Condition Overview: Achilles Tendinosis
Races are on the calendar. New shoes are purchased. Training plan is selected. Now it’s time to buckle down and hit it hard. But, after a long, cold winter, it’s easy to get excited at the first sight of the sun and go out too fast. That’s the perfect recipe for Achilles injuries, specifically tendinosis.
The Achilles tendon is the large, thick tendon located on the back side of the ankle. The two muscles that make up the calf, the gastrocnemius and the soleus, join together to form the Achilles tendon and inserts into the heel bone. These calf muscles are responsible for generating power at the ankle joint during the push off phase of the gait cycle, so a lot of force is transferred through the Achilles while running.
Symptoms of Achilles Tendinosis
Gradual onset of pain and/or tenderness in the back of the leg at or slightly above the heel bone is the common presentation of Achilles tendinosis. Typically, it’s worse in the morning and at the beginning of a workout until it warms up. Then the pain will return after training or towards the end of an extended training session. These symptoms can become chronic if not treated properly during the acute stages of the condition.
This is a common “too much, too soon” type of injury. This can include beginner runners increasing mileage too quickly, experienced runners quickly increasing their speed work or hills or even running in new shoes without taking the time to slowly break them in.
Other causes for this injury can be poor footwear, overpronation of the foot and ankle, not performing a proper warm up, running on hard, unforgiving surfaces, lack of adequate hip extension or generalized weakness of the area.
Treatment of Achilles Tendinosis
As with all running injuries, soft tissue treatments such as Graston Technique® and Active Release Technique®, as well as kinesiology taping are great treatment options. Custom orthotics can help support the overpronator as well as provide a lift to the heel which will release some of the tension from the tendon. Therapeutic ultrasound will help increase the blood flow to the area as well as work out some of the residual inflammation.
As always, it’s necessary to include proper stretching and strengthening exercises as prevention and recovery. The runner’s stretch is a great everyday stretch for your calves. You can see a video of it here. A great strengthening exercise is called an eccentric heel drop or eccentric calf raise. I highly recommend you perform this on a step with a railing to provide balance. You can see a video of it here.
If you’ve read some of my other posts, you know I like to try and keep runners running during their treatment plans but out of all of the injuries I treat, this is most often the one that requires rest from activity for adequate healing. Unfortunately, healing of this condition is slow because of poor blood supply to the area.
It’s important to have these injuries treated to avoid a chronic condition. The longer you wait for treatment, the more difficult it becomes to treat. So, if you’re experiencing something you suspect is Achilles tendinosis, schedule an appointment with a health care provider immediately. Don’t let Achilles pain literally become your “Achilles heel.”