The Comprehensive Guide to Curing Your Achilles Injury
Injury prevention, May 07, 2021
Stop achilles tendinitis and other achilles tendon injuries from ruining your training.
Get yourself back into full running and triathlon training with our 3 Step Path To Recovery.
Achilles injuries can turn into the bane of an athlete’s life.
This is one that is close to my heart having been plagued with problems on and off over several years.
This is a good thing for you however, as it means that I have gathered a lot of advice over time! Being desperate to find a cure, I have avidly read all the scientific research I can get my hands on. And I’ve done a lot (A LOT) of exercises….
All of this means that I can put together a pretty comprehensive list of things to do to help get you back up and running.
First things first though, if you have an injury, go to see a sports injury specialist or sports physiotherapist.
The exercises below are generally considered to be the best way to cure Achilles problems, but a physiotherapist will help you to address your own specific underlying causes of injury.
Why Is My Tendon Hurting?
It starts as a soreness and stiffness in your tendon that comes on gradually and usually continues to get worse unless you do something about it. It often starts with tightness or stiffness and creaking when first getting out of bed in the morning. Lightly pinching the tendon with the forefinger and thumb often results in soreness.
Tendons are made up of lots of collagen fibres intertwined together (see figure 1 below). When the Achilles is damaged, these fibres are torn. When they heal, they tend to get stuck together and the resulting scar tissue is not fully strong collagen, and is therefore likely to reinjure if not allowed to heal properly.
Achilles Tendinitis, Tendonitis, Tendinosis?
The terminology can be confusing, with people and medical professionals often using terms interchangeably. The umbrella name for an Achilles injury is Achilles tendinopathy.
If your Achilles is sore you are likely to have either Achilles tendinitis (or Achilles tendonitis) or Achilles tendinosis.
Achilles tendinitis (or sometimes spelled tendonitis) is more of an acute injury, whereby the tendon make-up is disrupted and results in inflammation.
Achilles tendinosis is more of a chronic condition and occurs when the collage of the tendon degenerates (due to aging, microtrauma through mechanical overload or compromised blood supply) rather than being acutely damaged.
You don’t need to worry too much about the terminology as the treatment pathway is generally the same and people very often confuse the two terms.
If you want to know exactly what sort of injury you have, then visit a sports physiotherapist. This is always a good idea anyway, to make sure you get comprehensive advice appropriate to your condition.
What Can I Do To Make It Better?
Ignore a ‘little bit of tightness’ at your peril!
The first thing to do if you feel any tenderness, stiffness or pain in your Achilles is to rest or reduce the amount of running you are doing(or whatever aggravates it). There is evidence to suggest that damage to the tendon starts to occur before you feel any pain, so responding immediately is important.
The next thing to do is to think if you have done been doing anything differently in training:
- Running further
- Running faster
- Running more often
- Running up hills or on uneven ground
- Changed running shoes
- Stopped doing any conditioning work you may have been doing
If you have changed something, then probably if you give your Achilles the chance to recover, then go back to what you were doing originally, you will be fine. You will need to make sure that any increase in running speed/intensity is done more gradually.
If you can’t see any reason why you are getting discomfort, then see a physio (and it’s probably worth doing this anyway).
The Two Most Common Causes Of Achilles Tendinitis/Tendinosis Are:
- Tight calves
- Biomechanical issues meaning that excessive stress is put on the tendon.
If you have biomechanical issues which are causing stress on your tendon, then a sports physiotherapist will be best placed to advise you on what you need to do. You could be advised to get orthotics or change your trainers if the problem is coming from your feet, or even if your legs are different lengths.
The problem could equally be coming from a muscle weakness or imbalance that can be corrected with appropriate exercises.
So knowing what is causing the pain means you can take the most appropriate course of action to get better.
Having said that, there are some standard things you can do that will help you on the road to recovery from achilles tendinitis, and that shouldn’t have any adverse effects regardless of the cause of the problem.
The Three Point Plan For Recovery From Achilles Tendinitis
A physiotherapist might carry out conventional treatment such as massage, friction massage and ultrasound. As well as this, icing your Achilles after exercise is also often recommended.
None of these are likely to do any harm, but the most effective treatment plan for most cases of Achilles tendinitis is as follows:
- Stretch
- Strengthen posture supporting muscles ( core and glutes )
- Strengthen and promote healing of the tendon itself
Basically you want to reduce tension on the Achilles, ensure you are not putting undue stress on the tendon and prevent further collagen damage. Most important is step 3, which helps stimulate the synthesis of new collagen and ensure that this collagen is correctly aligned.
1) Stretching:
Tight calves are a common cause of Achilles tendinitis. Tightness means that there is more tension on your tendon which can result in microtears to the fibres of the tendon.
Upper Calf
- Stride forward and lean against a wall
- The front leg should be bent, back leg straight
- The heel of the back leg should remain in contact with the floor
- Ease forward until you feel the stretch in the upper calf
Lower Calf
- Lean against a wall as for stretching the upper calf
- The heel of the back leg should remain in contact with the floor
- Bend both knees, and sink your hips to shift your weight onto the back foot
- As you sink down, you should begin to feel the stretch in the lower calf
2) Strengthen Posture Support Muscles:
Weak lower limb and foot muscles can mean that your lower body doesn’t maintain correct alignment when you run. This often results in increased tension and stress on your achilles tendons, resulting in tendinitis.
Have a look at our Lower Limb Conditioning page for some exercises to do to improve the strength and stability in your lower legs.
In addition, weak glutes can result in a lack of support round your hips upon impact. This means that your legs turn inwards more than they should when your foot hits the ground, which again can put stress on your Achilles.
Have a look at our Glute Conditioning page for exercises to do to strengthen this area.
3) Strengthen And Promote Healing of the Tendon – Eccentric Exercises
This is the most important (and in my opinion the most effective) thing to do to cure Achilles tendinitis. In fact it’s not just me, many research studies have found these exercises to be more effective than conventional physiotherapy treatment.
Eccentric exercises involve the lengthening of a muscle–tendon unit as a load is applied to it. This is the opposite to concentric exercises where the muscle–tendon unit shortens and isometric exercises where the muscle–tendon unit length remains constant.
Exercises:
- Stand on the edge of a step with your toes and the ball of your foot on the step and your heels hanging off the step
- Then go up onto your toes using both feet
- Lift one foot off the step
- Lower down on your other foot
- Repeat.
As well as doing this with a straight leg, do it with your knee slightly bent, and with your leg bent change the angle of your foot, so you do some facing straight forward, and some with your foot pointing left and then right, so you get a different angle.
How Often Should I Do These Exercises?
Most of the research studies I have come across look at people doing 3 x 15 reps of lowers twice per day, once with straight leg, once with bent leg.
This is what I started off doing, and had some success.
However nowadays a lot of specialists will recommend doing more.
I have heard of athletes being told to do 400 reps a day by a top surgeon and researcher into achilles tendinitis and achilles tendinosis. Being desperate for anything to cure me, I had a go at this.
It took a couple of weeks (and some severe calf pain – negociating stairs and even getting out of a chair became hard!) to get up to 400 reps, but boy did I notice the difference! My Achilles felt significantly better with each day that passed.
I suggest you start off with:
3 sets of 15 reps twice a day - with both straight leg and bent leg.
Build from there, increasing the number of reps by 5 – 10 per set per day until you can do
100 – 200 without difficulty.
You may feel some low level pain in the achilles during this but if you keep going you should find this wears off. If you’re feeling enthusiastic and still have a sore tendon, then by all means work up to doing more reps.
Once you can do 100 – 200 easily (ie no side effects the next day), then progress to doing the lowers with a light weight. You can start with a backpack of books, or if you have access to a gym and a smith machine (see picture below) then this is even better.
When you progress on to using weight, take it easy.
Build up very slowly, and remember it is how you feel the next day that is most important. You might feel fine when doing the exercise but then feel a bit of soreness the next day. If this is the case, you’ve put on too much weight too soon. You might read elsewhere that you should feel pain during these exercises.
However as a triathlete your perception of pain is probably different to that of a non-athlete. And then you’re likely to do yourself damage by putting too much weight on.
So as a rule of thumb, use a weight that is just below the level that initiates pain. After 4 – 6 sessions you will probably feel confident with this weight and not feel any pain during or after the exercises. In this case you can then add some more weight (2.5kg at a time max).
The benefits of these exercise are two-fold:
- Improve the make-up of your tendon
- Strengthen your calves to withstand high forces when running
A good routine would be:
2 days per week: 3 x 10 with a relatively heavy weight and 100 – 200 with no weight.
3 days per week: 4 sets of 20 reps with bent leg, 20 reps with straight leg with a lighter weight.
How Long Will It Take To Get Better?
How long it takes for your Achilles tendinitis to heal will be different for each individual. It will depend on how damaged your tendon was in the first place. Bear in mind though that this is generally a long process unless you’ve been sensible and caught this right at the start of the injury.
Why Do These Exercises Work?
There have been quite a few research studies carried out to find out why these exercises help, and what the best way to do them are. There doesn’t appear to be a definitive answer to this at the moment. It is agreed though that the tendon does not go through a successful healing cycle when suffering from achilles tendinitis or achilles tendinosis.
During eccentric exercises the tendon is subjected to greater forces than during concentric contractions and hence to a greater remodelling stimulus.
One theory is that when a tendon is damaged, lots of new tiny blood vessels and nerves form to try to help heal the tendon. This is thought to cause the pain associated with achilles tendinitis, and one line of thought is that these exercises ‘kill off’ the blood vessels and nerves.
Another theory is that the ‘lengthening’ action causes the new (glued together in a bit of a mess) collagen fibres to become properly aligned.
Yet another theory is that the eccentric exercise stimulates a greater rate of production of collagen.
Whatever the reason, these exercises WORK.
In addition, they are a great conditioning exercise meaning that when you do get back to running, your calves are stronger and able to cope better with the forces placed on them, meaning less stress on your tendons.
Getting Back To Running
Remember that when you first felt pain in your Achilles the damage had probably already started?
Well, the same goes for coming back from injury. You may be pain free, but don’t just jump straight back into full-on training. Chances are, if you do this, you’ll end up back where you started.
Start off with a nice slow jog on a level surface. 10 minutes max! Then see how you feel the next day. If you’re OK, then start gradually building up your running.
The rule of thumb is to not increase the amount you do by more than 10% in one go.
Remember to take this into account when looking at your weekly volume. And keep an eye on your running speed too – increase this gradually too.
I find it helpful to actually write down a plan – that way you don’t risk accidentally increasing your running time by too much each week, or getting carried away feeling ‘fine’ and doing a longer run than you should.