The Achilles Tendon Injury Guide
/The Achilles tendon is like the spring of your ankle. Causing you to spring from one foot to the next. Saving you energy so you don’t have to work as hard.
However your ankle springs are a little vulnerable to being overloaded by too much spring. Some really common examples are
A runner that has some speed work in their program for the first time in a few weeks
A basket baller that gets called up to play a second game the same day
A runner that goes from 5kms of running to 10kms of running in one week on a background of no running,
Starting preseason training after doing nothing over summer OR being in lockdown for weeks and then getting thrown straight into games with no preseason!
The other way an achilles tendon can be injured is when the very bottom of it is compressed against the heel bone at its insertion whilst being overloaded with excessive springing.
Sometimes the way you use your springs can aggravate them such as people who over stride when they run or walk.
Unfortunately some people are also a little more susceptible to achilles tendon injuries due to systemic issues.
Did you know that 6% of the whole population will get it? this doubles for runners at 12% and this doubles again for elite runners at 24%. So you aren’t alone.
But I injured mine walking? That isn’t exactly springing is it?
Spring is relative to the amount of exercise you do normally. For example if the most springy thing you do is walking and you walk too far then yes you overloaded your spring.
If you jog and then you decide to do some hill sprints you have overloaded your spring.
The key here is that we are all individuals and no two people's tolerance for spring load are the same! So if your friend at the run club doesn’t get achilles issues and you do it isn’t your fault. There are so many variables it isn’t funny for example if you didn’t do a lot of springy exercise as a kid but got into it as an adult then you are more at risk.
As a bonus there is still plenty of exercise you can do HARD that won’t annoy your achilles tendon for example the rowing machine or the bike. Why? There is no spring in either of those activites ….
So why is my Achilles Tendon sore????
So you’ve been out running. Admittedly it was a lot faster than normal but you were feeling really good so you went with it. The next day you get out of bed and you literally could barely walk. You look down at your achilles tendon and it’s a lot larger than normal. It almost looks swollen. You have a week off running to rest it and boom it is back. Not even rest fixed it….
What is actually going on?
There is a change at the cellular level of the achilles tendon whereby the tendon cells become activated creating a bunch of changes which result in water accumulation and biochemical agents released which causes pain. Some inflammatory and some degenerative.
How long you keep overloading the tendon before you see us - the more degenerative the process becomes.
We don’t yet know entirely the exact process in the tendon once it’s overloaded. We still rely on models which differ between inflammatory and degenerative.
If you had asked me 10 years ago I would have told you there is no inflammation and used the phrase “tendinopathy” However at this stage in research, we still don’t know (despite now being able to fix most of them pretty damn well).
SO HOW DO WE FIX IT?
Exercise!
Believe it or not exercise is the most proven thing to fix tendons hands down.
There are so much research to show it’s the best solution to achilles tendon pain...
It’s also interesting to note that complete rest - without exercise just doesn’t help at all!
Progressing an exercise program over 12 weeks where each week is harder than the week before, AND without creating pain flare ups is the goal and best chance of a good recovery. This can be longer if you have had tendon issues for years.
Below are a couple to start with. If you don’t have a seated calf raise machine you can use a small child, bag of potting mix or in this case a 40kg bag of concrete.
The first is an isometric calf raise which is basically a calf raise and hold.
Seated calf raise with weight 20seconds x 5 reps
I would also encourage you to add slow calf raises. The seated position is a nice place to start. I’d do 3 -4 sets of 6 reps and a ration of 4 seconds up and 4 seconds down to be safe. Tendons when they are sore initially respond better to slower contractions.
Managing Bad load
It kind of seems funny that doing exercise got you to this point and now we’re asking you to do more exercise!
However slow heavy calf raises are really helpful, but too much spring isn’t. It doesn’t necessarily need to be pain free, however we need pain during exercise and 24 hours after exercise to be under a 3/10 on the pain scale.
This can be an art as well as a science but keeping a basic journal including
how many steps you have taken or how much of your sport you did per day,
how much pain you had during sport, after sport and the following morning
I highly recommend a fitbit or apple watch to track your step count.
Occasionally if you have been doing really well with your rehab then you have a flareup we can see clearly what went wrong to cause this.
Don’t Stretch (Initially)
I know this also seems counter intuitive. We know it actually feels like it needs a bloody good stretch, but it can actually make it worse in the short term. Particularly when the base of your achilles is the issue.
Don’t Stress!
It is very rare that an achilles tendon injury doesn’t come right with the above advice. Admittedly they are the slowest healing tissue compared with bone or muscle but if you do the work, reduce your spring load, improve the capacity of it you will most likely recover.
Did you know that stressing about the pain actually makes it worse. So try and remember that you will be ok and worrying about it isn’t helping.
A couple of fun facts to finish
That first thing in the morning pain is actually the last thing to go. You will be back exercising long before it goes
There is no relationship between the damage to your tendon on an MRI and the pain you are experiencing.
The pathology on the tendon can look exactly the same even though you are back to full training, pain free and not even thinking about your tendon. Maybe even getting personal bests!!
It’s not always Achilles Tendonitis that is causing your pain!
It is not always the Achilles Tendon that is the issue. Particularly if you find these exercises aren’t helping or even making it worse!
You actually have a sheath around the tendon called your Paratenon which can become inflamed from friction such as wearing the wrong shoes over an extended bout of exercise.
You also have a sural nerve on the outside of your achilles which can be caught in your tight calf muscle.
You can also have a retrocalcaneal bursitis at the base of your heel independent of the achilles tendon. Again the above exercises will make this worse and it is definitely time to come in and let us figure out what is going on.
Finally you can rupture your achilles tendon. This happens more than you think and someone will usually say “it felt like someone had shot me in the back of the calf” OR “it sounded like a bomb or gun going off”
It is fairly easy for us to diagnose. Interestingly 5 years ago this almost always required an operation however some Sydney foot and ankle surgeons are now experimenting with casting and boot immobilisation with great results.
So if you are sick of the pain in your Achilles Tendon, you just want to get it sorted and are prepared to put in a bit of work then click the book now button and schedule an appointment to see us.