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

 

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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

Simple exercises to do at home for heel pain and plantar fasciitis

Here is a video of some simple exercises to do at home to help with heel pain and plantar fasciitis. Do them gently and don’t exceed 4/10 on pain when doing them. If the symptoms are not getting any better then make an appointment with for a check up or with your local physio.

 

To learn more about heel pain and plantar fasciitis go here.

How to manage an acute injury yourself

Runners knee pain“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 to fitness and potentially 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

 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 effected 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.

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.  Why not call the clinic today to arrange a free informal consultation and stop that niggle turning into a pain!

Great stretches for running

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 held for over 30 seconds – don’t rush. Aim to do these exercises once a day although doing them twice a day is three times as beneficial. Stay relaxed and breathe out as you develop the stretch. Develop the stretches gently to avoid overstretching and injuring yourself.

The 3 stretches we recommend for running are: hamstring, hip flexor and calf and here is how to do these.

You can download the stretches for running for free here VBHM stretches

Hamstring stretch

Dynamic hamstring stretch

Sets three each side

Hold 30 to 60 seconds

  • straighten one leg, grabbed the back of your thigh and target your leg towards your chest until you feel a gentle stretch.
  • Bend your leg at the knee slightly coming off the stretch
  • repeat by pushing your heel towards the ceiling
  • alternate your legs

Note: avoid kicking violently or arching your lower back

If it’s shaking your doing it well!

Hip flexor stretch

Hip flexor stretch

Sets three each side

Hold 30 to 60 seconds

  • hands on hips, tuck your tailbone under to flat on your back
  • lean forwards while maintaining a straight posture and keeping your head up
  • avoid arching your low back or letting your hips roll forwards

Note: do it next to a wall if you feel out of balance

Calf stretch

Sets three each sideCalf stretch

Hold 30 to 60 seconds

  • have front toes and knee touching the wall
  • move your foot back a little until you can just about keep your knee against the wall and heel on the floor
  • hold
  • Move the back foot away from the wall to feel a stretch
  • keep back heel on the ground and knee straight as possible
  • hold
  • swap legs

In partnership with the Vitality Brighton Half Marathon

VBHM logo

The 7 R’s – Brighton Marathon Training Tips

Jewel runs Brighton Marathon
Jewel runs Brighton Marathon

The Brighton Marathon is the highlight of our sporting calendar. We have supported Brighton runners and their charities for many years but we have noticed that many people are not getting the support and advice they need to complete the marathon injury free. One in five people who enter the marathon will not complete it because of injury. We aim to make sure you are not one of them!

Pre-Training/Training Tips

Before you begin marathon training, you should be able to run for at least 30 minutes without stopping. Distance is not important right now. You just need to get your body used to running.
Combinations of runs/walks are great to use during pre-training because they ease your body into the exercise and minimize the chance of experiencing a running injury. Follow a set schedule or rota of training leading up to the event, so that you can set yourself small goals to work towards on a weekly basis.

Recovery Tips

Take recovery days equally as serious as your running days.
You should not run every day as your body needs to rest between runs, so it can recover from one run to the next, getting stronger between each run.
Use your non-running days to rehabilitate and to refuel with the right foods.  Ice any soreness, particularly in your knees or shins, four times per day for 15-20 minutes.  Stretch all the muscle groups in your legs, spine and upper body as you use them all!

Injury prevention

Never run through an injury, get it checked out by a professional!  Most of us are aware to use the RICE (rest, ice, compression and elevation) principle if we sustain an acute injury such as an ankle sprain or shin splints but there are other, less acute pains to be aware of, that may turn from a niggle into a strain.
Wear the correct footwear.  Your trainers should be no more than 6 months old or have been subjected to 500 miles of running.  Older shoes lose shock absorbing ability and increase the risk of injury. Check the soles of your trainers for abnormal wear as this could indicate a biomechanical problem elsewhere.  When choosing new running shoes go to a running shop staffed by experienced runners who can advise you on the correct shoes for your foot and running style.

The 7 R’s for marathon training

Run for 30 minutes before starting specific training
Rota – set up a schedule of training with goals
Rest is important because your body builds muscle, strength and stamina in this recovery phase
Refuel – improve your diet with our video program to get the right building blocks for recovery
Rehabilitate – stretch all over and ice any injury
Replace worn out running shoes
Runners MOT – this free check up is available to all Brighton Marathon runners – don’t let a niggle turn into a pain
Our physios and chiropractors support Brighton marathon runners with the offer of our Runners MOT at either of our Brighton clinics.  So if you have an injury or just a niggle, call and get it checked out!

How to prevent running injuries? – Runners MOT

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. One in five people who enter for the Brighton Marathon will not complete it because of injury. We aim make sure you are not one of them.

For the next few weeks we are offering a free Runners MOT especially aimed at runners in the Brighton Marathon and the half marathon. We want you to be fit, strong and ready to run.

Our physios will check you out top to bottom concentrating on your footwear and leg and foot movements. We will check all the usual things like over-pronation but also things that often over-looked like jamming of the hinge joint of the ankle which changes stride length. We will look at knees, hips and backs too. At the end of our Runners MOT you will have an in depth risk profile of the likelihood of future running injuries and a plan for prevention.

So don’t let a niggle turn into a pain, call to make an appointment.

Runners MOT – New

Most runners know that a good warm-up and warm down routine, including stretches, is likely to minimise the risk of injury whilst running. In spite of this, the injury rate in runners is still too high, especially knee injuries. Runners are increasingly us to help prevent injuries as well as treating them once they have occurred.

We are helping out with the Rockinghorse runners again this year. Antony our physio has already been giving training tips and we have all been helping runners get over niggling training injuries. If you are running, whether for Rockinghorse or not, you might like to book an appointment for our Runners MOT. Bring your running shoes along and we will check them out along with your back, hips knees and feet for running problems. Some problems will not cause pain until they build up to a critical point so don’t wait for symptoms to tell you if there is an issue.

The fee for this service is £5 which we will donate to the Rockinghorse charity.

Sundial supports Brighton Marathon

Antony, our physio, has been busy following on from the Brighton Marathon. He has seen lots of runners who have not recovered as well as they had hoped or who have pulled muscles or aggravated knee and foot problems on the gruelling 26.2 miles course. Our state of the art laser is proving a real bonus in treating these injuries and is the only one in Brighton.

Sundial also supported the Rocking Horse Appeal runners in the marathon. The runners raised over £200,000. Our very own massage therapist, Yvette Knapman, was on hand at the end of the run to knead tired muscles and soothe away at least some of the aches and pains. We also provided the runners with pre-run training tips, check-ups and a goody bag full of useful things like an ice pack for emergency first aid.

Our other massage therapist Jewel O’Connell actually ran the marathon. She said “I raised £630 for the Rockinghorse Appeal, a local Sussex Children’s Charity.  I ran the course in 4hours 24mins, which I was really pleased with.  The atmosphere on the day was amazing and the crowds gave everyone a wonderful support.  I can’t wait for the next one.”

She must be mad!