Many runners are familiar with the burning sensation that accompanies Achilles tendinopathy. What starts as a dull ache soon grows into a fiery pain, quickly evaporating any chance of a successful workout.
One might even say it’s every runner’s Achilles Heel (sorry, I couldn’t resist).
But Achilles tendinopathy is actually quite common — and luckily, it’s usually fairly easily to treat (unlike IT Band Syndrome, which is often trickier and more stubborn). It’s important to know that there’s no such thing as Achilles tendinitis, which must include inflammation because of the ‘itis’ suffix.
“The Achilles tendon is incapable of swelling (the bursae — a tiny sac of fluid between the Achilles and heel can swell, but that’s different),” according to Jay Dicharry, a physical therapist and biomechanics expert at Rebound Physical Therapy in Bend, Ore. “We should call the injury Achilles tendinopathy. Basically, the tendon is weak and dysfunctional, and thus compromised.”
Therefore, treatment includes strengthening and correcting the function of the Achilles tendon. There are two stages of Achilles tendinopathy treatment: the acute stage and the rehabilitation phase.
The Acute Stage of Achilles Tendinopathy
The first phase of treatment begins as soon as the injury starts and usually lasts about 1-3 days. The goals during this stage are to reduce pain and manage any swelling around the Achilles tendon.
This is when the standard RICE (Rest, Ice, Compression, Elevation) treatment is very helpful. Runners with a painful Achilles tendon should stop running, ice the painful area, use compression socks, and elevate the leg for 10-15 minutes 1-2 times per day.
Wearing shoes with a slightly higher heel-toe drop can also reduce the stress on the tendon. Spending time barefoot or in zero-drop shoes can further irritate the tendon, so it’s best to give the Achilles more support during this phase of treatment.
This approach can help you manage the early pain signals from the injury but it probably won’t heal it outright. There needs to be a much more specific treatment plan after the acute phase of the injury.
The Rehabilitation Stage of Treatment
Once there is no sharp pain while walking, you’re ready to start more targeted treatment.
For Achilles tendinopathy, there are two reasons that the injury can occur:
- The tendon is tight and short, resulting in a significant strain at push-off during the running gait.
- The tendon experiences frequent twisting from poor foot stability.
If your injury is caused from a shortened tendon, massage and light static stretching may be all that you need. Mobilizing the tissue using a foam roller or other self-massage tool can be particularly helpful. Focus on finding specific trigger points and roll them with firm pressure to loosen the area.
If your Achilles tendinopathy injury is caused by poor foot stability, it’s critical to strengthen your feet and lower legs and improve your stabilization capabilities.
There are several ways to do this:
- Gradually transition to four barefoot strides 1-2 times per week on synthetic turf or grass.
- Avoid overly cushioned shoes that reduce the foot’s workload
- Practice a variety of single-leg balance exercises (barefoot, of course)
Finally, you can implement “eccentric heel drops” to strengthen the Achilles tendon. These exercises are the opposite of a calf raise: you gradually lower the heel from a raised position on a step and then use the healthy leg to raise it back to the starting position.
These are like “negatives” at the gym since they utilize an eccentric muscle contraction. And since there’s no swelling in Achilles tendinopathy, you won’t hurt the tendon (if you do have swelling, it’s the bursae in between the tendon and the heel, and you should wait until the swelling is gone until you attempt eccentric heel drops). If you experience some pain, that’s actually fine.
Most runners are best served utilizing both strategies: loosening the tendon with self-massage and strengthening it with barefoot balance exercises and eccentric heel drops.
If you just injured your Achilles tendon, be sure to start any treatment protocol gradually and cautiously. Just like on race day, you shouldn’t try anything new while recovering from an injury.
Barefoot strides and more minimalist running shoes can be used once you’re healthy. But first, focus on relieving pain, building strength with barefoot exercises and eccentrics, and mobilizing the tissue using self-massage techniques.
It’s also recommended to increase your general strength, make sound training decisions, and follow a smart injury prevention strategy before you succumb to injuries in the first place.
These treatment strategies for Achilles tendinopathy target the root cause of the injury and serve runners much more effectively than simple advice to “rest and run less.”
Train smart, recover smarter, and run faster!