Are you familiar with the story of Achilles? He’s one of the greatest warriors in Greek Mythology. He was essentially unbeatable, except for his one vulnerability – his heel (or rather, his tendon). If you’ve ever experienced this injury, you know how it can literally stop you in your tracks. It’s common in runners, and is especially aggravated by sprinting and uphill running.
Don’t let this injury hold you back! There are a few essential stretching and strengthening exercises that can help you rehab your Achilles tendon and get back to your workouts pain-free.
What Is Achilles Tendinitis?
The Achilles tendon is the largest and strongest tendon in the body. It allows us to extend our ankle (plantar flexion) and push off. Achilles tendinopathy, or more generally known as Achilles tendinitis, occurs when the tendon fails to heal fully. At first, this may start as short-term tendinitis where the pain is mostly due to inflammation. However, if the pain and inflammation continues, tendinitis becomes a tendinosis, and neovascularization (growth of new blood vessels) occurs.
It is thought that much of the pain associated with Achilles tendinitis comes from the neural pathways associated with these new vessels. What this means is that, once you are dealing with tendinosis, you must be very careful about how you continue to exercise, as the problem then becomes a long-term condition. The collagen matrix in the tendon becomes more disrupted, and it can take weeks to months for the tendon to repair itself. Until it does, expect increased pain with exercise.
What Are The Common Causes?
There are four causes primarily associated with Achilles tendinitis. To prevent developing this injury, follow the tips included here.
1. Sudden Increase In Activity
Your body becomes accustomed to a specific amount of activity. If you suddenly and rapidly increase your activity level, your tendon may not be able to handle the excessive stress and will break down.
Tip: Always ramp up activity slowly to allow the tendon to acclimate.
The human body is always trying to heal itself, but when the rate of damage from overuse outweighs your ability to heal, your tendon will start to breakdown. This eventually leads to the long-term changes in your tendon associated with tendinosis.
Tip: Make sure to take enough rest between workouts, so your body has enough time to heal fully. Also, cross-train so that you strengthen your body in multiple ways.
3. Flat Feet & Poor Foot Mechanics
When you lose the arch in your foot, the biomechanical efficiency of your foot significantly drops. The action of “pushing off” with a stable midfoot that has a solid arch compared to a flat foot is like comparing lifting weights to lifting a floppy, old mattress. The old mattress might be the same weight, but it’s much harder to control as you lift.
Tip: If you have flat feet, consider using orthotics. If you have poor foot mechanics, incorporate some foot strengthening exercises and stretches to fix your mechanics.
4. Tight Ankles
Stiff ankles can also lead to poor foot mechanics. When the ankle joint is tight, it will cause increased stress to the rest of the foot, which may alter the alignment of your foot.
Tip: Include stretching exercises like the calf and soleus stretch to maintain proper ankle range of motion. You can also consider strength training in minimal shoes, or barefoot to encourage proper foot flexibility and mechanics.
What Are The Symptoms?
How do you know if you have Achilles tendinitis? Here’s what to look out for:
1. Pain or inflammation in the Achilles tendon, especially the day after exercise.
2. Pain in the Achilles tendon or the back of your heel when you stretch your ankle.
3. Pain in the Achilles tendon with walking or running.
4. Thickening of the tendon (a sign of prolonged tendinopathy).
Note: Pain in the middle of the tendon is more common. Some people have pain at the bottom of the Achilles where it inserts into the heel bone (known as insertional Achilles tendinitis). These symptoms often take longer and can be more difficult to treat.
Top Exercises To Fix Achilles Tendinitis
If you’ve determined that you have Achilles tendinitis, you might be wondering how to rehabilitate it. Follow these steps to manage and fix the inflammation and pain in your Achilles.
Rules Of Fixing Achilles Tendinitis
- Before exercising, minimize the pain! It is ok to exercise with pain, but the pain should not increase to the point where it’s unbearable.
- You should be able to walk normally without a limp.
- The next morning, the pain should not be worse than the previous morning.
- If you cannot walk without a limp, it is advisable to either rest, or use a heel lift, which helps to decrease the tensile load on the tendon.
- As the acute inflammation decreases, try to wean off the heel lift.
If you can follow those rules, try these 5 exercises:
1. Calf & Soleus Stretch
This is the first and easiest step. Loosen the gastrocnemius and soleus with these stretches. Make sure to drive your heel down as you bring the rest of your leg forward. By bending the knee, you can focus on stretching the ankle and soleus more.
Maintain the alignment of your foot with doming, and potentially orthotics. The doming exercise (also known as short foot) teaches you how to maintain your arch using your foot muscles. If you are unable to do this, then supplement this with arch support. You should be able to maintain this position whenever you stand.
3. 3 Position Single-Leg Balance
Challenge your balance (with proper foot mechanics) to help strengthen your foot muscles. Start with simply standing tall and balancing on one foot. Once you can do 10 seconds consistently, also try these two other positions: single leg squat and single leg hip hinge (pics). And then once you can do 3 of those consistently, grab a weight and perform halos while maintaining your balance.
4. Eccentrics & Time Under Tension
These are the most important exercises for rehabbing Achilles tendinopathy. When there is pain in the Achilles, most people are told to rest. This is good advice at first, however the calf muscles AND the tendon will also begin to atrophy. To avoid this, practice isometric and eccentric exercises.
Introduce isometric exercises first, where you load the tendon without movement. Just stand on one leg, and lean forward so that the weight is on the ball of your foot (heel should still be touching the floor). Hold this for 10 seconds at a time. Repeat for sets of 10. You should feel your calf working as you lean forward. This is a very physiologically safe exercise as there is no movement to the tendon. Ideally, you would perform this throughout the day for multiple sets of 10.
This exercise is generally considered the gold standard for tendon rehab. After you are comfortable with isometrics, transition to eccentrics, which add in motion mostly in only one direction.
Also known as negatives, you will rise onto the ball of your feet using the strength of both legs. Then, put all of your weight on your injured side, and SLOWLY lower yourself. Take at least 4 seconds to get back to the start position. You can even do this on a step and allow your heel to go lower than your forefoot (unless you have insertional pain at the heel bone). Once you hit bottom, use both legs to press back up, and then repeat.
Parameters: As this is your main exercise, perform as many sets as you can.
As your strength increases and you can do 3 sets of 15 without too much fatigue, you can wear a backpack with weights (or hold dumbbells). However, if this causes too much soreness the next day, decrease the weight.
5. Foam Roll
Lastly, help the calf muscle relax by spending a few minutes rolling it out with a foam roller. Try to get both the medial and lateral sides of your calf, and be patient – the more weight you apply to the calf, the slower you should roll.
The hardest part about exercising with Achilles tendinopathy is trying to find the right balance of exercise without flaring up the tendon, and rest.
Remember the basic rule: you should stop BEFORE the pain makes you stop, and your symptoms the next day should never be worse than the previous day. If you are able to do this while exercising to increase the strength and flexibility of your leg, then your tendon should slowly be able to recover and regenerate.
Try out these exercises, and be patient! If you have any other questions about rehabbing your Achilles tendon, reach out in the comments below.