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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Plantar fasciitis – pain in the heel and foot

 

What do runners and couch potatoes have in common? They can both get pain in the heel and arch of the foot from problems with ligaments there. These ligaments are called the Plantar Fascia and the problem is known as Plantar Fasciitis and it can cause sharp pain in the heel, arch and foot especially in the morning.

 

What is Plantar Fasciitis?

Your Plantar Fascia is a tight band of connective tissue that runs from the heel of your foot and fans out into five bands to the base of your toes. Plantar Fasciitis (PF) is the most commonly reported cause of heel pain (1).  It is characterized by pain at the calcaneal origin (heel bone) of the plantar fascia and increased thickness of the plantar fascia (2).  

Although this stubborn condition is prevalent in people who sit a lot it is also extremely common in the active people too and is the third most common injury amongst runners (3).  Like most runners I’ve had a few battles with PF pain myself, so here’s some useful information and a few handy tips on how you can avoid, manage and treat this stubborn condition.

 

What causes Plantar Fasciitis?

The condition itself is thought to be caused by overload of the long arch underneath the foot.  In active people this is often caused by a rapid increase in exercise for example, an increase in hill running or the classic too much too soon.  In the sedentary people PF pain is often caused by joints and muscle not working correctly, that is, poor biomechanics or weight gain. The exact cause of this condition is still poorly understood and recent findings suggest that the name Plantar Fasciitis may be misleading as it doesn’t usually involve an inflammatory phase (-itis means inflammation).  The term Plantar Heel Pain, Plantar fasciopathy or fasciosis is probably more accurate. Below is a list of some of the common causes of PF pain that I see in clinic.

  • Pes Cavus (high foot arch) and Pes Planus (flat feet) deformities
  • Inappropriate footwear
  • Overweight – high BMI
  • Diabetes
  • Poor ankle range of movement
  • Increase in weight bearing activity e.g. hill running, speed training, high intensity work out classes
  • Excessive dynamic foot pronation
  • Poor balance and lower limb control

 

What are the signs and symptoms of Plantar Fasciitis?

A common presentation for a patient with PF symptoms is pain and tension on the sole of the foot, pain is often worse with the first steps in the morning but eases with time and movement.  Runners will often say that the pain is present before their warm up or at the start of the run but eases once activity increases, however the pain comes back with vengeance after activity or the next morning.  

 

How can a physiotherapist help?

A physiotherapist will be able to diagnose your symptoms by taking a taking a careful history of your complaint.  During the assessment stage we will look at your biomechanics, functional ability and carry out various tests to diagnose Plantar Fascia pain and rule out any other conditions which may be causing your symptoms.  From here we can formulate a treatment plan which may consist of soft tissue release, joint mobilization, taping techniques, electrotherapy and an exercise rehab programme. We can also provide you with advice on orthotics, appropriate footwear and help gradually get you back to full pain free activity in the shortest possible time.

 

How can I avoid plantar fascia pain when running or training?

Here at Sundial we work with several of the local running club in Brighton and Hove and we provide support for the Brighton Half Marathon. This is the programme we recommend:

  • Have a gait analysis with us here at Sundial
  • Purchase appropriate footwear
  • Grade yourself into running slowly, have a training plan and avoid the dreaded too much too soon
  • Don’t just run, mix up your training with other forms of exercise for example, swimming, cycling, strength training
  • Give your feet a break, have a rest day, try some foam rolling or low impact exercise such as yoga or Pilates
  • Remember, if in doubt, get it checked out and don’t let a niggle become a pain.

Sundial, at our two clinics here in Brighton, 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.  Why not call the clinic today to arrange a free informal consultation and stop that niggle turning into a pain!

 

James

Sundial physiotherapist, Brighton and Hove

 

References

  1. Singh et al, 1997 and Buchbinder, 2004
  2. Buchbinder, 2004
  3. Ribeiro, 2011

 

Brighton Marathon Training Advice

Antony, the Sundial physio here in Brighton recently attended a pre-marathon meeting to give advice to charity runners who are giving their sweat and blood to race the next Brighton Marathon in April 2011. They have kindly given their time to run for the The Rockinghorse Appeal. A talk was given by personal trainers, a nutritionist and Antony from a physiotherapy perspective. They offered advice on the top tips to complete this gruelling but rewarding challenge without injury. Continue reading “Brighton Marathon Training Advice”