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Achilles Injuries: How To Recover

By on Jul 6, 2013
Image illustrating Achilles injury

It’s a remarkably common injury. But there are ways to speed your recovery. Take a look at our RunningInjury guide to Achilles injuries for the lowdown on this frustrating injury.

The Achilles tendon is the largest, and arguably the most vulnerable, tendon in the body. Some estimates suggest that it accounts for around 1 in 10 running injuries.

Full recovery is common. But, for some, it can take a frustrating length of time. As this guide details, such a recovery may be aided by a straight-forward stretching and strengthening programme.

What is Achilles tendonitis?

The Achillles tendon, which connects the two major calf muscles (the gastrocnemius and soleus muscles) to the heel bone, is strong. But the tendon lacks flexibility. It is particularly susceptible to injury.

Achilles tendonitis – sometimes referred to as Achilles tendonosis – is characterised by soreness above the back of the heel. Given its well-developed nerve supply, it can be very painful.

The pain is often felt in the morning. It can also be aggravated by exercise – with particular pain felt the day after exercise.

Different forms of Achilles injury. The condition can take many forms. The pain may be felt in the lower portion of the heel, where the tendon attaches to the heel bone. Alternatively, and more commonly among the young and active, it may be felt a few centimetres higher in the mid-portion of the tendon.

In the worst cases, runners can suffer a rupture of the Achilles tendon (typically associated with a sudden snap or pop in the back of the calf or heel).

Source of the pain. There is some uncertainty about the source of the pain. It may be related to new blood vessels growing into the damaged tendon. The central nervous system may also be important in Achilles pain.

Achilles tendonitis and Achilles tendinosis. The terms Achilles tendonitis and Achilles tendinosis are often used to refer to Achilles pain, reflecting an ongoing debate as to whether Achilles pain is an inflammatory condition (referred to as tendonitis) or a degenerative condition (referred to as tendinosis).

Tendonitis was traditionally used to refer to Achilles conditions. But with analysis of supposedly inflamed tendons revealing an absence of inflammation, use of the term tendinosis has become increasingly common and is considered by some to be the medically correct term.

What causes Achilles injuries?

Research has highlighted a range of factors that could contribute to Achilles injuries, though the precise cause of Achilles tendon injuries remains open to debate.

Unsurprisingly, some studies have highlighted overuse as a key factor. During running, the Achilles tendon is estimated to transmit forces equivalent to seven times body weight.

The type of running may also be important. In addition to sudden increases in distances run, contributory factors to injury could be an increase in running pace or an increase in the frequency of hill running.

Those who overpronate, with their running characterised by excessive inward rolling of the foot and ankle, may also be at particular risk. And runners can be particularly susceptible to Achilles injuries when unsuitable running shoes are worn.

…runners can be particularly susceptible when unsuitable running shoes are worn…

More generally, those with tight or weak calf muscles – which can increase stress on the Achilles tendon – may be particularly susceptible to Achilles injuries. The wearing of high heels, which shorten tendon and calf muscles, can also contribute to the condition.

Finally, some studies have also suggested that genetic factors may play a significant role.

How can I speed my recovery from Achilles injuries?

You’ll find a full range of products to aid your rehabilitation in our dedicated Achilles-injury store.

In addition, the following recovery methods may be of use.

1. Rest. A key area of debate is the merits of rest versus continued activity.

Some argue that Achilles pain should be treated with immediate rest from running. An alternative view is that to stop walking or running can actually be detrimental to long-term recovery. Over the past few years, scientific evidence has supported the idea running should continue during the recovery process – provided that this results in no greater than moderate pain.

There is general agreement, though, that some forms of running – most notably, hill running – are best avoided when Achilles pain is present.

More generally, a cautious approach is typically advised. Although there may be no need to refrain from other sporting activities, it may be necessary to scale back where such activities result in soreness.

Danny Dreyer, the man behind the Chi Running approach, argues that without the stretching of the tendon that walking or running provides, the tendon will heal at a shorter length. That can leave runners vulnerable to the injury returning at a later date.

If you do continue running, to what extent should you scale back? The approach recommended by Bill Pierce, Scott Murr and Ray Moss − proponents of the so-called ‘Run Less Run Faster‘ approach to training − is that weekly mileage should immediately be reduced by 50%. Once the pain has disappeared, your return to previous mileage levels should be gradual.

2. Stretching. Simple leg heel raises (sometimes referred to as calf drops) form the core of standard recovery programmes, helping to strengthen calf muscles. As noted in the excellent ‘Running Anatomy‘ guide by Joe Puleo and Patrick Mulroy, such stretches “should be a staple of every runners’ strength training programme” – though the authors also note that they should be avoided if you are still suffering the initial effects of the injury.

It is typically recommended to incorporate in the stretch an eccentric component (whereby muscles and tendons are lengthened, in contrast with concentric stretches). Some studies have suggested that this may help speed recovery.

Our featured video below, courtesy of Runners World TV, provides a good demonstration of one such stretch. Some pain may be experienced in the process; where this pain is disabling, it is not advised to continue the exercise.

The exercise can be progressed by adding weight. For example, if the exercise can be performed comfortably, a weighted backpack can be added. The load of the backpack can be gradually increased over time.

There is no consensus over how many repetitions and how many times a day you should perform this kind of exercise. The classic 1998 paper by Hakan Alfredson, Tom Pietila, Per Jonsson and Ronny Lerentzon reported excellent results from such an exercise. But they tested an especially time-consuming recovery regime – 180 repetitions per day for a 12-week period.

It’s also worth noting that, to prevent reoccurrence, this stretch may need to be repeated long after Achilles pain has disappeared.

3. Footwear (men’s; women’s). As with many injuries, a change to more suitable running shoes may improve the condition. That may involve more effective motion control running shoes that are designed to limit excessive inward rolling of the foot and ankle. Heel raises, for example from Sorbothane, or orthotics, such as in the Footmedics range, can also be effective, acting to reduce tension on the Achilles tendon.

4. Surgery. For a rupture of the tendon, surgery is normally necessary. In general, most patients make a good recovery.

Note that steroid injections are rarely recommended as they can cause the Achilles tendon to rupture. And even non-steroidal strategies are increasingly discouraged, with some research suggesting that so-called NSAIDs, or non-steroidal anti-inflammatory drugs, can have an adverse impact on tendon injuries.

When will I recover from my Achilles injury

Overall, recovery from Achilles tendonitis can be relatively slow, reflecting the poor blood flow in this area. Severe cases may take several months to resolve.

In general, though, full recovery is typical. As a recent review in the American Journal of Sports Medicine concluded, there is little agreement on the best way to treat Achilles tendon disorders. But research appears to provide compelling evidence of positive results where eccentric calf muscle strengthening programmes have been followed.

More information about Achilles injuries

If you would like to learn more about the extensive research in this area, a useful literature review is provided by this paper. A more recent review of Achilles tendon disorders is provided here. For arguably the definitive guide, however, see ‘The Achilles Tendon: Treatment and Rehabilitation‘ (edited by James Nunley).

We hope that this article has proved useful to you. But, as we always emphasise, different runners’ injuries are never identical. If in doubt, we advise that you consult your doctor or sports injury specialist to assess your own individual injury.

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