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Achilles Tendonitis: Moderation and Stretching can Keep it at Bay

If you are active in sports, you may have experienced discomfort or soreness in your Achilles (uh-KIL-eez) tendon at one time or another, or you may have heard one of your friends complain about Achilles tendonitis. The Achilles tendon connects the large calf muscles to the back of your heel. If you trace your finger along the back of your leg staring at the heel and moving upward toward the knee, you will appreciate both the Achilles tendon as well as the calf muscles, which pull on it from above.
illustration of Achilles Tendon posted by Arun Shanbhag
What causes Achilles tendonitis?
The Achilles tendon allows you to rise up on your toes, as well as push off from the ground. This tendon is thus crucial for standing, walking, running and jumping. Repeated and continuous exertions can lead to small injuries, or micro-tears, in the tendon. If the Achilles is not given time to rest or if the micro-tears have trouble healing, the tendon can become inflamed and sore. This inflammation is referred as Achilles tendonitis.

While Achilles tendonitis certainly can affect professional athletes, it is more likely to afflict amateur athletes and commonly is seen in runners who have recently started increasing the intensity and duration of their running, like during marathon training. People with sedentary work styles may also encounter tendonitis when they participate in occasional but strenuous athletic activities like basketball, soccer or tennis.

Achilles tendonitis affects about 1 in 5,000 people at any time, and while it can occur in people of all ages, it most commonly can be found in people between the ages of 30 and 50. Some of the common symptoms of Achilles tendonitis include cramping, tightness, pain and stiffness along the back of the calf and lower leg in the morning, pain along the back of the heel that worsens with activities, thickening of the Achilles tendon itself and severe pain after exercise.

“Around January and February, we see a lot of runners training for the Boston Marathon, coming in with running related problems, and Achilles Tendonitis is one of the most common,” recounts Dr. Holly Johnson, Foot & Ankle Orthopaedic Surgeon at the Massachusetts General Hospital Department of Orthopaedic Surgery. “By resting, cross-training and conservative treatment, they can usually get back to their training,”

illustration of Achilles Tendon posted by Arun Shanbhag

The treatment for Achilles tendonitis is something you can try on your own and it can be very effective at times. It involves rest, stretching and physical therapy.

    Resting the Achilles tendon from activities that cause pain is important. At the very least you need to reduce the intensity of the workouts, and preferably take a break from the activity for 2-5 days.
    Consider cross-training to maintain fitness levels. If you participate in high-impact activities like running, basketball or tennis, switch to a low-impact activity like biking, swimming or using the elliptical machines.
    Consult with an athletic trainer or physical therapist as necessary to check if your form and techniques are correct. They may pin-point specific deviations from correct form, which could have caused the injury.
    Stretch the calf muscles. Simple exercises like calf stretches and heel drops help to relieve the pain and improve flexibility. Work with an athletic trainer to improve strength of the quadriceps and hamstring muscles. Many people find relief with using a foam roller.
    Use ice to soothe pain and soreness after a workout.
    Consider replacing your shoes if you are a runner.

Remember not to get back into high-impact activities too soon. If you have been avoiding high-impact activities, but the pain still persists beyond a few weeks, you should see a doctor.

“I had just started training for the 2014 Boston Marathon and felt a sudden pain in my Achilles tendon,” says Allison Downy from Boston, MA, looking to run her third Boston Marathon. “I knew if I didn’t take care of it right away it could potentially get worse and prevent me from running. I stopped running for a few days and instead worked out on low impact machines. I stretched and applied ice everyday and was able to continue back on my training schedule.” Allison successfully ran the Boston Marathon on April 21, 2014.

If Achilles Tendonitis is left untreated, it can be harder to treat, the tendon becomes inflamed, and the duration of pain and time to recovery increases. In rare cases refractory Achilles tendonitis requires surgical intervention.

“Achilles tendonitis is often very treatable. Proper care mandates a prompt protocol of rest and stretching. Patients should remember that recovery of Achilles tendonitis takes time. Graduated reintegration into activities is important to avoid re-injury” says Dr. Chris DiGiovanni, Chief of the Foot & Ankle Service at the Massachusetts General Hospital.

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