Achilles tendinitis or tendinopathy is a common condition that is characterized by pain at the back of the heel or at the heel cord (Achilles tendon).
It is often accompanied by inflammation and swelling in the short term, but pain can stick around long after the inflammation subsides.
Achilles pain can be tricky to deal with, especially if it’s affecting your walking, running, or training. Fortunately, it can be treated surprisingly well with consistency and some well-designed intentional loading. However, there are some misconceptions about managing Achilles tendon pain that I wanted to take some time to bust through so that you can get on your way to strong, happy Achilles tendons. Below are the top three myths that I see impacting Achilles tendon recovery followed by some strategies to manage pain.
Myth #1: If my Achilles is bothering me, I need to rest until it feels better.
Of all the ways to manage your Achilles pain, this is probably the worst one. More often than not, the tendon is irritated due to insufficient strength/endurance to meet its daily demands, so resting the tissue can have the undesired effect of further weakening the tendon and muscle. While we do want the tissue to calm down, we simultaneously want to improve its capacity to handle its daily load. The best way to relieve pain and start developing strength with an irritated Achilles tendon is to add in a strengthening program that starts with isometrics (see below)
While we do want the tissue to calm down, we simultaneously want to improve its capacity to handle its daily load.
Myth #2: If my Achilles is bothering me, I should keep running through it (#NoPainNoGains)
This management strategy is equally detrimental to your progress since you’re expecting and hoping your pain will change without changing the activities that aggravate it. Rather than running or training through the pain, it’s important that you first determine your threshold for flare-up and plan to train underneath that for at least one week. For example, if you can run three miles without pain, but the fourth mile flares you up, you’re going to stick with three and supplement the remainder of your training with something that doesn’t aggravate you (water running, swimming) . Additionally, you’ll add in strengthening, starting with isometrics (see below).
Rather than running or training through the pain, it’s important that you first determine your threshold for flare-up and plan to train underneath that for at least one week.
Myth #3: I need to stretch my calves to help my Achilles loosen up
This management strategy is well intentioned, and while it can sometimes help with pain relief, it can sometimes be detrimental for people whose Achilles tendon pain is located closer to the heel. With my Achilles’ tendinopathy clients, I tend to hold on aggressive stretching in favor of progressive strengthening into a lengthened (or stretched) position once symptoms allow it. Often times, when we are able to strengthen into a certain range of motion, our tightness naturally loosens up.
Myth #4: My Achilles is going to bother me forever if I’m not careful.
Tendinopathies can stick around for a long time without proper management, but if you give your body sufficient time, recovery, and strengthening stimulus, they don’t last forever. Flare-ups are sometimes just your body’s way of telling you that the tendon or muscle’s capacity wasn’t enough to handle what you asked of it. The best workaround for this is to strengthen it beyond what you ask of it on a daily basis so that your tendon always has some extra juice in the tank.
Tendinopathies can stick around for a long time without proper management, but if you give your body sufficient time, recovery, and strengthening stimulus, they don’t last forever.
Truth: Manage Achilles Pain using Isometrics
If you’re dealing with Achilles pain, use this simple protocol to control your pain on days when you’re flared up:
Seated Heel Raise Holds: Start with both feet flat on the ground while sitting in a chair. Push your toes into the ground to raise your heel and hold for 45-60 seconds. Repeat five times. Then go about your day. You can perform one set of these five times per day. Expect your pain to rise 2-3 points (out of 10) during these exercises and settle back down afterward.
Standing Heel raise Holds: If seated doesn’t feel challenging enough, you can do these exercises standing with your hands against a wall or railing. Rise up onto your heels and hold that position for 45-60 seconds. Repeat 5 times. Perform them five times per day. Expect your pain to rise 2-3 points (out of 10) during these exercises and settle back down afterward
Curb Heel Raise Holds: If both of the above exercises aren’t challenging enough, you can move the exercise to a curb or a step to increase the difficulty and range of motion demand. Let your heels drop down slowly into a stretch then rise up onto your heels and hold that top position for 45-60 seconds. Repeat 5 times. Perform them five times per day. Expect your pain to rise 2-3 points (out of 10) during these exercises and settle back down afterward.
Try these out, feel free to add some weight as you get stronger, and if you’re still having nagging issues, give us a call at Sports Performance Physical Therapy: (619) 397-1391!
As always, I hope this helps! If you have any questions or would like to read about certain topics, send us an email at TeamSP@SportsPerformancePT.com.
-Dr. Marissa Rescott, PT, DPT, CF-L1
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