Achilles Injuries

What is Achilles Tendinitis ?

The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heal bone (calcaneus). This tendon can become inflammed through overuse as well as a number of contributory factors. It is estimated that 11% of all running injuries can be due to Achilles tendinitis. The Achilles tendon has a poor blood supply which is why it is slow to heel. Achilles tendinitis can be acute or chronic. Acute tendinitis will happen as a result of overuse or training too much, too soon especially on hard surfaces or up hills.
If your feet roll in when you run or overpronate then this can increase the strain on the Achilles tendon because the tendon is twisted as the foot rolls in.
If the warning signs of Achilles tendinitis are ignored or it is not allowed to heal properly then the injury can become chronic. Chronic Achilles tendinitis is a difficult condition to treat. The pains experienced during the acute phase of the injury tend to disappear after a warm up but return when training has stopped. Eventually the injury gets worse and worse until it is impossible to run.

The symptoms for acute inflammation of the Achilles tendon are:
Pain on the tendon during exercise.
Swelling over the Achilles tendon.
Redness over the skin.
You can sometimes feel a creaking when you press your fingers into the tendon and move the foot.

The Symptoms for chronic Achilles tendinitis are similar to those of acute tendinitis as well as:
Pain and stiffness in the Achilles tendon especially in the morning.
Pain in the tendon when walking especially up hill or up stairs.
Chronic tendinitis differs from acute tendinitis in that it is more of a long term persistent problem.

What can the athlete do?
Rest and apply cold therapy or ice (not directly onto the skin). See a sports injury professional who can advise on treatment and rehabilitation.

What can a Sports Injury Therapist or Doctor do?
Prescribe anti-inflammatory medication.
Identify the causes and prescribe orthotics or a change in training methods.
Tape the back of the leg to support the tendon.
Apply a plaster cast if it is really bad.
Use ultrasound treatment.
Apply sports massage techniques.
Prescribe a rehabilitation programme.
Some might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture.

If you look after this injury early enough you should make a good recovery. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not look after this injury then it may become chronic which is very difficult to treat.

Rehabilitation(Achilles tendinitis) The following is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.

Aims of rehabilitation:
1. Decrease initial pain and inflammation.
2. Improve flexibility.
3. Improve the strength of the joint.
4. Re-establish neural control and co-ordination.
5. Return to full fitness.

Decreasing pain and swelling
Ice - apply for 20 minutes at least three times a day. Every two hours if possible for the first day.
Identify the cause of the injury. Training too much too soon, training on hard surfaces, wearing the wrong shoes or shoes that are too old and not warming up are possible reasons for the injury occuring. Also, if you over pronate, the Achilles is twisted putting more strain on it.
Rest - use crutches if needed. A good taping method is available which supports the tendon. Place a heel lift of about 1cm into both your shoes to help take the stress off the tendon. Do not leave it there for ever and only use if you are or intend stretching. If the calf muscles adaptively shorten, an increased strain will be placed on the achilles tendon in future. Anti-inflammatory medication can be taken (under Doctors advice of course). Maintain fitness by non weight bearing exercise such as cycling if pain allows. There is still a strain on the tendon when cycling and swimming so if your injury is bad rest only.

Improving flexibility
Concentrate on improving the flexibility of the calf muscles (Gastrocnemius and Soleus). This will reduce the strain on the achilles tendon.
Two stretches in particular are important, one with a straight leg for the Gastrocnemius muscle and one with the leg bend to target the Soleus muscle.
Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
Use sports massage techniques. This will help prevent adhesions (sticky bits) forming. These adhesions stop the tendon sliding smoothly in its sheath.
Sports massage should also be used on the calf muscles themselves to aid in improving the flexibility and general condition of these muscles.

Strengthening The aim is to strengthen the calf muscles and the achilles tendon. It is important that you strengthen the tendon in the stretched position. See strengthening exercises.

Start off with three sets of 10 and gradually increase day by day making sure you do not over-do it. If it is painful or sore afterwards then rest for a day and reduce the workload.

Improving proprioception (neural co-ordination)
It is possible that the neural control or co-ordination of the ankle has been affected, especially if the injury has been bad and required a sustained period of rest.

Standing on one leg with your eyes closed is a good way of developing proprioception. This will help prevent spraining the ankle in future and is a good all round strengthening exercise for the ankle. Aim for 2 minutes without wobbling.

Return to fitness
When you have gone at least a week without pain then you can begin to return to training. If you feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.

After training apply ice or cold therapy to the tendon for 10 minutes to help prevent inflammation from returning.
Day 1: walk 4 minutes jog 2 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 3 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 4 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 6 minutes repeat 4 times

Continue this gradual progression until you can confidently run and resume normal training.

Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed.

Continue with the stretching and strengthening programmes. It is important to do these even if you do not gain pain at this stage. Continue for at least three months. Continue to ice the tendon after training. You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return.

Prevention of achilles tendinitis
Achilles tendinitis can be prevented by understanding the possible causes of the injury:


1. Training too much too soon.
2. Training on soft surfaces such as grass or sand for long periods of time. The soft surface allows the heel to drop more, so placing more strain on the tendon.
3. Wearing the wrong shoes or shoes that are too old.
4. If you over pronate, the Achilles is twisted putting more strain on it.
5. Not warming up properly.
6. Failing to stretch properly.

If you feel you have done just about everything right and still have ongoing problems you may need to see a Podiatrist and get a full biomechanical analysis to identify the cause.

Source: Sports Injury Clinic