The Achilles tendon is a thick band of tissue that runs along the back of the lower leg and connects the calf muscle to the heel. It is highly active any time you walk, run, or jump and this high level of stress leaves it vulnerable to injury. Achilles tendinopathy is any irritation of the Achilles tendon and it can affect both active and inactive people. It is estimated that 7-9% of runners will be affected by Achilles tendon pain, but it is also common in volleyball and soccer players.
Achilles tendon injury has been linked to a lot of different factors, including tight calves, weak calves, abnormal foot mechanics, and sudden changes in activity. The pain may be located in the middle of the tendon (non-insertional) or where the tendon meets the heel (insertional). The tendon will usually feel tender to the touch, the calf will feel tight and there will likely be pain and stiffness when you walk or run.
So how can a physical therapist help?
Physical therapy can address issues of pain, flexibility, strength and balance. The first step is really education. Your physical therapist can help problem solve to help you first reduce load and then gradually re-introduce load back into the tendon. You may need to get some new shoes. Icing the heel and temporarily reducing how much time you spend on your feet can also be helpful in the beginning.
Gently stretching the tendon and restoring full ankle motion is often necessary. Here are a few stretches that could be helpful:
Hold onto the wall for balance. Place your toes on a foam roll or dumbbell. Keep your knee straight and lean forward until you feel a stretch in the calf. Hold for 30 seconds and repeat 2 or 3 times.
This stretch is similar to the Gastroc stretch, but targets a different muscle in your calf. Hold onto the wall for balance. Place your toe back on the foam roll/dumb bell, but this time bend your knee and lean forward into the wall. You will feel the stretch slightly lower and deeper. Hold for 30 seconds and repeat 2 or 3 ties.
In addition to stretching, the mainstay of treatment for Achilles tendinopathy is gradually re-loading the tendon with exercise. Muscle weakness can also cause excessive strain on the tendon. A progressive lower-extremity resistance program can help correct any weakness that may be contributing to your pain. Here are a few basic ideas for how to strengthen your Achilles tendon.
It’s easiest to start off of your feet, where there is less strain on the muscles of your lower body. Sit on your bed and wrap a resistance band around your foot. Push your foot down as if you are stepping on the gas pedal of your car. Repeat 3 sets of 10-15 reps.
Once this gets easier you can progress to your feet. Stand facing a table or your kitchen countertop, holding on for balance. Keep the knees straight and stand up onto your toes, keeping your weight even between your left and right leg. Slowly lower yourself down to the starting position. It’s okay if this is a little uncomfortable, but shouldn’t be too painful. You can progress this to doing the heel raise off of a step or progress to doing it just on the injured leg.
Once your motion has been restored, the pain has subsided and your strength looks good you can gradually begin functional training. For some people maybe that would mean just a return to walking program, and others may need to gradually progress back to a running program.
The prognosis for non-operative treatment is good, but may be slow, with some patients taking several months to improve. For those that don’t respond to conservative measures, injections and surgery are always an option.