Dealing with Achilles tendinitis
This post is in response to someone asking me how to deal with a bad case of Achilles tendinitis. I am not a doctor and you should not take medical advice from me, but I will share with you what I think from my experience.
I also created a video that illustrates most of what I talk about here and shows you the stretches I use to address Achilles issues. https://youtu.be/Lftf8TBAE0s
I have had bad Achilles tendinitis in both of legs. I have had to stop running for a few months due to having minor tears in both as well. I have been through the doctor loop with thee injuries. In fact the Achilles tendinitis was my first real running injury and set back when I started running seriously.
First thing you need to ask is what did you do differently to aggravate the Achilles tendon? Is it a new pair of shoes? An old pair of shoes? A drastic change in workouts or surfaces? Typically, there is some sort of triggering event. If you can figure that out you may get some insight into how to alleviate the symptoms.
Most common trigger for Achilles problems is overuse. This means you stepped up your mileage or your intensity too quickly. Or you just increased your mileage/intensity to the point where the Achilles became the weakest link and was the first to go.
In new runners Achilles tendinitis is one of the most common ailments. Right up there with runner’s knee and IT band issues. It’s basically the first thing to complain when you bring your mileage up.
The Achilles tendon attaches that big calf muscle to the back of your foot. It’s designed to be a flexible cord, like a bungee cord, that stretches every time our foot hits the ground. In doing so it takes the shock of your body weight, stretches and releases that power from the legs into forward motion. The Achilles is one of the unique adaptations that makes us humans great runners.
You can’t run or walk without that Achilles. It is part of the chain of muscles and tendons and fascia that run up the back of your leg.
The symptoms of this ailment is soreness in the Achilles tendon and/or the fascia surrounding it. If you poke it with your finger, you’ll feel the soreness. It tends to be sore in the morning when you first get up. It will be sore when you start running, but then feel better as the run progresses and you warm up, only to stiffen up again after your run when you cool down.
As it starts to worsen you may ‘hear’ a creaking sound when you walk or flex the foot. This is the fascia catching on the tendon as it moves. It starts as a sore spot. That’s not a real problem. You can run through that and treat it with stretching and therapy.
The next level of progression is when you have tearing in the tendon or the fascia. When this happens, you will have visible swelling and redness in addition to the soreness. The worse the tear, the worse the swelling will be. If you have any swelling in your Achilles, don’t be a dumbass, stop running.
If you keep abusing it, eventually scar tissue will form and that is difficult to rehab. In advanced cases you will additionally have ossification, or bone growth at the attach points, which is also difficult to rehab. This is what we mean when we say you have chronic Achilles tendinitis. You kept running on it until it developed scar tissue and bone growth.
The problem with the scar tissue and bone tissue is that they are not at stretchy as the original tendon is. When you use the Achilles, this hard tissue doesn’t stretch, it tears, and you have this worsening cycle of tearing and scaring as each new run opens the old wound.
How do you treat it?
If there is visible swelling and you think there is a tear you need to stop running until that comes down. Obviously, you can treat the swelling with ice and ibuprofen etc. like you would any other injury, but that doesn’t fix anything it just helps with the swelling and pain.
If there isn’t swelling or the swelling has come down, you can start to treat the injury. The Achilles tendon doesn’t get a lot of blood flow, so I have found active recovery a better solution than just sitting around waiting for it to heal, especially if there is scar tissue in there.
Ease back into running. Avoid the speed work and hill work until it recovers. Do your stretching and therapy before and after every run.
This type of nagging injury requires patience. It may take a few months to get on top of it and it will never fully go away. You will always be at risk of it returning when you bump your mileage up.
- You can break up the scar tissue by digging in there with your thumbs, fingers or any type of roller or tool you feel comfortable with. That’s what the PT is going to do if you go. This will break up the hard bits and bring blood to the area for healing.
- You can stretch the Achilles and the whole chain of muscles and tendons in the back of the leg. If you stretch out the system it will start to recover. Nice, long, stretchy tendons don’t tear. I have demonstrated the stretches I use in a video which I will include here. https://youtu.be/Lftf8TBAE0s
- Wear a night splint. This will keep it from tightening up overnight. It really helps that morning pain.
As always, I’d be remiss if I didn’t comment on running form. These types of injuries can be caused by bad form. Take this as an opportunity to make sure your mechanics are good. have a coach look at your stride and form.
For the Achilles tendon shoes can be part of the problem. One of the common things is when you change the heal drop in your shoes. I’m not going to get into the barefoot or zero drop argument, but that heel drop directly impacts the length of you Achilles and is something you can look into.
In summary, this injury is a bitch because you feel fit everywhere else except for this tiny stretch of tissue. You feel like you should be able to push through it. But the Achilles is a keystone element to everything else, and you need to give it the attention it deserves.
Achilles tendinitis is not the end of your running career. You can work through it, but it takes patience and persistence.