Achilles Therapy

Achilles Tendinitis

Its summer, and the time for road races. Whether it is a 5K, 10K or 15K, the warmer weather is inspiring people to participate in running. A significant amount of training programs exist guiding the coach potato or seasoned runner. Their focus tends to be on how to increase mileage and/or time with an effort to avoid injury. However, sometimes a little too much running, not enough strengthening and stretching and poor form can result in injury. Runners appear to have 10 times greater frequency than their controlled age group with respect to Achilles injuries, with Achilles tendinitis being more common. Understand Achilles tendinitis treatment and prevention, requires understanding tendinitis and it possibly being misdiagnosed for tendinosis.

Tendinitis refers to an acute inflammation of the tendon. In other words, an inflammation that has recently occurred, and that has not been present for a long time. When there has been a tendon injury with poor healing and pathology of degeneration over a long period of time, this is called tendinosis. Think of this injury as chronically healing poorly. Tendinopathy refers to injury to a tendon, but is more general as to the pathology. More frequently, clients are presenting with a longer history of Achilles pain versus an acute injury. Understanding tendinitis versus tendinosis allows for an appreciation of treatment’s intention. A tendonitis will focus on decreasing the acute inflammation, and restoring strength and function. A tendinosis will also focus on restoring strength and function, but also recognizing what factors are contributing to continued tendon breakdown. Tendinosis recovery can take several months to achieve results, as it can take up to 100 days to lay down new collagen. In other words, if you have recently injured your Achilles, get treatment sooner than later. And for those who have a chronic Achilles issues, be patient and respect the healing phase, otherwise injuries will continue.

As mentioned above, injuries can occur from a multitude of factors. For example, footwear, foot mechanics, to strength and mobility, and types of running surfaces can influence the Achilles tendon. Thus treatment recommendations for one person may not work for another. However, in all cases, there comes a phase of strengthening and stretching. Strong glutes and core are needed to stabilize the hip and back and help absorb running forces. In the beginning phases of healing, focus on strengthening the hips and core. If strengthening exercises like squats, lunges, and dead lifts are increasing Achilles pain, then leg lifts on hands and knees or on the belly or side may be the place to begin. The following are a list of ideas of how to gradually progress a strengthening program. Reps can be 8-12 with sets 1-3. Keep to the lower end of repetitions and sets until you know how your Achilles will respond.

Initial Phase:

Straight Leg Raises

On your back lifting a leg up and down

On your side lifting top leg up

On your side lifting bottom leg up

On your belly lifting the leg up

Bridging

One legged or two legged

Clams

On your side knees bent, lifting and lowering the top knee while keeping the heels together.

Core exercises

Heel slides inverted

Pull over crunch

Toe taps with a pull over crunch or with triceps press

Scrunch

Knees facing forward

Knees angled to the side

When you start to progress into strengthening, the next challenge is balancing strengthening with returning to running. When returning to running, only 1-3 times a week may be all that is recommended. Below are some considerations. Be honest with how your body feels, and implement changes slowly to avoid setbacks.

Running Considerations:

1. You need good mobility at the ankle, including the heel, big toe, and hips.
2. Core and hip strength are needed for dispersal of forces, and off load increased stress to a hypermobile, too flexible foot.
3. Improper shoe wear can lead to chronic strains or can help prevent injuries. Shoes should still allow you to feel your foot on the ground to allow proprioceptive changes. Shoes are constantly evolving, thus working with a person who understands these changes is important. If using barefoot shoes, recognize that the foot needs time to adapt. The arch of the foot can increase and the weight bearing load may increase from quadriceps to calf.
4. Injury is associated with training errors:

Too much mileage or intensity, variable surface, and lack of consistency and/or rest days.

Mileage should increase no more than 30% weekly. Progress only 10% every 2 weeks and then a week to back off or hold at that level.

Intensity, pace and effort with only 2 of 6 runs are intense with racing equating to an intense run.

Avoid speed work until 4 weeks of tempo and hill running are completed consistently and without injury.

Ideally get off the road. Running on the road increases forces throughout the body.

5. Suggested Benchmarks to achieve without pain to return to running

Walk before jump for at least 45 minutes.

Jump before run for at least 3-5 minutes.

Run before miles for at least 2k per day.

Run uneven surface mileage before hills.

Run hills 4-6 times for 1 minute each before sprinting.

Train fully before competing.

5. Dynamic warm up (see video)

Hip 3-D stretching (see video – Hamstring, Hip Flexor, Adductors)

Calf 3 way stretching (see video – Knee drivers hands on wall or on glideboard)

Hip Swing Forward/Backward, side to side

Skipping

6. Strengthening routines can gradually increase in complexity with respect to movement patterns, as well as, the routines incorporating more agility work. Below are two less complex routines. As your progress, you can begin to incorporate more agility drills, which can be introduced in 20, 30, 45 and 60 second bouts. Strengthening sessions may be 1-3 times a week with 1-2 days between sessions.

Strength Routine 1: Squat Focus

Squats

Bilateral (Both Legs)

Unilateral (One leg, toe touch for partial assistance)

Bridging

Side Lying Squat

Heel at the edge of the platform

Wide squats

Side Lying Squats

Foot in the middle of the platform.

Wide Squats on Toes

Bilateral (Both Legs)

Unilateral (One leg, toe touch for partial assistance)

Calf Raises

Knees can be straight

Knees can be slightly bent to focus on the deeper calf muscles

Bilateral (Both Legs)

Unilateral (One leg, toe touch for partial assistance)

The focus is on slowly lowering the heel

Sprinter Start

Chugs – standing straight leg pulls in all directions with or without resistance

Planking with lower body reaches (see video)

Heel lifted for more core focus

Heel down to incorporate more of a heel stretch

Strength Routine 2: Lunge focus

Lunging facing away from tower

Initiate the motion with the buttocks

Keep pelvis facing forward

Single leg dead lift/ teeter totter (see video)

Pelvis is facing parallel to the floor

Back leg can stay on the glideboard

Back leg can lift up then reach forward

Lunging Facing Tower

Full range of motion

Hold lunge and focus on back leg straightening and bending (see video)

Lunging Standing Sideways (straight leg splits)

Monster walk

Criss cross theraband in front of legs and behind the thighs) sideways (see video)

Cross Pattern Lunges

across the body and to the front to behind the body to the back (see video)

Single arm pull up with opposite leg lift (see video)

Leg can be straight or bent

Focusing on stability of the hips and back

Bridging with feet on the floor and the hips staying lifted throughout the motion

Feet in straps to stretch

Scissor legs – Back of the leg

Feet in a V – inner thigh stretch

Low kneeling

shoes off to stretch the foot and facilitate mobility of the big toe. (see video)

Strengthening Exercises For Achilles Tendinitis

Achilles Tendinitis