acupuncture, low-level laser therapy and taping, all of which can help to improve your symptoms and reduce pain. After the treatment phase, you will be given some exercises for you to practice at home which will help you to manage your condition and begin your rehabilitation back to normal activity.
Sundial Clinics offers a free physiotherapy assessment to anyone who would like advice about an injury. This session is a great way to get some useful tips on how best to manage your injury and to see if physiotherapy is right for you. Why not call the clinic today to arrange a free consultation and stop that niggle turning into a pain!
Part one covered what types of Achilles tendinopathy there are and the causes.
James Masterson
Physiotherapist
Running injuries often start with a niggle. Knee pain, muscle strain, tendon pulls, bursitis, ligament sprains and all sorts of other aches and pains are a constant reminder that marathon training and actually running it can be a hazardous business. Many people who enter for the Grand Brighton Half Marathon will not complete it because of injury. We aim make sure you are not one of them.
If you have suffered from Achilles pain in the back of the heel or calf you know how long it can last and how bad it can be. Understanding why you’re getting Achilles pain plays a big role on the road to recovery and prevention. The pain is often due to Achilles tendinopathy and used to be called Achilles tendinitis; “itis” means inflammation and we now no longer believe that it involves inflammation so we don’t use that term anymore. Either way, Achilles tendinopathy is one of the most common runners’ injuries that I see at Sundial Clinics here in Brighton. In this series of articles you will learn some of the ways in which you can avoid, treat and manage this common and troubling tendon pain. 
