Overcoming Achilles Tendonitis: Empowering Strategies and Physical Therapy Techniques for Rapid Healing

Have you been sidelined from your daily routine and forced to take a back seat with running, weight lifting, jumping or any of your usual hobbies because of achilles pain? We are here to tell you that achilles tendinitis is a common condition, but that does not mean it is a normal condition you should experience time and time again.. At Clash PTHS, we are the foot and ankle specialists in Worcester, MA.  Too often we see clients come through our door reporting achilles pain after increasing their volume with running or choosing different footwear before setting off on a new adventure. It is our goal as the experts in central Massachusetts to provide you with education to help you live your best life. If this already sounds like you, feel free to request an appointment here.

You may have been told things from your doctor, podiatrist, or other healthcare professionals about your feet like…

• You need more support in your shoes
• You need more cushion when running on the road
• You have flat feet 
• You have tight ankles
• You need to be fitted for a different orthotic 
• You need to lose more weight
• You need to run less and walk more
• You need to be foam rolling
• ….The list is endless.

We are here to say that these are just words and not a formal diagnosis. These things are also most likely totally unrelated to your pain. Our experienced team can work with you to create a customized treatment plan to help you get to the root of your pain.

What is Achilles Tendinitis?

Achilles tendinitis is a common condition amongst young runners, walkers, and other athletes. This condition occurs when the tendon connecting the heel to the back of your leg becomes swollen near the bottom of the foot. Specifically, the achilles tendon connects two large calf muscles to the heel, allowing you to push your foot down. This motion is most frequently utilized in running, walking, and jumping. 

 Achilles tendon injuries can be separated into insertional tendinopathy (20%–25% of the injuries), mid portion tendinopathy (55%–65%), and proximal musculotendinous junction (9%–25%) injuries, according to the location of pain. 

It is important to note and understand that the use of the term tendinitis is discouraged because it implies more acute inflammatory activity, which may or may not be present in the injured tendon. Tendinopathy is described as either degeneration or failed healing due to continuous overload without appropriate recovery. 

Symptoms of achilles tendinopathy include 

• pain in the heel and along the length of the tendon during running or walking
• stiffness upon waking up in the morning
• warmth and swelling in the heel or along the tendon
• pain in the tendon triggered by touch or movement
• pain in the back of the heel when you wear shoes. 

Addressing achilles tendinopathy before it becomes serious is essential to mitigating further injury. When pain and swelling are not treated, the tendon may tear or rupture, requiring a longer recovery time. In addition, your body may compensate for achilles pain leading to referred pain or secondary injuries in muscles along the posterior chain. Your body may try to protect itself to prevent stress on the area, leading to altered biomechanics which will ultimately put unnecessary load on your hips and knees. 

At Clash Physical Therapy, we strive to educate our patients about total body mechanics, with the goal of equipping you with holistic methods for managing and preventing pain due to achilles tendinopathy. We recognize that your body contains multiple systems, working together in harmony. That’s why we don’t just address the site of pain; we take into account your whole person to help you develop ways to become your healthiest self so you can get back to doing the activities you love in and around Worcester, Massachusetts.

How Can Physical Therapy Help Me?

Physical therapy plays a crucial role in the management and recovery of Achilles tendinitis. This condition, characterized by inflammation of the Achilles tendon, often results from overuse, improper footwear, and biomechanical issues. Physical therapists are experts in musculoskeletal health and offer a multifaceted approach to address pain in the body.

Firstly, our expert physical therapists in will perform a thorough movement assessment from head to toe to identify any underlying causes and to get the big picture. They also do a thorough gait and posture analysis to address any and all biomechanical issues. From there, they sit down with you to create personalized treatment plans that may include a combination of specific exercise tailored to your deficits and strengths, manual therapy for restricted areas, and education you can easily digest around why you’re in pain. The goal is for you to be in the driver’s seat of your car with assistance from us to overcome your pain.

Strengthening exercises that target the 100+ muscles, tendons, and ligaments in our feet are central to the Clash Physical Therapy approach for Achilles tendinopathy. These exercises improve flexibility and build strength from your big toe up the chain. It is crucial when dealing with a tendon issue that proper load management is performed. We even take it a step further and will educate patients on proper footwear for their goals, temporary use of orthotics if appropriate, support or bracing, and taping to facilitate or inhibit movement at the foot to assist in the proper load management on the achilles tendon for rapid healing.

How much load does the achilles tendon bear with movement?

Studies in the last decade have conflicting information on the exact amount of body weight your achilles absorbs during certain activities. We have given some averages for the main movements just to give you an idea. The load on the achilles tendon ranged from 2.7 to 3.95x bodyweight when walking, from 4.15 to 7.7x bodyweight when running, and from 0.41 to 7.3x bodyweight  according to the strengthening exercise performed. 

What is load management?

There will always be an optimal load for your tendon – whether you train or not. This means your tendon will undergo a specific amount of stress when performing a movement such as walking, running, or hiking. When it comes to load management we are looking for optimal loading to produce tendon adaptation without causing harm from too much load. Injury will occur when your normal activity exceeds your tendons capacity to bear the load. After an injury, the load or stress the tendon can handle is less while it heals. Another critical aspect of physical therapy is addressing lifestyle and activity modifications for proper load management. Our Physical Therapists guide patients on gradually returning to their desired level of physical activity while minimizing the risk of re-injury.

A conservative, holistic approach 

Overall, physical therapy for Achilles tendinopathy aims to reduce pain, improve function, prevent recurrence, and enhance the overall quality of life for individuals dealing with this condition. It offers a holistic approach that empowers patients to take an active role in their recovery.

The treatment of Achilles tendinopathy depends on the severity of the condition. If you have mild to moderate symptoms we will recommend more of a conservative, non surgical approach. You may not know this but tendons need load to heal. Rest and Ice will only get you so far. Many studies have shown that movement, more specifically isometric and eccentric exercises, are helpful but they should be administered under the guidance of a physical therapist. Added bonus if your physical therapist is well versed in foot function. 

Eccentric exercise focuses on movements, or phases of a movement, that lengthen the muscles. For example- focusing on the lowering part of a squat would be an eccentric exercise.

Isometric exercises involve holding static positions for long periods of time. Evidence suggests the constant tension on the muscles may help improve muscle endurance and support dynamic exercises. For example, doing a bar hang or a plank would be an isometric contraction

Now let’s lay out what a holistic physical therapy treatment plan would look like for someone with Achilles tendinitis who were to seek treatment at Clash Physical Therapy in Worcester, Ma.

A holistic, non surgical approach to achilles tendonitis would look like this

1. Movement prescription tailored to you that emphasizes total body function
2. Education around hydration & overall nutrition to support healthy bone, muscle, and joint function/healing
3. Sleep hygiene education- Deep and REM sleep are where tissues repair and heal
4. Stress management education- Being in a chronic stressful state is not good for promoting healing and decreasing inflammation
5. Manual interventions such as soft tissue massage, dry needling, instrument assisted soft tissue massage or cupping to interrupt the pain signals and increase movement tolerance
6. Footwear education- our feet have 26 bones and over 100+ muscles ligaments and tendons so supportive, cushioned footwear doesn’t make sense for everyone. Especially if you are someone that is very active and wants to continue to be active for the years to come. 

It is important to take this approach since there are multiple factors that can contribute to one’s pain. Those factors include biological, psychological, and social factors. To learn more about these factors and their influence on your pain dial, click here. Regardless, the treatment with the highest level of evidence for Achilles tendinopathy is exercise rehabilitation

In conclusion Achilles tendinopathy is a debilitating injury that affects multiple domains of tendon health and physical function. Therefore, it is critical to perform a comprehensive evaluation. Ideally, the chosen treatment plan should be centered on activity modification and progressive tendon-loading exercises to promote tendon remodeling and restoration of calf-muscle function while considering the patient’s pain tolerance Furthermore, these interventions should be paired with extensive education to establish a realistic timeline for return to sport and the role of pain in guiding activity and rest. At Clash Physical Therapy & Health services, our expert physical therapists will be able to help you rapidly heal and overcome your achilles pain. To get $50 off your 90 minute comprehensive evaluation, use the phrase “heal your feet” today!

In addition, if you wanted to get started today, we would highly recommend looking into the following

1. Foot shaped footwear. Xero, Altra or Topo shoes are one of our favorites for our patients. They have a wide toe box and zero drop options in running, walking, and hiking!-make sure to get guidance on how to safely make the switch to this type of footwear.
2. Toe spreaders. You can order them on amazon today by clicking here. Start with wearing them for 10-15 mins a day. Be careful- they can leave you sore
3. Strengthen your big toes and little toes. Yes, your toes are tiny athletes that should be able to move independently
4. Stop stretching your calf and start strengthening your calf and do so barefoot to learn and feel what is actually going on at the foot.
5. Read “Born to Run.” You won’t regret it.