How to maintain a healthy Achilles Tendon

Achilles pain is a common problem with runners of all levels. Often it can start as stiffness at the start of a run or the next morning. Occasionally it may flare up especially if you have tried to increase the intensity, volume or speed of your training. Achilles tendon is located from the heel. It can be painful along the length but often it is in the mid portion or on near the heel.

So here are some handy tips on how to maintain a healthy tendon to keep you running:

Symptoms

Stiffness in the mornings or at the start of a run. Generally, not painful on walking/ at rest or on toe raises.

This is often a sign that the tendon maybe degenerative. This type of tendon symptom may benefit from specific exercises to the calf muscles to build strength through the muscle and tendon.

Week 1-2 Exercises

Circulation exercises (moving foot up/down)
Two‐legged heel raises standing on the floor (3 sets of 10‐15 repetitions/set)
One‐legged heel raises standing on the floor (3 sets of 10)
Sitting heel raises (3 sets of 10)
Eccentric heel raises standing on the floor (3 sets of 10)

Stretching after the toe raises can help to reduce calf stiffness.

Generally when you start the exercises you should not feel any pain during or after, you should feel an improvement of your symptoms within 2 weeks, but if not then it is worth getting a thorough assessment.

Week 2-5

Two‐legged heel raises standing on edge of stair (3 sets of 15)
One‐legged heel raises standing on edge of stair (3 sets of 15)
Sitting heel raises (3 sets of 15)
Eccentric heel raises standing on edge of stair (3 sets of 15)
Quick‐rebounding heel raises (3 sets of 20)

It is always best to talk through any protocol with a clinician as they understand the time frames and can help guide you through, so that your programme is effective and that you don’t waste time.

The main difference with the 2-5 week programme is doing the exercises off a step. Remember you may take longer or less time to run through the phases and the main aspect is that you do not let your pain levels reach >3/10, and that you have no lingering pain post exercise. Definitely do not continue if you have constant pain.

Some pain during a run but improves after an hour or so.

Morning stiffness, but not every day, worse with hill running or speed work.

Tender to touch the tendon and some discomfort on toe raises.

These symptoms imply that the tendon is not coping with the amount you are training on it. This tendon could possibly flare up and maybe has in the past and you have rested it.

Start by reducing the frequency and length of your running whilst building up the strength of the tendon/muscle. If toe raises are painful then start by going on to your toes and holding for 20sec (3 x per day). Once this has settled down then you can start the calf raises. Remember the exercises should never feel worse during/after or the next day.

REST- research has shown that rest does not necessarily have a positive effect on tendons and most of the research shows that a graduated strengthening programme is essential to controlling symptoms.

Jehan is a Specialist Sports Physiotherapist with an interest in tendinopathies. At JYPHYSIOTHERAPY we can offer you a full assessment and treatment to keep you running.

REFERENCES FOR THE EXERCISE PROTOCO­­­­L

Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity using a pain monitoring model during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med. 2007;35(6):897‐905.

↑ Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy‐load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360‐66.