Achilles injuries – what you should know as an athlete
Rosemary Marchese – Physiotherapist
Achilles injuries can be a source of confusion for athletes with so many versions of ‘treatments’ out there. Achilles tendon injuries are common in sports that require running, fast starts and stops and explosive type movements. If not dealt with carefully, these types of injuries can quickly become chronic and take longer to heel. In a worst case scenario the tendon can completely rupture and you’ll be in surgery! Keep in mind this barely happens.
Achilles tendonitis was a term used a lot in the past and refers to inflammation of the tendon. Most experts now use the term Achilles tendinopathy to include both micro-tears and inflammation.
Why do you have Achilles pain?
Tendons join muscles to bone and are pretty tough fibres. It may seem like you’ve developed an Achilles injury overnight but it’s often the result of tiny tears occurring over time. You are more likely to have a tendon injury if the tendon has been weakened by these tiny tears through time.
Why me? Common causes of Achilles tendonitis or tendinosis
If you’re experiencing pain in your Achilles consider the following factors that may have contributed to this pain:
- Old or poorly supportive footwear
- Hill running
- Flat (over-pronated) feet
- Sudden change in training surface
- Too much too soon with your training and lots of speed work
- Poor eccentric strength
- Wearing high heels too much
What are the signs and symptoms?
Achilles tendonitis may start as a burning type pain at the beginning of activity. It often improves as you warm up and then hits you again when you cool down. You may feel stiff in this area first thing in the morning or as you are warming up. In a nutshell you may experience:
- Pain, stiffness and loss of strength
- Pain with activities such as running and jumping
- Pain and stiffness during the night
- Pain first thing in the morning
- Tenderness when you touch the Achilles
- A ‘crunchy’ sound when you move it (not as common)
What can I do now?
First – apply RICE (Rest, Ice, Compression and Elevation). Keep in mind if you don’t have inflammation that the use of ice may be questionable but I find that patients often feel this helps with pain relief. If you are limping then you really need to apply active rest and reduce your weight bearing loads. This means backing off with intensity and duration of training. I try to keep people doing a modified version of their training where possible but it’s really an individualised situation. In some cases athletes find that a temporary heel lift gives them relief – although I often use taping to take the pressure off the Achilles.
Other things to investigate include your shoes. Are they in need of replacement? Are they still comfortable or contributing to your problems? If you’re a long distance runner for example, it’s a good idea to invest in two or three pairs of shoes and rotate them between runs.
It’s important to not leave the situation too long. If checking off the above recommendations didn’t work for you then you are likely continuing to cause more damage.
What will your physio do?
Find a physiotherapist that deals with these injuries. My approach to Achilles injuries starts with finding the cause of the problem. An initial assessment involves analysing the following:
- Training commitments (in some cases the pressure on the Achilles has simply built up over time because training is full on)
- Overall limb alignment (yes, you may have ‘flat feet’ but that doesn’t automatically mean you need orthotics although in some cases they may be useful)
- Muscle strength and flexibility (for example, relatively weak glutes can be strengthened or calf flexibility may be improved to help ease the situation)
- Joint mobility (landing hard on joints that are too stiff or even hypermobile can be contributing to the problem)
Once I’ve done that, I work with the patient to devise a plan that’s best for them. This often involves temporary taping to take some pressure off the Achilles tendon and a review of shoes. After this there’s often some work to be done in one or more of the following areas:
- Glute (butt) and core strengthening
- ITB (iliotibial band), hamstring and calf flexibility*
- Ankle and foot joint stability and strength
*I find stretching this too severely too early can exacerbate the problem and in fact massage and foam rolling often works better in the early stages of treatment.
What can I do longer term?
- Invest time in your flexibility program. Do you have tight hamstrings and calf muscles? What about your ITB? Foam rolling can be a great way to start to help in these typically tight areas
- Consider whether or not you do enough glute (butt) and core strengthening. Poor posture can also alter the pressure on your Achilles so you may need to look at your entire spine! Glute strengthening can be achieved without pressure on the Achilles through the use of a fitball or skateboard. Check out our Facebook videos for some recently uploaded ideas that even kids in our ‘Stretch and Strength’ class use
- Invest in a good pair of shoes (or several) for your sport
- Consider temporary taping to take pressure of the Achilles. In some cases a temporary heel lift may be useful
- Reconsider your training schedule. Don’t go in too hard too fast. Do you need further advice regarding whether the program is right for you?