These days, due to COVID-19, Chiropractic Clinics in Ontario are not seeing in-person patients unless it’s an acute/emergency situation.  That means that many of you who are out there experiencing pains that are upsetting your own life, activity and function are not able to get the treatment that you need to make it go away.  So let’s start with a lesson on Achilles Tendinitis and how you can work on it at home in order to help yourself while your therapist is unavailable.

What is your Achilles Tendon?

The achilles tendon is a very common injury in runners.  Most of the force generated from your toe off during your run stride is transmitted by the achilles.  This force can be up to 3 times your body weight and increases the faster you run.  

The achilles tendon is the largest tendon in your body.  It is a thick fibrous band of tissue that attaches your calf muscles to your heel.
It is responsible for plantar flexion of the foot (i.e. pointing your toe towards the floor, standing up on tip-toes, toeing off during walking and running)

What is Achilles Tendinitis?

Achilles tendinitis is when the achilles tendon becomes inflamed and irritated (note that there is a difference between tendinitis and achilles rupture.  Rupture is a sudden and severe pain at the heel / achilles area and this requires immediate medical

attention).  It can become hard and thickened with a bone spur at its heel insertion if it becomes chronic.  Insertional achilles tendinitis is when the damage is at the point where the tendon attaches to the heel bone and non-insertional achilles tendinitis is when the damage is in the middle fibres of the tendon.  Insertional happens throughout all age categories and non-insertional is most common in young active people.

If you have Achilles Tendinitis you may feel pain when you’re walking and/or running during toe-off, pain at the achilles tendon when doing a heel raise, tenderness to touch the tendon, warmth or swelling in the tendon area, increased pain or stiffness in the morning.

Risk Factors:

For runners, the risk of achilles tendinitis goes up for those doing a lot of speed training, hill running or running with a forefoot stride type gait.

Some other things that can increase your chances of getting achilles tendinitis include:

• Starting a new sport
• Increasing duration and intensity of a sport too quickly
• Tight calf muscles
• Poor ankle range of motion
• Improper footwear
• Bone spur at the heel
• Flat feet (pes planus)
• Wearing high heel shoes

Self Care: 

There are some things you can do to help yourself deal with and get over Achilles Tendinitis.

When you first start to feel it, stop running (or whatever activity you have been doing that is that seems to be the aggravating activity) and REST it.  If you don’t rest this can become a chronic and recurring problem.

Then, follow RICE for the first few days:
REST for any activities that cause pain at the achilles tendon (consider cross                                  training activities such as swimming or cycling)
ICE 15-20 minutes several times per day
COMPRESSION around the ankle with a theraband (wearing compression socks                                               may also help)
ELEVATE the ankle at or above heart level when at rest

Then, you can get into some self treatment to continue decreasing your symptoms, such as:

1. Cross friction massage at the sides of the tendon (where you feel restrictions) 5-15 mins/day – start lightly and gradually increase your firmness as the tenderness at the tendon decreases.  When a tendon gets damaged, some of it’s fibres are ruptured.  A strong tendon is made up of hundreds of fibres laid down in parallel and when a damaged tendon begins healing the body lays down new fibres to replace the damaged one’s, but in a more disorganized and erratic way.  The goal of the cross-friction is break up the fibres that are not aligned in order to help the body lay down parallel fibres that are smooth and aligned in a way that will re-create a healthy tendon over time.
2. Stretch calves your calf muscles – gently, up to 30s.  Be careful not to stretch too aggressively as it can damage the tendon.

When pain has significantly decreased and you no longer feel pain with walking and other daily activities, you may add progressive strengthening of the achilles tendon to your self program of management.  You should also continue the cross friction and the stretching as well and make this an ongoing part of your body work in order to prevent your achilles problem from recurring.

1. Start with heel raises off the floor, as high as you can without pain in the achilles. Start with 1 x 10 reps and build up to 3 x 10 reps over the course of time as the area gets stronger.
2. You can progress do doing these off a step, allowing for bigger range of motion, again starting at 1 set of 10 reps and building to 3 x 10 reps over time.  You can also progress to doing these one leg at a time.
3. Finally, progress to focussing on the lengthen, or the eccentric phase of the movement.  You can go up on the toes fairly quickly, to the top of the movement, and then very slowly let the heel drop back down (below the height of the step) to whatever your flexibility allows.  1 x 10 reps to start and building to 2-3 x 10 reps.  This exercise is designed to selectively break down those misaligned fibres mentioned above and by design will cause some discomfort.  This is one exercise where you can work through some mild to moderate discomfort as you work through your achilles tendon recovery.

These achilles strengthening exercises can be done 3 times per week, with a day of rest in between them.  At this time you can also initiate a gradual return to sport.  Sport activity can be initiated when it can be done pain free.  If you are a runner, start with a run/walk program and take your time building back up to constant running.  Build your weekly volume at a rate of 10-15% per week.  Be careful not to progress too quickly as you don’t want to set yourself back and have to go through these phases of treatment and recovery again.  Pain-free cross training can be done and is recommended to continue as you work your way through this recovery phase as well.  It will help keep you fit and balanced and you get back to your usual running program.