Achilles tendon pain is a common reason for seeking physical therapy in Durham. Despite its prevalence though, physical therapy is an excellent option for conservative management of Achilles pain. In this blog we’ll explain the function of the Achilles tendon, how it becomes injured and provide at home physical therapy exercises and stretches to help you overcome your Achilles pain.
Anatomy and Function
The Achilles tendon is a tick tendon at the back of our lower leg. The two main calf muscles, the gastrocnemius and soleus, converge into the tendon and it then inserts into the heel bone.
The Achilles tendon functions like a slingshot to help us walk, run & jump. When our foot is flat and the knee bends and the ankle dorsiflexes, the tendon is stretched and stores up kinetic energy. As the calf muscles contract and the ankle plantarflexes (or points) that energy is released and helps to propel us forward or up.
Achilles Tendon Pain
While the Achilles tendon is strong, it is also susceptible to injury, which is why many people seek out physical therapy related to Achilles tendon injuries. The most common injury to the tendon is an overuse injury, typically called tendonitis. While the term “tendonitis” implies acute inflammation it has actually been shown this is not the case, rather it is the start of tendon degeneration, called tendinosis. However, many people use these terms interchangeably. For the purpose of this blog we will use the term “tendinosis” to refer to any pain or injury at the Achilles tendon.
How does the Achilles Become Injured?
The most common cause of Achilles tendinosis is overuse. This typically occurs when someone does too much too soon, for instance increasing running milage too quickly. This can also happen if the surface or shoe wear used during training suddenly changes. For example, if someone does a lot of jump rope as part of their workout but typically does this on a softer rubber floor and then one day switched to concrete, it could cause an irritation of the tendon because the change to a harder surface is going to put more stress through the leg. The tendon can become painful either at the base of the heel where it attaches or within the midpoint.
Symptoms of Achilles Tendinosis
Typical symptoms include pain and stiffness at the tendon. The calf muscles may also feel tight in addition to the bottom of the foot. It is also common to see a thickening of the Achilles tendon. This happens as a response to the repetitive load placed on the tendon and can be thought of similar to a callus on the hand.
Physical Therapy for Achilles Tendinosis
Physical therapy is an excellent option for Achilles tendinosis. A physical therapist in Durham can help you by identifying the root cause of your issue, help you adjust your training schedule for a more gradual increase in activity and provide you with specific exercises and stretches to help address your symptoms. A physical therapist can also perform hands on techniques such as massage, dry needling and cupping to help reduce the pain and tightness in your calf and Achilles.
At Home management of Achilles Tendon Pain
There are many things that can be done at home to help manage and overcome your Achilles tendon pain.
Calf Foam Rolling
Many times, the calf muscles develop trigger points, or muscular knots from the overuse. While you may not have pain specifically in the calf muscle, these tight spots in the muscle can still pull through the Achilles and contribute to pain. Foam rolling is an excellent way to relax the trigger points.
Tips for foam rolling: While some discomfort is okay, this should not be so painful it makes you tense up and grit your teeth. A you continue to roll you should feel the muscle start to relax. Aim to foam roll for at least 90s as this gives ample time to allow the muscle to fully relax.
Negative Heel Raise
The negative heel raise is an excellent way to help strengthen, while also stretch the Achilles. This exercise focuses on going up on your toes and then very, very, slowly lowering down. This long, slow load applied to the Achilles will help to simulate blood flow to the area and strengthen the tendon without adding extra irritation.
Tips for negative heel raises: These should NOT be painful. A very small amount of discomfort is okay but you should not be rating the pain greater than a 2/10. Start by doing them on both feet and then gradually work towards putting all your weight on one leg.
Start with 2 sets of 10 and increase the reps as it gets easy.
Calf Stretching
Doing a simple calf stretch can help to relieve the feelings of tightness and tension at the Achilles. When performing the stretch, aim to hold it for at least 30 seconds in order to give the muscle and tendon time to relax. Performing this stretch first thing in the morning is an excellent way to help decrease pain and stiffness that comes on overnight.
If the above three things don’t work, you may also need to work on the strength of your entire lower extremity. Many times, we develop compensation patterns from a lack of strength or balance at our hips which then leads to the Achilles becoming overworked. Try the two exercises below to help strengthen the hips and provide more stability for the entire lower extremity.
Side Steps
Be sure to keep your trunk still and don’t lean side to side. Start with 10-15 steps for 2 sets, each side.
Single leg Deadlift
This is a great exercise to work the glutes and hamstrings, which aid the achilles in running and jumping. I like this variation because it takes out the balance component of the movement but still allows you to work one leg at a time! Start with 8-10 reps for 2 sets on each side.
Next Steps
In summary, Achilles tendon pain, typically called Achilles Tendinitis or Tendinosis, is a very common injury among competitive and recreational athletes alike. The most common reason for Achilles Tendon pain is overuse and or a change in training surface and shoe wear. Physical Therapy is an excellent option for treatment of Achilles Tendon injury and pain as physical therapy can provide multiple ways to decrease pain, increase strength in the Achilles and lower extremity and help guide you with proper training techniques and progressions.
This blog provides a few excellent exercises and stretches you can try to today to decrease your pain, however if this is something you have been dealing with for a while, contact us today to get started on a custom plan to help you overcome pain and injury and get back to the activities and workouts you love, pain free!
Sources:
NIH
