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

Related video

 

Get started today with a free consultation…

Book now

Recent Posts on Sports Injuries …

  • Brighton Half Marathon runners’ offer 5th February 2020 The Brighton Half Marathon is in just over two weeks time and we are entering a team as well as sponsoring the event with our Massage Tent. It might be a bit late to enter if you don’t run regularly as one of our previous team members found out. Becky had never attempted 13.1 miles ...
  • Runners MOT – Brighton Half Marathon 20th January 2020 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 ...
  • 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?
  • Brighton half marathon recovery tips: how to manage an acute injury 18th November 2019 Brighton half marathon recovery tips: how to manage an acute injury
  • 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 ...
  • Great stretches for running 10th February 2016 Stretching may help reduce injury and improve flexibility in runners. Most runners include stretches in their routine. It is important to prepare your muscles for a run by gently warming up and keep flexible by doing these stretches. These exercises put together by our physio can help stretch the main running muscles. These stretches should be ...
  • Do I need orthotics for running? 4th December 2014 Why would I need orthotics? Although running shoe design and technology has progressed leaps and bounds over recent years, there are certain foot types that will require more support, explains James Masterson, physio here at Sundial, Brighton.  However not everyone will benefit from orthotics and it’s important to gain professional advice before deciding on whether an orthotic is ...
  • Running shoes – top tips for the marathon season from Brighton physio 27th November 2014 If like me you’re considering starting your preparation for the up and coming marathon season then take a look at my top tips for staying injury free and completing the 26.2 miles with a smile on your face says James Masterson,  a physiotherapist here at Sundial, Brighton. Which running shoe shall I buy? Inappropriate footwear is the root ...

Brighton half marathon recovery tips: how to manage an acute injury

knee-examination-brighton-physioAs a physiotherapist, I get asked how to manage an acute running injury a lot and having just completed training session or race itself you may be asking yourself the same question.  So in order to help you with your post-run recovery here are a few useful tips to ease you back to fitness and training for your next race.

Physiotherapists love an acronym and what used to be known as RICE or PRICE is now often referred to in the industry as POLICE.  With each letter relating to a useful management strategy, this acronym can be a helpful tool in guiding anyone suffering from an acute injury.

Protection:  Depending on the severity of your injury you may want to use a brace, tapping or in more extreme circumstances casts and crutches, this will help to prevent excessive movement and protect the site of injury.

Optimal Loading:  The key part to remember here is OPTIMAL, the right amount of loading will help stimulate the healing process of a muscle, tendon, ligament and bone. This could be any type of activity such as standing, walking or swimming, however in more serious injuries such as fractures or full tendon ruptures the OPTIMAL load might be no loading and may require casting, crutches or surgical intervention.runners-start-vitality-brighton-half-marathon-sm

Ice:  Applying ice during the initial stages of an acute injury can be beneficial for reducing both pain and swelling.  Although medical professionals have been recommending ice for several years the evidence is far from conclusive.  I usually advise my patients to wrap an ice pack in a flannel or thin towel and apply directly on the site of pain for 15 minutes 3 to 4 times daily within the first 72 hours of injury.

Compression:  Similar to ice compression can be used for managing swelling, applying a simple tubigrip or neoprene strap can help to compress the injury site.  The applied compression should be tight but comfortable with good circulation above and below the strapping, I often ask patients to remove the compression for short periods throughout the day and take the strapping of at night to allow the skin time to breath.

Elevation:  Can also be very useful in reducing swelling.  For example, if you’ve acutely sprained your ankle lying on your back with your leg raised and supported can reduce the amount of blood rushing to the affected area.  With this specific injury you may wish to do a few ankle pumps to improve the blood flow and help with the healing process.

At this point, it is probably worth mentioning that I recommend anyone to seek medical advice if you are unsure about an injury.  Although the POLICE protocol is a useful tool for managing an acute injury it is not a one size fits all strategy!!  If you are having difficulty weight-bearing or have symptoms such as bony tenderness, considerable swelling, loss of range of movement or the feeling of instability in a joint then I recommend seeing a medical professional ASAP.

James
Sundial’s Physiotherapist

Sundial is a partner for the Brighton Half Marathon on 23rd February 2020 providing clinical care and advice for sports injuries for the runners. If you have any niggles then give us a call and our physio’s, chiropractors and massage therapists can see you quickly. Sundial Clinics offers a free 20 minute 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. Call for a free Runners MOT

Recent Posts on Sports Injuries …

  • Brighton Half Marathon runners’ offer 5th February 2020 The Brighton Half Marathon is in just over two weeks time and we are entering a team as well as sponsoring the event with our Massage Tent. It might be a bit late to enter if you don’t run regularly as one of our previous team members found out. Becky had never attempted 13.1 miles ...
  • Runners MOT – Brighton Half Marathon 20th January 2020 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 ...
  • 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?
  • Brighton half marathon recovery tips: how to manage an acute injury 18th November 2019 Brighton half marathon recovery tips: how to manage an acute injury
  • 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 ...
  • Great stretches for running 10th February 2016 Stretching may help reduce injury and improve flexibility in runners. Most runners include stretches in their routine. It is important to prepare your muscles for a run by gently warming up and keep flexible by doing these stretches. These exercises put together by our physio can help stretch the main running muscles. These stretches should be ...
  • Do I need orthotics for running? 4th December 2014 Why would I need orthotics? Although running shoe design and technology has progressed leaps and bounds over recent years, there are certain foot types that will require more support, explains James Masterson, physio here at Sundial, Brighton.  However not everyone will benefit from orthotics and it’s important to gain professional advice before deciding on whether an orthotic is ...
  • Running shoes – top tips for the marathon season from Brighton physio 27th November 2014 If like me you’re considering starting your preparation for the up and coming marathon season then take a look at my top tips for staying injury free and completing the 26.2 miles with a smile on your face says James Masterson,  a physiotherapist here at Sundial, Brighton. Which running shoe shall I buy? Inappropriate footwear is the root ...

Brighton Half Marathon runners’ offer

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 and what to do about it.

We understand how annoying aches and pains can affect your running and can even stop you doing what you love. You don’t have to put up with it.

We’ll give you 50% off your next physio or massage session here at Sundial for all Brighton Half Marathon runners.

  1. Book an appointment for a massage or physio session
  2. Get a customised treatment plan based on our review
  3. Take the first step towards pain free running

50% off your next physio or massage session – Book now

Download Top Tips to Beat Running injuries pdf

We have treated thousands of runners over many years and have been the clinic partner for the Brighton Half Marathon for the last four years.
Achilles tendon massageOur patients say:
A sequence of physiotherapy and home exercises continued over the next few weeks and gradually the condition improved until it completely cleared.
Lee Ashton

He tried various techniques with me to find exactly what worked for me. We tried different physio exercises to build up the strength in my knees and the pain has reduced massively. I am really grateful for his help, and the lovely team at Sundial who are always welcoming and kind.
Charlotte S

50% off your next physio or massage session – Book now

Sundial at Brighton Half Marathon fundraiser

Click to play

Click here to watch video

Sundial supports the Sussex Beacon which provides specialist care and support for people living with HIV. Last Sunday we provided the massage at their flagship event – the Brighton Half Marathon as we have done for the last four years. This year we had 40 physio students, massage therapists and Sundial staff at the run from early morning on a beautifully sunny day giving pre-race massage and Rocktaping.

The atmosphere was buzzing as runners warmed up and stretched with some showing signs of nervousness as this was their first big running event. Some had not run 13.1 miles before and, judging from their faces at the end, may not again! Still, after a rest, a massage and general TLC most seemed to have perked up as they left the Sundial massage tent on Madeira Drive, right on the seafront.

Massage is helpful for recovery after a long run. In fact, it has proven to be the most effective treatment.  It helps ease the tight muscles and cramps that can occur and reduces swelling from traumatised joints and ligaments too.  Delayed onset muscle soreness (DOMS) is common after exercise, especially if you are not used to it. Whilst the runners may have been tired immediately after the Brighton run the worst muscle soreness usually kicks in the next day or even up to day three after the half marathon. The soreness can last for several days and is worse if the muscles are used again. If this is you, it is a good idea to rest with short occasional short walks to keep your flexibility. Anything that increases blood flow to the muscles can help recovery and this is where massage can help. Also, hot baths can help too.  You can add a large cup of Epsom Salts too as the magnesium is absorbed through the skin and can help muscle soreness.

One treatment for DOMS that has been hitting the headlines recently is curcumin which is the main ingredient in the spice used a lot in Indian cooking – turmeric. Interestingly, muscle strength also improved as well as the moderate to large reductions in muscle pain.

If you have muscle soreness after running then ice baths are unlikely to help. This will be welcome news to anyone who, like me, thinks you would have to be mad to climb into icy water. I’d rather have sore muscles.

Unfortunately, static stretching or warming up the muscles before or after exercise does not prevent the soreness from occurring. The best way to avoid DOMS is to gradually increase training before strenuous exertion to allow your muscles to build and adapt. This, of course, is not news. Anyone who has trained for a marathon or a half’ will know the benefits of a long steady training programme. So if you are thinking of taking part next February then best plan several months of training.

 

If you took part in the Brighton Half Marathon we are offering 50% off a massage or physio session here at Sundial. Book online above or call us.

 

 

BHM19-10

BHM19-13 BHM19-15 BHM19-18 BHM19-20 BHM19-24 BHM19-25 BHM19-3 BHM19-6 BHM19-9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References;

Massage

Curcumin study

Vitamin D

 

Should you stretch as part of your warmup for running?

hamstring-stretch-on-floorShould I Stretch or Should I Go Now?
If I don’t there will be trouble and if I do there could be double,
so come on and let me know…should I stretch or should I go?

The great stretch debate has been going on for several years now with lots of conflicting views leaving the average weekend athlete confused and unsure what to do.  It’s a question I get asked a lot as a physio.

“Should I stretch before or after exercise and what type of stretching should I do”?

This is a quick and simple guide into the benefits of stretching for warming up and cooling down during your half vbhm-sussex-beacon-runner-smmarathon training.  At this point it’s probably worth mentioning that there is no one size fits all plan, every individual is different and because of the conflicting evidence on this subject this post is partly based on research and personal experience as a runner and physio.

A study by Simic et al (2012) concluded that static stretching as a sole activity during a warm up routine should generally be avoided, as it was found to reduce power, strength and explosive performance.  However, the negative effects were only short term and generally returned to normal after 5 to 10 minutes, these negative effects were also unlikely to occur if the stretch was kept under 45 seconds.

Behm et al (2011) documented that dynamic stretching either has no effect on performance or may improve performance especially when the stretching duration is prolonged.  However, the study also went on to say that static stretching used in a separate training session could actually improve range of movement and health.

Confused?  Join the club.

Behm et al concluded that:

“Generally, a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities. Sports that necessitate a high degree of static flexibility should use short duration static stretches with lower intensity stretches in a trained population to minimize the possibilities of impairments”.

In other words if you’re doing an activity that uses long drawn out movements such as martial arts or ballet then static stretches may be useful.  However, if you’re a runner then short low intensity aerobic exercise, followed by dynamic stretches and finished off with a few running specific dynamic exercises is likely to be more important.

In my opinion stretching is very much a personal thing, I tend to spend 10 to 15 minutes warming up with a combination of light aerobic work followed by dynamic stretches and sports specific exercises.  When it comes to static stretches this is very much dependent on how much time I’ve already had away from the wife and kids, If I can get away with it I might spend 5 minutes doing short duration (under 45 seconds) static stretches on all the major lower limb muscle groups.

So to conclude you can find lots of conflicting views and counter arguments for all types of stretches, if you want my advice do what feels good for you but don’t spend all your non-running time stretching!  In my opinion a good balance between warm up, running, cool downs and strength work is the winning formula.

James
Sundial’s Physiotherapist

VBHM logoSundial is a partner for the Vitality Brighton Half Marathon on 26th Feb 2017  providing clinical care and advice for sports injuries for the runners. If you have any niggles then give us a call and our physio’s, chiropractors and massage therapists can see you quickly. Running the Vitality Brighton Half Marathon? Call for a free Runners MOT