How to Treat Achilles Pain

I’ve got 11 days until my next half marathon. This past weekend I went for an 11-mile run. Exactly halfway through, I started getting right calf tightness. I stretched, I continued to run and this process happened probably every half-mile for the remaining 5.5 miles. As I continued the discomfort intensified. I was able to finish but my calf, and into my Achilles, felt like there was a tourniquet around it. The pressure was intense and I knew I had to do some serious foam rolling in my future. I have to admit, I’m my own worst patient sometimes and have not been rolling throughout training, so this issue was likely brought on by my own actions, however, I would like to teach you some preventative and rehabilitative protocols you can follow to reduce your chances of developing Achilles injuries.

Anatomy

The calf is comprised of a few muscles: the smaller plantaris and the bigger gastrocnemius and soleus. The muscles combine together distally before the heel bone to form the Achilles tendon (the connective tissue of attaching muscle to bone).

Function

The calf helps to push the foot downward (the gastroc with the knee straight and the soleus with the knee flexed), like a ballerina pointing her toes. This is called plantar flexion. The gastroc and soleus also assist in bending (flexing) the knee. The Achilles tendon itself is like a spring and is responsible for storing kinetic energy for power moves like jumping and sprinting.

Achilles Injury Causes

A typical injury can be minor (tendonitis) which can be treated conservatively to quite severe (full rupture) which requires surgery. The cause for injury stems from two possibilities: structural tightness and mechanical instability.

When putting the foot under load (weight-bearing) the muscles and tendon will need to both shorten and lengthen in different phases of gait, therefore one must have adequate flexibility of the tissues. The foundation, bottom-up typically the forefoot which is made up of the big toe and arch and top-down the pelvis, must provide stability to demonstrate the efficiency of movement, again through different phases of gait.

Treatment

A physical therapist can help to determine your root cause (too tight or too unstable) but acutely (the first 48-72 hours after injury) you can start with the RICE treatment. R: rest, no running! I: ice, 10-20 minutes until skin turn pink, can be done several times throughout the day. C: compression, can be stockings or compression socks if there is swelling. If no swelling, massage. E: elevation, raising the foot above the heart to use gravity to eliminate swelling.

In the sub-acute phase (48 hours to 6 weeks), we can start to work on lengthening the tissue with stretches and soft tissue mobilization. Secondly, we can work on foot and hip stabilization.

Depending on the severity of the injury, the late phase (6 weeks to 12 months), load and agility will be the focus for return to sport. *This phase and the sub-acute, for a proper return to sport, should be done with a trained professional*

Exercises

To lengthen the tissue, begin with gastroc and soleus stretching. Hold each stretch for 30-60 seconds 2-3 reps, 2-3 times per day.


Incorporate foam rolling or trigger point massage with the use of a dense ball (lacrosse ball works). Sit on the floor and place the leg on apparatus, applying body weight and begin to roll from heel to back of the knee. When finding a tender spot, hold pressure for 20-30 seconds while flexing the foot up and down. Repeat process on each sore spot found.

Regular deep tissue massages can be helpful in prevention, and if you are near Luxembourg you can book directly online with me at LuxChiro.
To stabilize the foot, begin with 3-point single-leg balance. Stand on one foot with the opposite leg reaching out to a 12 o’clock position and hold for 5 seconds, shift non-weight bearing leg out to 3 (or 9, depending on if you are on the right or left) o’clock position and hold for 5 seconds. Lastly, shift leg to 6 o’clock position and hold for 5 seconds. Repeat 3 times in each position for each leg.

To work on eccentric lengthening, start with a small step (2-8 inches). Step onto a stair with heels off the edge. Begin with both feet in a stretched position and push heels up by putting weight on toes. Progress to single-leg with knee both straight and flexed. Work up to 3 sets of 10 reps on each side.

For pelvis, try side-lying and putting yourself into a modified side plank. Raise the top leg up straight, keeping hips stacked and toes toward the floor. Work your way up to 3 sets of 10 on each side.



Footwear

See my previous post on selecting the right footwear A PT’s Perspective on Running Shoes

I was lucky my injury was not too severe and has resolved in 72 hours with foam rolling, stretching and not running. My 5 miles today were a breeze and I incorporated the strength training after my run as well. Lesson learned and thankfully not too late.


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