Achilles tendon pain – Step by Step Guide to Recovery

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

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Achilles tendon pain? Which type do you have?

Massage on runners calf and Achilles tendonIf 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. 

Types of Achilles tendinopathy?

First off, it is important to establish exactly what is causing the problem and exactly what type of Achilles pain you have.  There can be several other reasons why you may be getting Achilles symptoms, but for the purpose of this article, we will concentrate on the most common.

Recent studies have shown that injury rates are as much as 29-58% in new runners. It’s also estimated that 60-70% of running injuries are due to overuse or training error.

In other words, don’t just concentrate on the painful point!  Rehabilitation from an injury can be complicated and unless you’re addressing the root cause of the problem, it’s likely to come back!  This is why seeing a physio can be useful: we can help you to understand the reasons for your symptoms and help you address the imbalance and weakness which may lead to injury.  

 

Diagram of Achilles tendinopathy, tendinitis

Mid Portion Achilles Tendinopathy

The most common cause of Achilles pain is mid-portion Achilles tendinopathy. This commonly affects the Achilles 2-7cm above the bony point at the back of the heel.  Typically, this is likely to appear swollen, be tender to touch and will often cause pain and stiffness first thing in the morning and when weight-bearing.

Insertional Achilles Tendinopathy

This condition is less common but still a prevalent problem that I see in the clinic.  The key difference between the two is that mid-portion tendinopathies are commonly caused by tensile loading and insertional tendinopathies are caused by compression.  

The main presentation for the insertional kind is a pain at the heel bone where the Achilles attaches and pain with the ankle flexed to stretch the tendon i.e. the position of the foot when walking up a steep hill.  This position of the foot is what causes the compression and aggravates the symptoms – and why exercises that exacerbate this should be avoided!

Below I will outline the best way to manage these conditions, along with links to some self-help videos for exercise and pain management.  However, it’s probably worth mentioning at this stage that these are only to be used as a rough guide and if you are unsure about your condition please book yourself in for a physio consultation.  The first appointment is free! And it may help you avoid getting it wrong and potentially delaying your healing time.

Tendinopathy Phases

Now that you have a rough idea of why you have tendinopathy, you now need to figure out what stage of tendinopathy you are dealing with.  To avoid going full physio geek on you, we’ll keep this simple and concentrate on two phases of tendinopathy, the first being the reactive type and the second being the degenerative tendinopathy. 

Phase One – Reactive Tendinopathy

Commonly caused by an increase in loading exercise, for example trying to run faster or further than you’ve ever done before…we’ve all done it!  This will typically cause pain during or after the activity and may be exacerbated first thing in the morning or during weight-bearing activity.  

The key to your management at this stage is to reduce the load that you’re putting through your Achilles and try and calm the symptoms down.  It’s pretty simple: if you carry on doing the same thing at the same pace and effort then you are likely to make it worse!

Phase Two – Degenerative Tendinopathy

At the tender age of 41 and having played sports for most of my life, sadly I would fit into this category.  In fact, I would say it is almost normal to have a degenerative tendon somewhere in your body if you’ve been active for most of your life, especially with high impact sports such as running, football, netball and basketball. So do not fear – this is common!  

Basically, if you’re older and have a previous history of Achilles pain and a grumbly tendon that is prone to flare-ups, it’s likely that you will also fit into this category.  The typical presentation is a thickened tendon, which is painful to touch and is often sore first thing in the morning and during weight-bearing activity. Again, load management is important. If you keep aggravating it, there is potential to make the situation chronic and potentially lead to a partial or full Achilles rupture.

It is also possible to have a reactive, degenerative tendon.  An example of this would be a 60-year-old man who has a history of Achilles pain with symptoms which have been under control for several years, but a recent increase in tennis has caused his degenerative tendon to become reactive.  If this is the case with you, then start your management at the reactive phase i.e. reduce the load, pain management, rehab exercises then graded return to activity.  Tendons are complicated and there is no one recipe for treatment. Finding the right treatment is an important part of your recovery.

Now that we have the geeky part out of the way, let’s look at treatment. Part Two is a step by step guide to recovery for both the mid-portion and insertional Achilles tendinopathy. Click to read it

James Masterson
Physiotherapist

 

Get started today with a free consultation…

Book now

Recent Posts on Sports Injuries …

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  • Achilles tendon pain – Step by Step Guide to Recovery 20th January 2020 Achilles tendon pain - Step by Step Guide to Recovery
  • Achilles tendon pain? Which type do you have? 4th December 2019 Achilles tendon pain? Which type do you have?
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  • Brighton Half Marathon runners’ offer 27th February 2019 After running the Brighton Half Marathon on Sunday you may still be getting muscle soreness or other aches and pains. Simple muscle soreness will get better over the next few days and massage can help speed this up. If you have a more persistent or painful niggle then you probably want to know whats wrong ...
  • How to manage an acute injury yourself 29th February 2016 “As a physiotherapist this is a question I get asked a lot and having just completed the Brighton Half Marathon you may be asking the yourself the same question.” says Sundial physio James Masterson.  He goes on to say “So in order to help you with your post run recovery here’s a few useful tips to ease you back ...
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Achilles tendonitis, Brighton physio explains treatment at home

Achilles tendonitis is a broad term that is used to describe a recurrent pain below the calf muscles of your leg and coming from the tendon. Sometimes more accurately called Achilles tendinopathy it is a very common injury and most sports people are curious about, whether you are an experienced athlete or someone returning to sports.

For the least experienced of us, the Achilles tendon is a band of tissue linking your calf muscles to the base of your heel. It is very strong and thick to allow you to push through your forefoot when walking, jogging, climbing stairs and doing many more activities.

Achilles tendonitis – how does it get injured and can you prevent it?

A question I am often asked is ” How do I know I have this problem and how did it come on in the first place ?” Well, in the case of Achilles tendonitis the pain slowly increases at the back of the leg and it’s often brought on by specific activities such as climbing stairs or running. If you touch the painful area you might feel thicker tissue compared to the other side. It may be warm when painful and slightly “crunchy” when you are resting.

If you have such symptoms then maybe a simple change in your routine can help you. Think about those things. Do you wear appropriate footwear on a daily basis? Did you change your exercise program or take on a new sport? Are you climbing stairs several times a day? Did you change the surface on which you do your jogging? All those can be factors which could bring on an injury.

Achilles tendonitis treatment at home?

To start with, nothing replaces the diagnosis of a healthcare professional. The following is for information only and you should still seek appropriate advice.

The main thing you should remember is that tendons like movement and activity but don’t heal if left inactive. An injury to a tendon, if not dealt with appropriately, can become a long lasting problem.

These exercises, if performed with NO PAIN, are a good start as self treatment for Achilles tendinopathy.

1. Go up on tip toes, slowly lower heels 2. Roll foot arch firmly on tennis ball 3. Back knee locked, heel on ground, lean forward

http://www.youtube.com/watch?v=OUpcFZM-V68

How can we help Achilles tendonitis?

By making sure that Achilles tendonitis is the right diagnosis. The internet does not carry out a physical examination where as musculoskeletal specialist does. Our physio’s will be able to differentiate between several types of potential injuries affecting similar area and carry out the appropriate treatment.

After 2 weeks it is starting to get chronic. If your pain does not subside within 2 weeks then give us a call.  It is often easier to get rid of an ache or pain when it just started!

Further treatments we use for Achilles tendonitis here at Sundial in Brighton may include:-

– Deep tissue friction to the Achilles tendon will activate the renewal of the fibres.
Laser therapy will reduced any inflammation provoked by the deep tissue friction and encourage tissue healing.
Dry needling with acupuncture needles around the site of injury to activate the renewal of fibres. This can be an alternative to deep tissue friction.
– Athletics taping (rigid tape) or kinesio taping (stretchy tape) can help to off-load the Achilles tendon during its repair phase.

Quentin Guichard BSc MCSP

Physiotherapist at Sundial Clinics

Addendum:

Recent research underlines the importance of laser therapy and exercises in Achilles tendonitis

Physical therapies for Achilles tendinopathy: systematic review and meta-analysis.

Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM.