_{Originally posted on WilliamsonSource.com} –

With spring on the horizon, many runners are gearing up for distance races and beginning to increase their mileage. But doing so too quickly or without the right strength training could lead to Achilles tendinitis, which can also be called tendinopathy.

Logan Burton, DPT, ATC, a physical therapist with Bone and Joint Institute of Tennessee, offers insights into the common running injury, including when it’s time to see an expert and some rehab exercises that can help take away the pain.

What Is Achilles Tendinitis?

This is a common overuse injury seen in runners who increase their volume or load too quickly. Increased volume can look like an increase in mileage, too much high intensity work over a short period of time, or not allowing for intentional rest and recovery time.

Achilles tendinitis can present as pain in the achilles near the heel or more mid tendon closer to the muscle belly. The achilles is where the two muscles of the calf complex – the gastrocnemius and the soleus – meet to attach to the heel bone. The soleus is a key player in push-off during running and is often the cause of pain where the achilles attaches at the heel. 

Oftentimes runners neglect strengthening the calf complex and loading their achilles tendon making them more susceptible to this type of overuse injury.

Preventing Achilles Tendinitis:

The best prevention method for Achilles tendinitis is strength training. Runners need to spend some time in the gym with weights preparing those muscles and tendons that need to perform during their running workouts. 

The muscles and the tendon need to be overloaded in the gym to perform their best while running and preparing for the upcoming race. If you are unsure about your volume and risk of overuse aches and pains as you train, seek out professional input from a physical therapist to ensure a decreased risk of injury while training.

If you aren’t responding well to strength training or volume adjustments, then your medical professional could assess your presentation and give you exercises to focus on your specific needs. Additionally, another component your doctor or physical therapist could take into consideration is your running form to address how your body is accepting loads through your legs when running.

Signs of Achilles Tendinitis to Watch Out For

The first sign of Achilles tendinitis is pain in the back of the heel or calf. You’ll feel the pain lower down near the ankle, often while you’re running. But as the injury worsens, you might start noticing the pain during daily activities, such as going down stairs or walking. 

Take note of the pain and the patterns it presents with. Some other possible red flags that could use medical attention are when you experience pain when simply putting weight on that leg, if you notice it at the same mileage point during every run, and if it continues as you keep running but decreases shortly after you stop running. It could be indicative of something requiring more serious attention.

How Common is Achilles Tendinitis?

It’s very common among athletes who are increasing their volume when preparing for a race or just trying to increase mileage too quickly in a short period of time. Trying to monitor how much mileage and time spent running you’re adding week-to-week and day-to-day is important. Don’t try to increase the number of miles or minutes spent running between each workout. Make it gradual. 

And of note, this injury impacts runners of all abilities. Those just starting out can suffer the injury, but so can seasoned athletes. So while you may be a seasoned runner, you are still at risk for achilles pain.

How to Treat Achilles Tendinitis:

Tendons respond well to isometric and eccentric loads. So treatment plans generally incorporate these components and work on both muscles that make up the calf and achilles complex.

Your physical therapist might recommend calf strengthening with knees bent and knees straight, which addresses both calf muscles while the soleus is more isolated when the knee is bent and the gastrocnemius muscle is targeted with your knees straight. 

Once you address the strength component with isometric (prolonged holds) and eccentric loads (slow lowering) and you can tolerate walking for 20-30 minutes with no pain, you can add in plyometrics. Plyometrics would be jumping-related exercises to prepare your tendon for the recoil to absorb each strike of the leg to the pavement while running.

Taking that extra step of adding in plyometrics will help you before returning to running. You’ll do these exercises as double-leg, single-leg, and in different directions of motion to best prepare your achilles. Then you’ll slowly return to running with the guidance of medical professionals and see how you respond to it.

Can You Still Race with Achilles Tendinitis?

Whether you can still race when dealing with Achilles tendonitis depends on the severity of the injury and your level of irritability. Often you can work through some of that initial pain and help the tendon calm down by reducing inflammation and loading it up to prepare it for your race. 

Runners often have experience working through some level of pain, so they can usually find a good middle ground to make it through the race. But if you’re experiencing pain, you should certainly work with a physical therapist or doctor to help manage it until you make it to race day to prevent long-term injury, and to rule out any injuries of higher concern.

What Are the Long-Term Effects if Left Untreated?

If you don’t take the time to treat Achilles tendinitis some more extreme things could happen. There is a risk of calf strain or calcification of the tendon. The worst possible injury would be an achilles rupture.

It’s certainly worth getting this pain addressed early to avoid these more serious consequences. Severe injuries are not as common, and generally, treatment is quite effective at preventing risk of serious injuries.

Exercises to Treat Achilles Tendinitis

Your physical therapist might recommend some of the following exercises to treat Achilles tendinitis. All exercises below are easily found on YouTube. If you are unsure of how to perform any of these safely and effectively, seek out help from a physical therapist.

Start with the following isometric and eccentric exercises:

• Calf raise – double-leg and single-leg with knees straight

• • Isometrics: hold the calf raise at end range with your knee straight
  • Eccentrics: single leg slow lowering with your knee straight

• Calf raise – double-leg and single-leg with knees bent

• • Isometrics: hold the calf raise at end range with your knee slightly bent
  • Eccentrics: single leg slow lowering with your knee slightly bent

 

Once you’ve started experiencing reduced pain, you can add in these plyometrics:

• Double-leg and single-leg pogos 
• Jumping horizontally, laterally and vertically (double-leg and single-leg) 
• Box jumps and depth drops

 

The above exercises are basics to get you started on your own. While each individual reacts differently to various exercises, experts like Logan at Bone and Joint Institute of Tennessee can help develop a plan designed specifically for you to keep you on the road to your next race without Achilles pain. To make an appointment with Bone and Joint Rehabilitation Services, give them a call at (615) 791-2640.

Bone and Joint Institute also has physical therapy clinics in Brentwood, Franklin, Nolensville, Thompson’s Station and West Franklin. To find the closest location to best suit your needs, visit BoneAndJointTN.org/Rehab-Services.