What to do about those Achilles issues?

My Achilles is starting to get tight and sore, what should I do? 

Typically people shy away from using their Achilles when it is irritated. Rest, ice, stretching, and taking an anti-inflammatory is the generic recommendation for almost all injuries. Unfortunately these have little value in treating most most Achilles issues. Each person will have unique things which contributed to developing the problem, but there are things which apply to everyone. Let's start by avoiding the wrong things. 

Ice

While ice may numb the pain temporarily, it isn’t providing any benefit to your healing process. This is especially true with the Achilles tendon because this is an area which does not have a readily available blood supply to support its healing. Don’t limit the blood flow further by icing it. 

Stretching It

This will probably not help - sorry but it's just true. If you have irritated your Achille's tendon, stretching it will often cause more harm than help. 

Rest

In certain situations, there is a short window when rest may be useful. But typically this is no longer than 10 days. If you have an acutely inflamed Achilles tendon you may have to rest long enough to let the tendon calm down a little bit. The signs of this are: visible swelling, very tender to the touch, and painful with walking and daily movements. If you are not in this phase, rest will not help you. Also, understand this is rarely how tendon pain presents for most people. The majority of people who develop an Achilles tendon problem are in a more chronic degenerative phase, not an inflammatory one.

You will undoubtedly have to adjust your activities but complete rest will only cause atrophy and stiffness from disuse. 

 

So, if the usual approach doesn’t work what should I be doing? 

This should go without saying but if you are having Achilles issues you need to seek out a rehab professional. There are different types of Achilles injuries and the approach to each will vary slightly. In the mean time here are the basic guidelines you can use to make sure that you are doing the right things. 

Strengthen It!

While there is no way to generalize what the contributing factors may be for each person, EVERY Achilles tendon rehab program should include loading. As with most tendinopathies, Achilles tendinopathy responds best to strengthening exercises. To heal the tendon you need to load the tendon enough to create some tissue adaptation. There are many different ways to load the Achilles tendon which we will cover below. 

Check Your Cadence

By increasing your run cadence you reduce the load into your Achilles tendon.

An increase in your running cadence of 5% above your preferred cadence, regardless of foot strike pattern, reduces Achilles tendon stress and strain. This is a simple and highly effective technique to reducing Achilles stress.

Loading Suggestions

Caution: an insertional Achilles tendinopathy (on the heel bone) should not be loaded below parallel. If you are unsure, you should consult your rehab professional and avoid any loading below parallel until you know. Until then just do the exercises from the flat ground not off of a step.

Phase One

In a more acute phase, start with isometrics and preform them daily. 

Isometrics - 10 second holds, 3 sets of 15 reps. Add weight if you can tolerate it without an increase in pain. I typically have patients do this for about the first 10 days of treatment, give or take. You should start to see a reduction in symptoms. 

 

Phase Two

Next, we start to load slow and through full a range of movement. Again, if you are unsure of the type of Achilles issue you are dealing with, DON'T GO BELOW PARALLEL. Start by doing this daily if you are only using body weight. Once you start to increase the weight you can back off the frequency to every other day. 

Slow Heel Raises - 3 second up and 3 seconds down. 4 sets of 15. Start with body weight. If the pain is still >3/10 when doing single leg then do a double leg calf raise. Once you have completed single leg body weight work for one week we start to add weight. You can also do these seated. 

When you are ready to add weight either hold a weight in your hand if you have access to a gym or load up a backpack with books if at home. 

 

Phase Three

It should be heavy and hard. 

Slow Heavy Heel Raises Here I’ll increase the load up to about an 8 rep maximum. This means you can do 8 reps but not a 9th. You will have to experiment a little to find this weight, but don't get too hung up on the details. It should be heavy and hard. These should be done standing as well as seated. 

Again, 3 seconds up and 3 seconds down - 6 seconds per rep. 4 sets of 8 reps at a weight which is about an 8 rep maximum. Do this every other day. 

 

Here is an example of a seated calf raise with heavy weight.

Michael LordComment