Let’s Talk About: Achilles Pain
Most Achilles pain falls into two categories: tendonitis or tendinopathy. These pains are very different and require different treatments! In short:
Tendonitis. Acute damage to the tendon that happens quickly due to extreme overstress. The area is typically red, hot, swollen, and inflamed.
Tendinopathy. Accumulated microtrauma to the tendon that happens over time when the tendon is not given proper to heal. The area will be painful, but not typically swollen, red, or hot.
There’s a lot more to say about this, so if you’re curious, you can read our distinction between tendonitis and tendinopathy on our blog! But know that a majority of the time, the Achilles pain we see in runners is tendinopathy, not tendonitis.
The solution to Achilles tendonitis is typically 5-7 days of rest (no running!)
The solution to Achilles tendinopathy is slow, tolerated, progressive overload. By applying tolerated linear stress to the tendon, you slowly but surely allow the body to make stronger linear bands.
Time is key here! There is no quick fix for tendinopathy. The process of rehabbing the cranky tendons that cause you pain can take a minimum of 12 weeks and can go on for up to 32 weeks.
Yes, we know this is not something people like to hear. The good news is that you can prevent both of these injuries by strengthening your Achilles tendon. So get a jump on preventing Achilles pain by incorporating these exercises into your training!
Exercises to Prevent & Treat Achilles Pain
The Disclaimer: Unless you’re actually seeing us as a patient, we are not your medical provider! All exercises here are meant to be jumping-off points for prehab/rehab – they are by no means an exhaustive list, nor at they an all-encompassing solution. If you believe you have an injury, always make an appointment with a medical provider to have yourself assessed. If you want to see us, click the “Book Appointment” button on the top right!
Ankle Mobility (Knees-over-toes)
The unsung hero of prevention is mobility. Mobile joints tell the brain that all is well – if the brain thinks otherwise, it often will tighten things up to protect your body. If you have tight calves, this drill is for you!
Start by standing with your feet and knees shoulder-width apart. You’ll want to use your arms to support yourself on something like a chair or wall.
Start bending your knees. Think of keeping your knees moving straight forward (imagine your knee moving in the direction of your 3rd toe).
Press your knees forward until your Achilles stops you from going further
Hold for 1 second
Using the muscle in the front of your shin, continue to PULL your knees forward and towards the ground. You should feel like the muscle in the front of your shin is flexing like you would feel during a bicep curl.
Do 15-20 reps before running (or any activity!).
Pogo Hops
Pogo hops are a great way to start getting used to the impact of running. Start with performing them with both feet over 3-4 weeks and then progress to single-foot pogo hops.
Squeeze your butt and lock your knees.
Jump a small amount off the ground. When you land, think that you’re high-fiving the ground as fast as you can using only the ball of your feet and toes.
You don’t need to jump high – just a few inches off the ground to start. Think more about speed and efficiency. It should feel like you’re bouncing on a mini trampoline. If you want, you can progress to higher pogo hops in 3-4 weeks.
Start with 20-30 before your runs and progress to 40-60 as it gets easier.
Calf raise with eccentric focus
Eccentric simply means the lowering phase of the calf raise. If you’re already having pain, eccentric forces are often tolerated better than concentric forces (the raising part) in the beginning of rehab. They also give you the most bang for your buck because they allow for greater adaptation stress on the tendon.
Find a stair, ledge, or book.
Place foot on a stair with your heel off the step.
Keeping your knee straight, raise the heel as far as tolerated - it does not have to be to the top of your range of motion. No pain is the key here.
Lower your heel past the step over the course of a 4-count and hold at the bottom while still maintaining tension (don’t stretch)
Repeat TOLERATED reps. Don’t try and work through pain early on in care. It’s not going to push the ball down the field much faster if at all. This point is contested a bit but trust me, slow and steady.
Shoot to work up to 3 sets of 10
Bent knee calf raise
IMHO this exercise is one of the most overlooked strengthening exercises for the lower leg. Almost no one does it, but everyone should, for two very good reasons.
The first reason is that the Achilles tendon is DIRECTLY linked to the soleus muscles and bending your knees takes the gastrocnemius out of the equation. This allows you to put more stress on the soleus, which in turn, targets the Achilles tendon more specifically for better strengthening outcomes.
The second reason is that, during the push-off phase of the running stride, your soleus produces the most force. Strengthening the soleus maximizes your power during this phase and therefore helps you run faster. Boom.
Find a stair, ledge, or book
Place your foot on a stair with your heel off the step. Leave a slight bend in your knees.
Raise the heel as far as you can tolerate and pause. If you can’t get to the top of your range of motion, don’t sweat it, that will come.
Slowly lower your heel past the step. By slow, I mean, over the course of a four-count. Hold this position at the bottom of the movement while still maintaining tension in your calf. Don’t stretch. This is not a stretch. You want to be able to feel activation in the calf muscle.
Repeat for a tolerated amount of reps. Don’t try and work through pain! Shoot to work up to 3 sets of 10.
Key takeaways
Your Achilles is important! Strengthen it with regular drills before you have pain to guard it against injury.
Read the warning signs. If the area around your Achilles is red, hot, swollen, and/or creaky immediately following a workout, you probably need 5-7 days of no running as a minimum. You could need up to 21 days. Sad face, but there’s no way around it.
Rest won’t heal a tendinopathy. Tendinopathy pain may go away after 3-5 weeks of no running but the second you return to the stress level that started your pain, it will likely begin to hurt again. This may have you thinking, “Oh shit, it’s back!” But the reality is, it never actually went away because you didn’t change the tissue problem.
Don’t stop rehabbing just because you feel better. When you start doing your rehab, you may stop feeling Achilles pain within 3-6 weeks, maybe even 1-2. But you’re not done! You’ve reduced your pain but you haven’t “fixed” the issue yet. You need to give your tendon the time to reorganize it’s cellular structure, which takes longer than you think. 8-16 weeks to be specific.