Achilles pain? These methods really help

Typical symptoms

• Pain when getting up in the morning or after prolonged sitting that subsides when getting up
• Pain during or after exertion, such as when running, jumping, or climbing hills
• Pressure pain and stiffness in the tendon, sometimes a palpable thickening
• Loss of strength when falling, for example when climbing stairs or stepping on toes

Causes of Achilles tendon pain

Most often, there is an overload: the tendon is working harder than it can handle at the moment. Typical triggers are:

• rapidly increased running distance, more speed or many hill runs
• Re-entry after a break with too much at once
• new shoes, a new surface or a new sport with many jumps
• Insufficient strength in the calf muscles

What you can do yourself

Adjusting the load instead of completely stopping

The Dutch guideline for Achilles tendinopathy recommends temporarily reducing painful activities or replacing them with more gentle ones, such as cycling or swimming instead of running, and gradually increasing the load thereafter (de Vos et al., 2021).

A complete sports break is often not necessary. In a randomized study, the participants were allowed to continue running and jumping using a pain scale. After twelve months, they were just as well off as the group that took a break from sports (Silbernagel et al., 2007). So you use the pain scale from 0 to 10: If the pain during sports remains mild and is not worse the next morning than usual, the load is usually appropriate. If it gets worse, reduce the load again.

Building leg strength

The centerpiece of the treatment is a leg-strengthening program that is increased over at least 12 weeks. Here’s how you can get started:

1. Ankle-raising both legs: Lie down with your hips wide open, hold yourself lightly and slowly move your toes back and forth. 3 rounds of 15 repetitions.
2. Ankle-raising with one leg: If it succeeds, do it on one leg. Slowly raise it up, slowly lower it down.
3. With additional weight: Later, with a backpack, to further strain the tendon.

For pain at the tendon insertion, the guideline recommends that the exercises be performed initially on flat ground, not beyond one step on a staircase.

Patience is worth it

The tendons are slowly adapting. Expect several weeks before the pain noticeably improves, and continue training even after that.

When to see a doctor?

Immediately, if you feel a pop or a feeling like a kick in the calf, can no longer feel the tips of your toes, or feel a tear in the tendon. These are signs of an Achilles tendon tear.

You should also have it medically checked if:

• severe swelling, redness, overheating, or fever
• Pain at rest or at night
• Complaints about both tendons along with other joint pain
• No improvement after about three months of consistent training

An ultrasound or MRI is usually not necessary. The guideline advises against using images to predict the course of treatment or to monitor the success of the treatment.

Treatment of Achilles tendon pain in physiotherapy

The Dutch guideline recommends starting each treatment with three components: information about the complaints, advice on the burden of the condition, and gradually increased leg-strengthening training over at least 12 weeks. That is exactly how we proceed:

• Investigation: We determine whether the pain is located in the middle or at the tip and check strength and mobility, for example with the Power measurement.
• Training plan: You will receive a program that we increase every few weeks, up to jumping and running.
• Load plan: Together, we determine how much exercise is possible at the moment and how you can get back into it.
• In addition: Manual therapy and Dry needling Stretching the calf can provide short-term relief, but it does not replace training.

Only if after about three months of clarification, stress counseling, and training little improvement has been achieved will the guideline recommend additional measures such as shock wave therapy. For anti-inflammatory medications and cortisone injections, it advises caution (de Vos et al., 2021). Also, in a large study involving 240 patients, self-blood therapy (PRP) did not provide any benefit compared to sham treatment (Kearney et al., 2021).

Do you experience pain more under the heel? Then read our post about Foot rot and plantar fasciitis. For female runners and male runners we also offer Sports Physiotherapy an.

Frequently asked questions about Achilles tendon pain

Can I continue jogging with Achilles tendon pain?

Often yes, if you control the severity with the pain scale: mild pain when running is okay, as long as it is not worse the next morning. If the pain is severe or increasing, stop and get advice.

How long does the healing process take?

That is very different. Plan at least 12 weeks for strength training. Many notice improvement earlier, but the tendon needs time to become fully capable of being loaded again.

Should I use inserts, bandages, or a night splint?

The guideline only considers such passive aids as a possible addition if training and load adaptation do not suffice after about three months.

Does a syringe help?

Caution is advised when using cortisone injections. Plasma-rich plasma (PRP) was not better than a sham treatment in a large study. Exercise remains the most important treatment.

Sources

• de Vos R.-J. et al. (2021): Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine. Full text
• Silbernagel K. G. et al. (2007): Continuous sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy. American Journal of Sports Medicine. PubMed
• Kearney R. S. et al. (2021): Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy. JAMA. PubMed

Date in Zürich Wipkingen and Höngg

Does your Achilles tendon hurt when you run or in the morning? We will examine your tendon and together we will create a training program that suits your daily routine and sports activities. Book appointment online or by phone at 044 585 99 49.

This article does not replace medical advice.