Overuse Injuries: Achilles Tendinitis
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Achilles Tendinitis: What it is, what causes it and how to treat it

The Achilles tendon is the largest tendon in the body. It runs down the back of the lower leg joining calf muscles to the heel bone and is designed to withstand significant force and power during the push off phase of running, jumping and walking. When the tendon experiences degeneration or repeated micro tears from overuse, it can become compromised and surrounding tissues inflamed, causing what is referred to as tendinitis. However, since the tendon itself doesn’t get inflamed, despite the damage, tendinopathy is a more accurate name. No matter what you call it, it can be frustrating painful and persist for long periods of time until it’s properly treated.

For an historical aside, it’s common knowledge that an “Achilles Heel” is a weakness, but do you know why? Achilles, the great warrior from Greek mythology, was vulnerable in only one spot—his heel, as that’s where his immortal mother held tight when dunking him in the River Styx (her thought was it would boost his invulnerability since his dad was a mere mortal). As you can guess that Achilles’ very own heel was also the cause of his demise… and, seemingly, ours when tendinitis strikes.

There are two types of Achilles tendinitis:

Noninsertional Achilles Tendinitis
– Pain presents in the middle portion of the tendon and there be a visible bump.

Insertional Achilles Tendinitis
– This type hurts in the heel in the general area where the Achilles tendon attaches to the heel bone.

Symptoms

Achilles pain tends to come on gradually. What begins as an ache in the back of the leg or around the heel after a run generally becomes more acute if you continue running without treating the pain and underlying causes.

Symptoms may include:

-Discomfort, swelling and tenderness in the back of the heel (it may hurt when you pinch the Achilles tendon or the skin at the heel may feel warm—more so than usual—to the touch)

-Stiffness and pain in the morning that lessens as you warm up and begin moving

-Pain along the tendon or at the heel that worsens as your run

-Tight calf muscles

-Limited range of motion when flexing the foot with the affected tendon

-Bone spur

-A sudden “pop” with persistent pain (see your doctor immediately if you experience this as you may have torn your tendon)

Causes

The primary cause of Achilles tendinitis comes down to overuse. But there are many other factors, which can contribute to the injury, including:

-Rapid increase in the amount and intensity of running

-Excessive speed training and uphill running

-Overstriding, where the foot lands in front of the body, not under it

-Being a “weekend warrior” when it comes to running and training. In other words, if you’re only running or doing vigorous exercise a couple of times per week, you’ll be more susceptible to Achilles tendinitis.

-The Achilles can weaken and degrade with age. (This doesn’t mean pain is inevitable though.)

-Tight calf muscles

-Reduced ankle flexibility and range of motion

-A bone spur where the Achilles tendon attaches to the heel

-Worn out shoes

-It may also be exacerbated/caused by forefoot running and certain antibiotics

Treatment

Try the following options when you begin to notice aching at the back of the ankle or a burning sensation on the bottom of the heel.

Rest, Ice, Compression, Elevation

Take a break from the activity causing the pain—as in cut back or stop running for a couple days. Ice the injured area for 10-20 minutes three to four times a day. Wear a compression sock to stimulate blood flow through the ankle and heel. Elevate the affected foot when you can.

Tape it 

Taping your Achilles may help relieve tension and pain.

Warm it up

If your pain is more chronic, applying heat and gently massaging the ankle and Achilles may help to ease discomfort, especially first thing in the morning or before activity.

Stretch

Gently stretch calves and tight legs.

Visit your doctor or physical therapist

In addition to considering the benefits of treatments like acupuncture, electrotherapy, arch supports, heel lifts and the Active Release Technique, a medical professional will be able to recommend stretching and strengthening exercises. Also, visit your doctor immediately if you experience a popping sensation, acute pain and suspect your Achilles may have torn.

Do Eccentric Calf Raises

As far as making a difference when it comes to Achilles pain, there are several exercises that can be simple but effective. Keep in mind, they may hurt–not too much, but don’t be surprised by some discomfort. Watch this video to learn how.

To help your medical professional, and you, determine the degree of your injury and pain, consider the questions from the Victorian Institute for Sports Assessment (VISA) Achilles questionnaire prior to your visit.

Prevention

Like any overuse injury, there are common sense steps you can take to keep running injury (and pain) free.

Stretch and roll
A regular self care program (one done every day) will help keep your body healthy and injury free.

Warm up
Before any run, but especially one that involves speed work and running uphill, it’s critical to warm up [http://www.runnersworld.com/run-nonstop/how-and-why-you-should-warm-up-before-a-run] and prepare muscles and ligaments for the rigors ahead. Not only does it help with injury prevention, but it will also help you have a better workout.

Ramp up gradually
Give your body time to adjust to the demands of increased intensity and mileage loads.

Cross-train
Cross training gives the opportunity to build aerobic fitness and work different muscle groups while giving running muscles a break from the high impact of running. To increase all-over strength, be sure to add weights to your weekly routine.

Analyze your gait
If you are new to running or have a history of running-related injuries, schedule a visit with your physical therapist to analyze your gait (be sure to check for over striding) and biomechanics.

Check your shoes
Worn out shoes or those that aren’t supportive enough through the arch may contribute to your Achilles pain. The Achilles may also be tender if you’ve transitioned to lower drop shoes too quickly.

More info

Watch this explanatory video for more information about Achilles tendonitis and how to treat it.

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