How To Treat & Prevent Achilles Tendonitis

A doctor’s diagnosis will come from a combination of a physical exam, the patient’s history (filling out a questionnaire) and if necessary, diagnostic tests. The tendon will be very tender when palpating (feeling) or squeezing it from the sides. There may be a nodule or lump felt in the middle of the tendon.

Another test is the “calf-squeeze” where they test the integrity of the Achilles tendon. The doctor may also ask the patient to do a series of exercises such as hops, jumps or leg lifts. They want to understand the level of activity-related pain, as well as exactly where the pain occurs.

Besides the clinical exam, the doctor will ask questions of the patient to ensure all details of the injury are understood.

For example, patients may describe pain as sharp versus dull, intermittent versus constant, and mild or severe. What makes the patient better or worse, such as whether the pain increases with activity. There will also be questions about his or her recent sports involvement, including any changes to the training schedule, surface or type of sport being played. Patients should expect to report past injuries and/or inflammations of the Achilles tendon, including when and how they occurred, if they recurred, and what treatments were used or have been recently used.

If you need a proven marathon training plan or affordable coaching to prepare you for your next race?
Train with me where I provide a CUSTOM EXPERIENCE based on your specific situation.

Lastly, the patient will be asked to describe any changes in the Achilles tendon area, such as increasing pain at the bony prominence at the back of the heel, swelling, tenderness, redness, or loss of strength or range of motion.

X-rays aren’t typically used in diagnosis of tendonitis, instead they can be used to help diagnose if there’s any bone problems. However, an MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis.

How to transform yourself into a confident marathoner.  Crushing26.2 is the most complete (step–by-step) marathon training plan exclusively for middle age athletes.  On Sale Now!

Treatment

Different therapy options can get you back to the trails and running healthy. Typically a doctor or physical therapist will recommend any number of the following nonsurgical activities:

To fight the pain, oral nonsteroidal anti-inflammatory medications may be prescribed to reduce pain and ease swelling. People with asthma, kidney disease, or liver disease should first check with a doctor. Steroid injections, like Cortisone, can reduce tendon swelling, but they don’t cure the problem. In my research, I found a number of sources indicate concerns that taking these kind of shots were associated with a greater risk of tendon rupture. Remember, managing the pain is only the initial part of the treatment.  The ultimate goal should be to address the root cause and prevent recurrence.

Other pain management strategies involve elevating the foot and keeping it raised above the level of the heart to help reduce swelling. An icing program involves applying ice to the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the injured area gets numb.

Alternatively, runners can switch to low impact activities such as biking, eliptical, swimming, rowing machines or other activities that put less stress on the Achilles tendon.

One of the treatments that my physical therapist tried in order to allow me to run a race, was heel lifts. These moved my foot away from the back of the shoe. Unfortunately, it only helped for about half the race, before the pain returned and became unbearable.

One unproven treatment option is with platelet-rich plasma (PRP) injections. I don’t have any experience with this treatment, but during my research for this post, it was identified as an option. However, a recent study couldn’t conclude that this was a viable protocal to treat the injury.

If the above treatments DO NOT improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur. These options are rare, but I wanted to point them out.

In most cases, lifestyle changes help improve symptoms. However, it’s important to remember that symptoms may return if you DO NOT limit activities (risk factors) that cause pain or if you correct bio mechanical risk factors, including stabilizing the foot, strengthening weak supporting muscles and correcting short calf muscles.

This is exactly what happened to me years ago. I would rest, ice, change to a more stable shoe and attempt to strengthen my calf muscles, but the root cause for me was a combination of pronation, weak glutes and hips and my footstrike was mostly on my heal (as opposed to fore or mid foot).

It’s really important that you ultimately understand which risk factors are causing your Achilles tendinitis. Left unproperly treated, the injury may make you more likely to have an Achilles rupture. This condition will cause a sharp pain that feels as if you have been hit in the back of the heel with a stick and surgical repair will be necessary.

Prevention

Below are stretching exercises that would be perscribed by your health care provider or physical therapist. they should be done under the supervision of a physical therapist, at least initially, because they could damage the Achilles tendon if they’re not done correctly:

Gentle calf stretching exercises can help stretch the muscles and aid recovery

Stretching Exercises

Sitting Heel Raises

Sit on a chair and raise your toes up as high as you can without pain. Slowly lower your heels. Do this 20 times a day. You can make it harder by pressing down on your thighs or holding a weight on your thighs.

Bilateral Heel Drop

Stand at the edge of a stair or a raised platform that is stable. Put the front part of each foot on the stair. This position allows your heel to move up and down without hitting the stair. Hold on to a railing or support to help your balance.

Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis. As long as the leading risk factors (as diagnosed by a medical professional) are addressed, performing eccentric strengthening exercises is one of the best ways to ensure that a full recovery can be achieved.

Strengthening Exercises

Grab a pair of heavy dumbbells and hold them at your sides at arm’s length. Raise your heels and walk forward (or in a circle) for 60 seconds. Be sure to stand as tall as you can and stick your chest out. Choose the heaviest pair of dumbbells that allows you to perform the exercise without breaking form for 60 seconds.

Grab a dumbbell in your right hand and stand on a step, block or 25-pound weight plate. Cross your left foot behind your right ankle and balance yourself on the ball of your right foot, with your right heel on the floor or hanging off a step. Put your left hand on something stable—a wall or weight rack, for instance. Lift your right heel as high as you can. Pause, then lower and repeat. Complete the prescribed number of reps with your right leg, then do the same number with your left (holding the dumbbell in your left hand).

Stand about 2 feet in front of a wall in a staggered stance, right foot in front of your left. Place your hands on the wall and lean against it. Shift your weight to your back foot until you feel a stretch in your calf. Hold this stretch for 30 seconds on each side, then repeat twice for a total of three sets. Perform this routine daily, and up to three times a day.

Place a foam roller under your right ankle, with your right leg straight. Cross your left leg over your right ankle. Put your hands flat on the floor for support and keep your back naturally arched. Roll your body forward until the roller reaches the back of your right knee. Then roll back and forth. Repeat with the roller under your left calf. (If this is too hard, perform the movement with both legs on the roller.)

Foam rolling can be a great tool for recovery, but I would caution that it doesn’t always work immediately, especially with really tight calf muscles. It’s not unusual for tight muscles to take a few weeks to release as long as you’re consistently rolling.