Zach Friedenreich, PT, DPT
Physical Therapist New York City
Is pain in the back of your lower leg stopping you from running, jumping, or walking around the city?
Have you been told that resting is the best way to improve your pain?
The pain you are experiencing may be some sort of Achilles Tendinopathy, which literally translates to ‘a condition of the Achilles tendon.” Often, this injury is referred to as Achilles Tendinitis, which is simply one possible injury under the Achilles Tendinopathy umbrella.
Achilles tendinitis is one of the most common “overuse” type injuries. It’s often mistreated via complete rest. Find out how you should be managing your calf or Achilles pain to set yourself up for success in the following blog post.
What is the Achilles Tendon?
The Achilles tendon is a strong cord of connective tissue that connects the calf muscles to the heel bone. It is responsible for transferring the muscular forces produced when doing a heel raise, running, jumping, or walking.
The Achilles tendon is divided into 3 sections: the musculotendinous junction (where the calf muscles meet the tendon), the mid-substance (middle portion), and the insertion (where the tendon meets the heel bone).
How is the Achilles Tendon Injured?
Using our quick review of anatomy, we can now classify the two main categories of Achilles tendinopathy: insertional and non-insertional. We will keep things simple in describing the difference between these two.
Insertional Achilles tendinopathy is characterized by pain and/or swelling near the heel where the tendon attaches to the heel bone. It is most often caused by overuse or repetition in the younger, active population. This is especially true with activities involving running and jumping.
Non-insertional Achilles tendinopathy differs in that it generally involves pain and/or swelling located in the middle of the tendon itself. It is also related to repetitive overuse, but tends to be associated with older, more sedentary individuals.
Although there is a higher likelihood of developing one type of Achilles tendinopathy over another in certain groups, this doesn’t mean that it is impossible for a young, active person to develop pain in the middle of their Achilles and visa versa.
Should I Rest If I Have Achilles Tendon Pain?
Contrary to popular belief, simply resting WILL NOT solve your heel or calf pain. Complete rest may reduce your pain in the short term, but it is almost certain that it will only return as soon as activity is resumed. In order to prevent this from turning into a cycle, a more active approach is required.
You may be asking yourself, “But you just said that achilles tendinitis is an overuse injury…how will I get out of pain without stopping completely?” More on this below!
Similarly, only stretching the area will not get to the root of the issue. In fact, it may just aggravate your symptoms, especially if you are in acute pain.
Physical Therapy for Achilles Tendinitis
As with other tendon issues, the greatest improvement in symptoms will come from gradual, progressive strengthening of the calf muscles and tendon itself. The goal of strengthening is to increase the capacity of the Achilles tendon and calf muscle group to deal with stress or load. In this case, think of stress and load as running, jumping, or walking. Increasing the tissue’s capacity will allow for less pain with activity over time.
Early on in the process, especially if your pain is recent and acute, strengthening will start in the form of isometric exercises. As your symptoms decrease, strengthening will progress to movements like heel raise variations of greater load. With further improvement, the strengthening program would gravitate towards compound movements like squats, lunges, and deadlifts, as well as plyometrics (jumping/landing).
Can I Still Run or Jump with Achilles Tendinitis?
In addition to progressive strengthening in physical therapy, workload management is one of the most important components of Achilles tendinopathy rehabilitation. The goal is never to stop activity completely; rather, it is to modify the level of activity as necessary to facilitate the development of greater tissue capacity.
Therefore, you absolutely still can run and jump while rehabbing your Achilles tendinopathy, as long as the level of discomfort experienced during and after activity is tolerable. This is especially true once you move beyond the acute stage of pain.
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Martin R, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2018;48(5):A1-A38.