Get up and Go – How to Fix Achilles Tendonitis
You wake up in the morning, jump out of bed thinking I’m late I need to get a move on but then… The first few steps you’re absolutely crippled with stiffness and pain in the back of your heel. You’re thinking “I’m just a little stiff from the run yesterday” and “I have trained hard so this is normal”.
But yet somehow you’ve felt this little ache for a week or two now and it doesn’t seem to be going away, even though it loosens up a bit after a couple of steps.
Yep, you might actually have the dreaded Achilles Tendinopathy (or “Achilles Tendonitis”) and no… no-one has kicked you in your calf! Most runners tend to neglect the warning signs and symptoms I discussed in the post on Achilles Tendinopathy so in this post you will learn what you can do to help get rid of this and also what I have found to be the best treatment “protocol”.
Before I go into the treatment side of things be sure to check in with your therapist or doctor to establish the origin of the problem as there may be a few things that have caused it and if these aren’t addressed your Tendinopathy may reoccur.
These techniques I have found to be the best strategy for treating Achilles Tendonitis but depending on the severity of the damage in the calf and tendon, it can take up to 12 weeks for full recovery.
- Deep Tissue Massage
- Self Myofascial Release
- Eccentric Exercises
- Dry Needling
- Orthotic Prescription
- Shockwave Therapy
Deep Tissue Massage
This is usually the first line of therapy intervention as it helps to free up tight and restricted calf muscles as well as improve circulation to get rid of lactic acid build up. Now in saying that most clients who come in expect a nice relaxing massage when they walk in the door, but I’m afraid they don’t call us Physio “Terrorists” for nothing!
The deep tissue massage should incorporate acupressure and myofascial release techniques like M.E.T (Muscle Energy Techniques) and PNF/Contract-hold-relax stretches as well. I also include the odd neural tension techniques and cross frictions to help loosen up chronically tight calf muscles. To perform the neural tension and cross frictions:
- Sit with your back supported and your knee bent to about 45 degrees – your calf should not have any tension in this position
- Wrap your hands around your calf with one hand on the inside and one on the outside of the calf
- place both thumbs together in the centre of the calf just below the knee joint line
- imagine trying to separate the calf fibres by digging into the calf with both thumbs
- you will feel a really tender spot as you reach the nerve fibres running through the calf
- with both thumbs rub diagonally across the nerve fibres while applying as much pressure as you can tolerate
- continue down through the whole calf and spend about a minute or two at most working up and down the nerve
- this is extremely tender to do, but usually frees up the nerve supplying the calf muscle – this is one major contributing factor to calf tightness
Self Myofascial Release
I would instruct the person to complete these self release techniques daily (sometimes twice daily depending on the severity of the condition) and also as a quick post workout recovery especially after an intense workout.
The self massage cycle:
- 1 Minute foam rolling – focussing on any tight spots or triggerpoints
- 30 seconds Gastrocnemius Stretch
- 30 seconds Soleus/Achilles Tendon Stretch
- 1 Minute foam rolling
- 30 seconds Gastroc Stretch
- 30 seconds Soleus/Achilles Stretch
Studies have shown that performing this exercise has proven very beneficial for tendon healing and recovery. In fact a study done by Fahlstrom et al in 2003 proved that 89% of patients with a chronic, painful Achilles Tendon were back to their pre-injury levels after 12 weeks!
The Heel Drop Protocol
- Stand on a Step with your toes on the edge and heels dropped over
- Start by going up onto your toes with both feet and keeping the ankle in straight alignment
- Slowly lower the sore heel as far down as possible keeping the ankle in straight alignment (prevent the ankle dropping in or out)
- Repeat for 15 to 20 repetitions
- A burning or aching sensation in the calf or Achilles is normal – in fact it’s essential!
- Stretch the Gastroc for 30 seconds
- Stretch the Soleus/Achilles for 30 seconds
- Calf raise 15-20 Reps
- Stretch Gastroc 30 seconds
- Stretch Soleus 30 seconds
- Calf Raise 15-20 Reps
- Stretch Gastroc 30 seconds
- Stretch Soleus 30 seconds
- Ice Achilles for 5-10 minutes
This technique helps to release active muscle spasms or triggerpoints as they are known. The needle is inserted into the skin over the muscle triggerpoint and then moved around until it elicits a local twitch response. This can be seen clearly as the muscle “jumps” or twitches as the spasm releases. This is quite painful but of all the techniques, I find that dry needling is the most effective in releasing muscle spasm.
I would use a few needles into the Gastroc/Soleus to ensure I release as much spasm as possible in the session. The calf feels VERY tender after a needling session and it is vitally important to perform several stretches directly after the session as well as for the next day or two until the stiffness has dissipated.
A few sessions of needling is needed to release the calves but it is the quickest most effective way of doing it (if the client can tolerate the pain though!) What’s that old saying of “No Pain… No Gain?”
I would tape the Calf and Achilles tendon to assist in the recovery and have also found that taping especially after a dry needling session to be very beneficial.
The Five main effects of the Kinesiotaping:
- Reduce Local Pain
- Improve Circulation
- Modulate Muscle Activity (Decrease Muscle Tone)
- Alter Fascial Alignment
- Support Joints
Read more about Kinesiotaping here
As mentioned earlier, I would prescribe an orthotic in the event of a biomechanical instability that needs a few degrees of correction. I also prefer the good old fashion manual way of testing for an orthotic as opposed to the computerised gait scanners and pressure sensors. I found that although these are great in establishing pressure points during the gait cycle, in my opinion it doesn’t give a “whole” clinical image of what is happening through the lower limb kinetic chain.
The way I would tend to measure for an orthotic is video gait analysis to establish biomechanical issues but then use a platform with different wedges and supports to establish the amount of correction needed.
Basically I would ask the person to stand on the platform and perform a squat. I determine the amount of movement in the Sub-Talar Joint and insert the varying degrees of wedges and supports until the STJ remains in a neutral alignment while performing the squat.
If there are any other issues that I need to address let say in the forefoot etc. I would also add in padding or little cut-out cushions depending on what is required.
On the odd occasion I have had to refer clients on for this type of treatment. This form of treatment consists of applying a shock wave through the tendon that breaks down any adhesions or scarring in the tendon and helps with circulation to the structures and thus healing of the tissue. You can read more about it here
And if none of this helps there is always amputation! But I’m confident enough that this will make a huge difference in getting rid of your Achilles pain.
Feel free to send me an email or leave a comment if you need any further assistance. In the mean time be sure to read the other posts in the ankle series and subscribe to the RSS feed and newsletter for updates on future blog posts. There will be plenty of high quality and free information on treating different conditions and what you can do yourself.