To deal with Achilles tendonitis we must first understand what the Achilles tendon is. The Achilles tendon attaches the calf muscles to the heel bone (calcaneus) so we can perform activities such as walking, running and jumping. It is the strongest tendon in our entire body as it can withstand 10x our body weight. As this tendon is such an integral part of many sports and activities, it is no surprise that we can develop some painful symptoms in this area. A very common condition affecting this tendon is Achilles tendonitis. Achilles tendonitis (often called Achilles Tendinopathy) is an inflammation-like injury. It is the result of tiny repetitive injuries to the tendon fibres which then produce pain, swelling and stiffness, often affecting our daily activities.
The biggest cause of Achilles tendonitis is repetitive use without subsequent rest. This is common in sports such as athletics, basketball, badminton, tennis, skiing, dancing etc. It is even more common in athletes who participate in their sport infrequently e.g. every weekend. This is due to them being less conditioned therefore increasing their likelihood of injury. Achilles tendonitis is also common in individuals whose work puts stress on their ankles and feet for example labourers.
Other causes of developing Achilles tendonitis involve wearing incorrect footwear, weakness in the calf muscles, biomechanical issues e.g. being flat foot, having over pronation or supination in the foot, and poor technique in sports.
Some numerous signs and symptoms can indicate the development of Achilles tendonitis. Here are a few of the most common ones:
1. Pain – this may start as mild pain which can develop into more severe pain. This is normally felt before or after sports and relieves during activity.
2. Swelling / Inflammation – This is when the Achilles tendon or surrounding areas becomes swollen. If this condition is left untreated, it can also start producing tenderness when pressed.
3. Stiffness in the morning – you may find it difficult to take the first few steps in the morning once you get out of bed. This should normally ease off once you start moving.
Of course, this is normally the first question we all want to know with most injuries. However, with Achilles tendonitis, this can massively range from 6 weeks up to even a year. This is the reason it can be very disruptive to athletes and workers. However, there are many things you can at home to speed up your recovery and prevent it from getting worse, but there are also numerous forms of treatment professionals can provide to help you. I will discuss these in more detail down below so make sure you have a read of that too!
– Regular Stretching – it is important to regain any reduced range of motion and make the muscles more mobile. To start I would recommend some basic mobility stretches for your calf daily. It may feel tight and sore but it should not be excruciating. If it is then you are stretching it too much.
– Strengthening – as well as mobility, it is important to start strengthening the muscles supporting the Achilles i.e. the calf muscles. This will result in reduced pain, more function, and quicker return to work/sport but also reduced risk of injury.
– Correct Footwear – make sure your footwear is comfortable and not causing any pain. You should have adequate cushioning for your heel and a firm arch to reduce the load placed on the Achilles tendon.
– Progressive overload – for the most effective recovery, it is vital to gradually increase the duration and intensity of the exercises you are doing. This may be in the form of increased resistance in the exercise, more reps and sets, more function-orientated exercises and progression to high-impact activities.
It is worthwhile to mention that the help of a trained physiotherapist or exercise professional will be extremely beneficial in this phase. This will not only give you structure in your rehabilitation process but also keep you motivated, thus getting you pain-free as quickly as possible!
Of course, there are also a few things you should avoid to prevent your pain from increasing or slowing down your recovery.
– Avoid activities that cause pain – this may be a no-brainer but do not continue any exercises or activities that are causing pain. If the pain is very mild then you can make small adjustments to e.g. duration, intensity and resistance. However, if the pain does not improve or gets worse, I would recommend you stop this and get some professional advice. The last thing you want is to make it worse and slow down your recovery.
– Avoid high-impact exercises – although I mentioned a progression to high-intensity exercise is important, it is advised to do this with the support of a professional. Return to high-impact sports and exercises too quickly may have the opposite effect and may leave your symptoms to be worse than before. Instead, try some low-impact exercises if you are struggling with high-impact exercises.
– Avoid doing nothing – although rest is key for any injury, Achilles tendonitis recovers best with constant exercise and progressive loading. Doing nothing may make the tendon and surrounding muscles weaker, tighter and more painful.
Pain may be a factor that prevents you from being able to do as much rehab for your Achilles tendon. However, there are many ways we can decrease your pain and allow you to do more.
– Pain medication – over-the-counter NSAIDs (Nonsteroidal anti-inflammatory drugs) such as ibuprofen are effective in decreasing pain, reducing swelling and restoring function. If this is not helping then you can also consult your GP to see if you need anything stronger e.g. corticosteroids
– Ice – ice can be a very good method to not only reduce swelling but also reduce pain. This is because ice can be an effective and natural pain reliever. I would recommend wrapping some ice in a cloth and placing again the tendon for around 15 minutes.
– Support – wearing ankle support has its pros and cons. Although it may make you feel more confident when doing high-impact exercises, we don’t want you to get used to them. Therefore, I would recommend using support in the early days of the injury but slowly start weaning off it.
– Warm up – always warming up before sport and exercise are important as it gets more blood flowing to your muscles, making them more pliable thus preparing them for the event. Not only does it have physical benefits but also mental benefits as it gets you in the right mentality to perform.
– Strength and Conditioning – if you are an athlete that only plays a few times a week, I would recommend doing your training outside of this. Not only will you have a stronger foundation thus reducing injury risk, but it will also improve your performance.
– Always ensure correct technique – this is vital as a poor technique in exercises, sports and at work be place more load in areas we don’t want. Therefore, this increases your risk of developing tendonitis-related issues. An assessment from a professional would be extremely beneficial with this as they are trained to pick up any biomechanical abnormalities.
If the home remedies do not seem to be working then it would be beneficial to see a professional e.g. a physiotherapist or GP who specialises in musculoskeletal conditions. Not only can they provide the advice and education needed, but they will also do a comprehensive assessment to accurately diagnose if it is Achilles tendonitis or not. Seeing a professional may also be beneficial to get other forms of treatment e.g. ultrasound, soft tissue techniques, dry needling and in some cases administration of injections. The assistance of a professional will be effective in having a rehabilitation intervention that is appropriately suited to your specific needs.