Achilles tendinitis can be frustrating for both the patient and therapist. This is partly because the condition itself is complicated and difficult to understand. And, although the term “Achilles tendinitis” refers to inflammation of the Achilles tendon, other structures in the area are often affected.
Confusion towards the type of Achilles tendon injury can lead to misdiagnosis alongside costly and ineffective treatments. Others waste time seeking injections and treatment from different providers without lasting relief.
To get the results you want, it is important to figure out how to manage Achilles tendinitis or any Achilles tendon injury. But, first, let’s talk about the Achilles tendon before we explore your options for achilles tendinitis treatment.
What is the Achilles Tendon?
The Achilles tendon consists of muscles in the calf known as the gastrocnemius (“gastroc”) and soleus.
An easy way to find these two muscles is to rise onto your toes and perform a heel raise. The muscles that pop out in the back of your shin are the gastroc and soleus. Together, they form one thick cord-like tendon at the back of your heel, known as the Achilles tendon.
The purpose of the Achilles tendon is to handle large amounts of force. It is stronger than any other tendon in the ankle, which means that it is important for explosive movements like running or jumping. Since the Achilles tendon activates during activity, it is easy to see how it is vulnerable to injury.
What are the Different Types of Achilles Tendinitis?
There are two types of pain associated with an Achilles tendon injury:
If you have insertional pain at the Achilles tendon, then you might feel pain where the tendon meets the heel bone. There may be a bump where the pain is, and the area around it might be extra sensitive.
Mid-substance pain typically occurs somewhere along the length of the Achilles tendon as opposed to its end point on the heel.
Knowing where your Achilles tendon pain is coming from is extremely important. Otherwise, you may be wasting time, money, and energy on treatments that won’t help your problem.
Achilles Tendinitis Treatment
There are many factors to consider for Achilles tendinitis treatment. Sometimes, pain in the back of the heel can be affected by underlying problems in your hips or low back. Unfortunately, there isn’t a tried-and-true approach to getting rid of Achilles tendinitis. So, expect your physical therapist to use a variety of treatment methods.
The number one secret to Achilles tendinitis treatment is activity modification. This means that you will need to find ways to alter your workouts, especially if a certain movement is the cause of your pain. Your physical therapist can give you pointers on how to do this. In doing so, you avoid aggravating your pain and give the tendon time to heal.
Like other tendon injuries, it is important to remember that Achilles tendinitis happens for a reason. Discussing your daily activities and fitness routine with your therapist may uncover something that is causing your Achilles tendon pain. This is undoubtedly important for runners who may need to alter their running volume, frequency, or form.
Activity modifications are specific to each person due to the nature of Achilles tendinitis injuries. For example, someone who is a skilled weightlifter may need to tweak his or her stance during squats. The person who loves to exercise on a spin bike may need to decrease mileage to avoid aggravating pain. Your activity modifications will be unique to you, your skill level, and your sport. Check out our favorite ways to train while injured in our blog: 12 Workout Modifications to Help You Train When You Have An Injury.
Here is another way to look at activity modification: Imagine you have a paper in front of you, and you are tasked with writing down 10 activities that you do everyday. On the left side of the board, you would write the activities that caused you pain. On the other side, you would note the activities that you could do without pain. The goal of activity modification is to add more to the pain-free side while reducing the activities on the left (painful) side.
Remember, if you suffer with Achilles tendon pain, you do not have to stop exercise altogether. It’s all about altering your activity for a short period to give your Achilles tendon some time to heal.
What is the Purpose of Achilles Tendon Loading?
Another treatment for Achilles tendinitis is to strengthen your Achilles tendon through tendon loading.
This is a critical part of your rehab process. It is also one of the top reasons why you should seek expert help in dealing with Achilles tendinitis. Tendon loading involves finding the perfect balance between “too much” and “not enough.”
Loading the Achilles tendon refers to the amount of tension that the tendon can handle. Underloading is ineffective because loads that are “not enough” will not increase the tendon’s strength. On the other hand, overloading the tendon may lead to a painful flare-up and can halt your progress in therapy.
Once the right amount of tendon loading is achieved, strengthening the Achilles tendon can begin. In the beginning, it is common to experience mild discomfort or pain. This is normal and should get better as the Achilles tendon becomes less sensitive to the tendon loading process. However, finding the right amount of load for your Achilles tendon may take some trial and error. It will involve tweaking your reps, sets, training volume, and tension that your tendon can currently handle.
Many people tend to focus on the gastrocnemius and heel raises for Achilles tendon strengthening. But, the soleus should not be neglected during the rehab process for Achilles tendinitis.
Recall that the soleus is the second muscle that makes up the Achilles tendon. It lies underneath the gastrocnemius and is active during seated calf raises. Because the soleus is often forgotten, it can be a contributing factor in Achilles tendinitis pain.
Thus, treatment for achilles tendinitis should always include soleus strengthening exercises.
Research on Achilles Tendinitis Treatment and Strengthening
Research studies have found some interesting information on Achilles tendinitis and heel pain.
These studies show that people with Achilles tendon injuries tend to be weaker than those without. This is especially true when it comes to strength and endurance of the muscles that point the foot. And, as you probably had guessed, the muscles that point the foot are the gastrocnemius and soleus.
Pointing the foot downward, aka plantarflexion, is necessary for walking, running, climbing stairs, or jumping. Not only does it produce the “push off,” but these muscles also work to control the movement of your foot, ankle, and leg as you land. Weakness in the Achilles tendon muscles can lead to serious injury, which is why strengthening is a crucial part of the rehab process.
These studies show the importance of tendon loading and strengthening for Achilles tendinitis. Also, for rehab to be successful, tendon loading must be able to meet the demands of various athletic activities. Otherwise, athletes will not be able to cut, jump, sprint, or land without risking injury.
Stretching for Achilles Tendinitis
Contrary to popular belief, stretching is not always the best treatment for Achilles tendinitis.
Stretching can be safe for certain types of Achilles tendinitis. However, if performed incorrectly, it can cause more harm than benefit. This is because stretching the Achilles tendon can increase the amount of friction against the heel bone, potentially leading to irritation or a tear.
Instead of stretching, your physical therapist may choose to perform ankle joint mobilizations that can decrease stiffness within the joint. Stiffness within one, or both, ankle joints is a common culprit that can frequently contribute to problems with the Achilles tendon.
Dry Needling for Achilles Tendon Pain
Although dry needling will not get rid of your Achilles tendon pain completely, it is great for short-term pain relief.
If your physical therapist recommends dry needling for your tendon pain, then know that needles will not be placed into the tendon itself. This is true regardless of where your tendon pain may be. Avoiding this can prevent further damage and preserve the structure of the Achilles tendon.
Instead, your physical therapist will direct the needle into the muscle belly in an attempt to find a trigger point. In doing so, dry needling can stimulate a mild reaction in the muscle that will relieve pain for a brief amount of time.
As a result, short-term pain relief from dry needling can allow you to make progress on other aspects of treatment, like tendon loading or joint mobilizations.
Use of a Heel Lift or Orthotics for Achilles Tendon Pain
Right now, there isn’t strong evidence for the use of a heel lift or orthotics for Achilles tendon pain or problems. That being said, there are some people who might benefit from them.
If your shoes are contributing to improper tendon loading, then an orthotic, or a custom-made insert, could be useful. However, that is best determined by a professional since not everyone with heel pain or Achilles tendon problems will need an orthotic.
Your therapist may suggest that you temporarily use a heel lift to unload the Achilles tendon, especially if your pain is new. Experts and research studies agree that short term use of a heel lift can provide external support while allowing your tendon to heal.
Other Achilles Tendinitis Treatments
What happens when Achilles tendinitis and heel pain extends beyond the ankle joint?
It is not uncommon for other areas of the body to become affected from Achilles tendon injuries. Pain in your heel does not necessarily mean that it is the only area that is problematic.
Because of this, your physical therapist will screen for issues with your low back, nerves, and sacroiliac joint. He or she may also check your hip, glute, and core strength as well as your body’s ability to stabilize itself.
Key Points about Achilles Tendinitis
Like shoulder and low back pain, Achilles tendinitis can be difficult to understand and complex in nature. And, unfortunately, doing calf stretches and heel raises will not be enough to get rid of an Achilles tendon injury.
Because of this, you seek expert help as opposed to treating Achilles tendinitis on your own. Seeing a professional ensures that you are treating the right part of your Achilles tendon and receiving the most effective treatments to get rid of your pain. Otherwise, you may experience lingering pain that can turn into chronic ankle issues.
Finding expert care for Achilles tendon injuries can be a challenge. You want to find a physical therapist who listens to your problems, understands your limitations, and discusses treatment options that will work for your lifestyle. Dr. Andrew Junak is a physical therapist and board-certified specialist in orthopedic physical therapy with vast experience with Achilles tendon injuries. If you are searching for ways to get back on your feet, then Dr. Junak is the best option for you.
Right now, Dr. Junak is offering free phone consultations to new patients. This is a great way to learn about him and ways in which he can help you re-establish a healthy and active lifestyle after suffering from Achilles tendon pain. Reach out to him today to begin your rehab journey.
About the Author
Dr. Andrew Junak is a Doctor of Physical Therapy and Board-Certified Orthopedic Specialist. Dr. Junak received his Doctorate of Physical Therapy from Walsh University and completed his Orthopedic Specialist training at the Cleveland Clinic Orthopaedic Residency Program. He is the owner of Peak Physiotherapy and Performance, a physical therapy clinic in Canal Winchester, Ohio where he serves the local communities of Lancaster, Reynoldsburg, Grove City, Pickerington and Columbus. In his practice, Dr. Junak helps clients with jaw pain, neck pain, and headaches find relief without resorting to medications, injections, or surgery.