Pain in My Achilles Tendon

Achilles tendon disorders are common in athletes involved in recreational and competitive sports, particularly in running.  Complaints of pain and stiffness around the Achilles tendon are common after bouts of inactivity (ie. sitting), which are then slightly relieved with a small bout of exercise, but can be exacerbated afterwards.

Who is at risk of developing Achilles tendinopathy?

Individuals with:

  • Abnormal ankle dorsiflexion range of motion (dorsiflexion- bringing the ankle upwards)
  • Abnormal subtalar joint range of motion
  • Decreased ankle plantar flexion strength (plantar flexion- bringing the ankle downwards)
  • Increased foot pronation (pronation- fallen arch)
  • Abnormal tendon structure
  • Obesity
  • Hypertension
  • Hyperlipidemia
  • Diabetes

As you age, the tendon changes in the following ways:

  • decreased collagen diameter and density 
  • decreased water content
  • decreased tensile strength
  • decreased capacity for collagen synthesis

 

FYI: Incidents of Achilles tendon pathology has been more frequently reported in men aged 30-50.

What can be done?

  • For chronic non-inflammatory Achilles mid-portion tendinopathy, eccentric loading of the Achilles tendon may help to decrease pain and improve function (strong evidence)
  • Eccentric loading involves a lengthening muscle contraction
  • A typical eccentric exercise for the Achilles includes standing on the edge of a stair with the heels hanging off and performing a heel raise
  • *Start with two legged heel raise, and then progress with one legged heel raise
  • 15 reps x 3 sets everyday, 1-2 times per day

 

(A) Achilles Ankle             (B)

(A) Standing with two feet on the edge of a stair or platform, start with a heel raise and (B) slowly lower yourself with knees straight (shown) and knees bent (not shown). Progress with eccentrically lowering with a single leg.

Other forms of intervention performed by a medical professional may include:

  • Low-level laser therapy to decrease pain and stiffness (moderate evidence)
  • Iontophoresis to decrease pain and improve function (moderate evidence)
  • Stretching to decrease pain and improve range of motion  (weak evidence)
  • Foot orthoses to modify foot and ankle mechanics during activity (weak evidence)
  • Manual therapy to improve mobility of the ankle (expert opinion)
  • Taping to decrease strain of the Achilles tendon (expert opinion)

 

Cheers,

Jessie Wong, Physiotherapist from the Physio Room

 

*The exercises provided on this website are for educational purposes only, and are not to be interpreted as a recommendation for a specific treatment plan, or course of action. Exercise is not without its risks, and this or any other exercise program may result in injury. They include but are not limited to: risk of injury, aggravation of a pre-existing condition, or adverse effect of over-exertion such as muscle strain, abnormal blood pressure, fainting, disorders of heartbeat, and very rare instances of heart attack.

To reduce the risk of injury, before beginning this or any exercise program, please consult a healthcare provider for appropriate exercise prescription and safety precautions. The exercise instruction and advice presented are in no way intended as a substitute for medical consultation. We disclaim any liability from and in connection with this program. As with any exercise program, if at any point during your workout you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately and consult a physician.

 

References:

Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy‐load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998; 26(3): 360‐66.

Carcia, Martin, Houck, & Wukich. Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis. J Orthop Sports Phys Ther. 2010:40(9):A1-A26.

 Cook,  Khan, Maffulli, Purdam. Overuse Tendinosis, Not Tendinitis: Part 2: Applying the New Approach to Patellar Tendinopathy. The Physician and Sportmedicine. Vol 28 - No. 6 - June 2000.

PABC Tendinopathy Toolkit. A. Hoens, D. Hughes, A. Ezzat, A. Fearon, A. Scott, J. Anthony. The Tendonopathy Toolkit for Clinical Management of Achilles Tendonopathy. 2012.

Silbernagel et al. Continued sports activity using a pain monitoring model during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med. 2007;35(6):897‐905.