Achilles tendinopathy is a common problem that can cause pain in the back of the heel, or through the achilles tendon.

How do we diagnose achilles tendinopathy?

  • If you have pain that is localised to your achilles tendon, typically very pin-point
  • Pain with the first few steps in the morning, that warms up with movement
  • Worse with higher load activities i.e. hopping, running or jumping, compared with lower load activities i.e. walking or standing
  • A recent change in load i.e. an increase in running frequency, a change in shoes, or a weekend of playing sport after a period of time off

What symptoms typically are not associated with achilles tendinopathy?

  • Pain that is worse with exercises with low impact i.e. cycling or swimming
  • Pain that spreads along the achilles tendon, instead of localised pain
  • Pins and needles in the heel or foot

Does it sound like you have achilles tendinopathy?

FAQ

Do I need to stop training for my achilles pain to get better?

Do I need to stop training for my achilles pain to get better?
Typically no – unless your symptoms are very irritable (pain that lasts for a long period, after a small aggravation). In these cases, it is recommended that you respect the symptoms and reduce the load through the tendon. This can be achieved in a variety of ways depending on your activity;

  • Reduce running distance by 20-30%
  • Temporarily reduce overall walking load throughout your week
  • Reduce hill walking/running temporarily – there are higher loads on the achilles tendon with uphill
  • Cross train to exercises that are low impact on the tendon i.e swimming or cycling

Remember, these are temporary strategies that you might like to try for a few weeks before progressing back into your normal loads.

“What can I do about my pain?”

Adjuncts that might be beneficial;

  • Heel lifts – normally a 6 millimeter heel lift can be sufficient – this reduces the stretch on the achilles tendon.
  • Sometimes a moon boot might be needed if your symptoms are particularly high and irritable
  • Reduce stretching and poking the achilles tendon

 

“NOW THAT MY SYMPTOMS ARE TOLERABLE, WHAT DO I DO NEXT?”

The most evidence-based treatment for achilles tendon pain is strengthening of the calf and foot muscles. Some exercise options might include seated and standing calf raises and strengthening the muscles on the inside and outside of the ankle (see below, or head to our YouTube channel here).

  • Seated calf raise – we want to achieve are at least our bodyweight on the machine, for 4 sets x 8 reps
  • Standing calf raise – the goal is to achieve 20 single leg calf raises, depending on your ultimate goal

Once your symptoms are tolerable, and your strength has improved, we want to reintroduce some bouncing exercises to ensure our tendon can absorb forces well (also below)

  • Typically starting double leg, to single leg hops over time.
  • Introducing some side to side and diagonal movements can be helpful if your goal is to return to sport

Once you have completed all of these, you can start to gradually increase the speed of your running and building back to your pre-injury levels.

 

If you are having trouble with your running, or achilles pain, we offer full running assessments (which you can read more about here), or please do not hesitate to get in touch if you have questions!

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