A Pain in the Achilles

A Pain in the Achilles

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A Pain in the Achilles

The Achilles tendon is the strongest tendon in the body, connecting the calf muscles to their insertion on the heel bone, or calcaneus. Achilles tendinitis is a common overuse injury in sport. It can be a killjoy – it affects walking, hiking and many sporting activities.

Pain in the rearfoot can arise from several sources – the most common site is in the mid-portion of the tendon, or at its insertion point at the heel. Classically, the tendon becomes thickened, stiff and very tender to touch. Other conditions that can cause pain in this region are bursitis, and rarely – a neuroma in the nerve that runs along the inside of the tendon.
The term “Achilles tendinitis” is somewhat misleading, “itis” meaning inflammation. Often, the tendon’s cellular make-up is degraded, and the more accurate term would be “tendonosis”, or “tendinopathy”. This is why anti-inflammatory medications often don’t work – as the underlying problem may not be inflammation.

There are several factors that predispose to Achilles tendinopathy: years of running (runners have a 30 times greater risk of tendinopathy), a recent change or poor choice of footwear, excessive calf tightness or calf weakness, and most commonly – a sudden increase in activity, such as speed, distance or volume of uphill running. Non-runners can develop Achilles pain – some have feet that pronate excessively. In over-pronators, a whipping motion of the heel is created which produces strain in the mid-portion of the Achilles tendon.

Your physiotherapist can provide several different treatment options for Achilles tendinopathy. These vary according to the location of the lesion and whether the condition is acute or chronic. A physiotherapy assessment is helpful to identify whether there are biomechanical factors that have contributed to the problem. It is important to rule out a partial tear – which may require a diagnostic ultrasound to determine.

An eccentric heel drop program works very well with chronic tendinopathy in the mid-third of the Achilles tendon. This is a graded exercise protocol. The heel is lowered over the edge of a step repeatedly, one set with the knee flexed, another with the knee straight. The volume of repetitions and speed are increased over time, generally 6-8 weeks.

Therapeutic ultrasound, and friction massage, performed by your physiotherapist, can help. Both provide an increase in the volume of collagen, an important component of tendon tissue. If tight areas in the calf muscles are found, massage, acupuncture and soft tissue release can help. Other issues in the rearfoot, such as a stiff subtalar joint (just above the heel) can be mobilized to help improve shock absorption. In some cases, a temporary slight heel lift can provide short-term relief. Kinesiotape, a one-way stretch tape applied along the tendon and margins of the calf muscle often provides immediate reduction in pain as the tendon is repairing. Relative rest and a change in training patterns for runners is critical in many cases to allow the cells in the tendon to repair and regenerate.

In cases where the tendon problems don’t respond to conservative therapy, there are other medical options available.

Sun City Physiotherapy Locations


1468 St. Paul Street, Kelowna, BC
Phone: 250-861-8056
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103-437 Glenmore Road, Kelowna, BC
Phone: 250-762-6313
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Lake Country/Winfield

40-9522 Main St., Lake Country, BC
Phone: 250-766-2544
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3970 Lakeshore Road, Kelowna, BC
Phone: 778-699-2006
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It’s that beautiful, sunny time of year again. It’s time to hit the tennis court, walk the golf course, hop onto the bike, or participate in other active ways of enjoying the Okanagan spring weather. As you increase your strength and endurance through these activities, be sure to also keep flexible. Make stretching a part of your routine.

Stretching describes a maneuver used to increase flexibility of soft tissue, lengthening the structures that have become shortened or stiff. Shortening can occur from situations such as immobilization (i.e. being in a cast), prolonged postures, weakness or imbalances of muscle groups, injury, or developmental conditions. Vigorous activity can also lead to shortening and tightening of muscles.

Benefits of stretching

Stretching improves flexibility by increasing the range of motion of a joint and decreasing stiffness in a muscle. This improved flexibility can improve performance in some sports, such as gymnastics, dancing, martial arts, or goalies in hockey. In other situations, improved flexibility can help obtain better posturing or help with pain.  Other goals of stretching are to reduce the risk of muscle strain, reduce muscle soreness, and enhance mental and physical relaxation.

The risk of injury from stretching exercises is low when done correctly (described below), and when held for a short duration pre-exercise (less than 8-10 minutes of stretching per area), won’t compromise muscle strength.

When to stretch

It is important to ensure that you are warmed up prior to stretching. It is best to do so actively, such as by doing a light jog, bike, or quick walk for 5-10 minutes. If you are stretching pre-activity, do so after your warm-up regime. If stretching post-exercise, it follows the active cool-down.

The American College of Sports Medicine (ACSM) recommends stretching to be a part of overall fitness program, performed for the major muscle groups at least 2-3 times a week. In some cases, stretching should be performed daily.

How to stretch

Two of the more common kinds of self-stretching are static and dynamic. Dynamic stretches are usually performed pre- rather than post-exercise. These take the joint through the range of motion rather than being sustained at an end position. These exercises should be performed as instructed by a physiotherapist or your coach.

For static stretching, go into the position slowly, just to the point of feeling tension, not pain. Hold the position for 15-30 seconds if pre-activity, and the full 30 seconds if post. It is a low intensity stretch—it should not feel strong. If you feel like you are unable to hold the full duration, back out of the position slightly. Don’t bounce while here—just hold the position. When the 15-30 seconds is up (I recommend using a stop watch, or sing the ABCs—you’d be surprised at how long it actually is!) slowly release the tension, not allowing the muscle to recoil. The ACSM recommends 3-5 repetitions per stretch.

In order to avoid injury, it’s important not to overstretch, by taking the posture too far. The position should not cause discomfort or pain, and should be within a normal range of motion for the joint being exercised (don’t hyperextend).

Overstretching can do harm by causing strain, hypermobility, or even instability. Make sure that proper alignment is used—if you are unfamiliar with a stretch, seek assistance. Otherwise the exercise may not target the proper muscle, and can even cause stress to other structures

In some cases, extra help is needed. A trained individual, such as a physiotherapist, can use manual (hands-on) techniques to help you through the maneuver. Sometimes special techniques, such as ‘contract-relax’, will be used.

What to stretch

Post-activity, you’ll want to focus on the muscles that were just exercised.

Typically the muscles most frequently shortened are the hamstrings, calves, hip flexors and pectorals (front of the chest).

If unsure of how or what to exercise, or if you have an injury, be sure to seek advice from a trained individual to ensure you’re getting the maximum benefit from your stretching program, safely.

Tess is a registered physiotherapist at Sun City Physiotherapy’s Winfield/Lake Country location.