Achilles Tendonitis in Runners

By Sydney CBD Physiotherapist Dr Domenic Simeoni

Achilles tendon pain can really hinder your running training. In this article we discuss what is Achilles tendonitis? What are the symptoms of Achilles tendonitis? How severe is Achilles tendonitis? What causes Achilles Tendonitis? How is Achilles tendonitis treat? And can you train through Achilles tendonitis? 

What is Achilles Tendonitis?

Achilles tendonitis is an acute inflammation of the Achilles tendon, which connects the calf muscles (gastrocnemius & soleus) to the back of the heel bone (calcaneus). Achilles tendonitis is a common injury experienced by runners and endurance athletes, and frequently causes disruption with activities such as walking, running, cycling, and swimming. There are several causes of Achilles tendonitis, however due to the nature of this injury it is commonly caused by overuse, improper running mechanics, or an improper increase in training volume.

What are the symptoms of Achilles Tendonitis?

If you are suffering from an Achilles tendonitis you may experience:

  • Pain along the Achilles tendon (located from the top of the heel bone to the bottom of the calf muscle)
  • Swelling and tenderness along the Achilles tendon or at the base of the heel bone
  • Pain along the back of the ankle with activities such walking, running, cycling, swimming, going up and downs stairs, standing, doing a heel raise

If you think you may be suffering from an Achilles tendon injury it is best to be assessed by a health professional. Your Physio, Osteo, or Chiro will be able to diagnose and form an appropriate treatment plan to get you back to running as soon as possible.

How Severe is Achilles Tendonitis?

  1. Mild – Pain along the achilles tendon only during activities that cause an increased load on the calf such as running, jogging or jumping. Mild achilles tendonitis is typically not associated with increased swelling along the achilles tendon, however there may be tenderness along the calf muscle or at the back of the heel bone.
  2. Moderate – Pain along the achilles tendon with all high impact activities as well as with lower impact activities such as walking, standing, and performing a heel raise. Swelling is typically present with moderate severity, and you may notice that certain points along the achilles tendon feel more swollen than others.
  3. Severe – In this phase, all weight bearing activity will cause pain along the achilles tendon. Severe swelling along the achilles accompanied by several points of sharp pain is typical in this phase.

What causes Achilles Tendonitis?

Achilles tendonitis can be cause by a variety of different activities or circumstances, such as:

Ankle range of motion assessment and achilles tendon stretch
  • Poor running mechanics – Running mechanics are extremely important to every runner, and will help to determine how fast you can run as well as how far you can run. Running is a highly repetitive activity, which leaves many runners susceptible to overuse injuries in their hips, knees, ankles, and feet. Taking a comprehensive look at running mechanics will assist your Physiotherapist to correctly diagnose and treat achilles tendonitis.
  • An increase in training volume – Rapidly increasing the amount that you are training can sometimes increase the likelihood of developing injuries, as you are not allowing your body the appropriate time for rest and recovery between training runs.
  • Poor footwear – Wearing proper and supportive footwear is extremely important for all runners. Worn out shoes will no longer offer the correct support for your foot and ankle, which will leave you susceptible to the development of achilles tendonitis.
  • A lack of variety in training – Variety is the spice of life, and when it comes to running it is important to remember that incorporating cross training and strength days are vital to help prevent the onset of a variety of running injuries including achilles tendonitis.
  • Hill training – Running uphill puts an increased demand on your calf, and on the achilles tendon. This can cause inflammation and pain as your calf fatigues, and can eventually result in the development of achilles tendonitis.
  • Poor ankle mobility or strength – Poor strength or mobility in your ankle will often result in poor running mechanics at your foot, ankle and knee. Since running is a highly repetitive activity, these poor running mechanics can eventually result in pain and injuries.

How is Achilles Tendonitis Treated?

Depending on the stage of the injury, achilles tendonitis can usually be successfully treated by a Physiotherapist or similar allied health practitioner. A full assessment of your ankle should be performed in order to identify specific areas of reduced mobility and strength that are contributing to the development of achilles tendonitis. Along with this examination, a detailed assessment of your gait pattern (walking pattern), may be necessary to perform in order to gain deeper insight into any movement patterns that will predispose you to the development of achilles tendonitis.

Once the assessment is performed and the information is gathered, your Physiotherapist will be able to guide you through a tailored exercise and mobility program targeted at your specific areas of deficit. Your Physiotherapist may also educate you on your specific running mechanics, and be able to offer advice on different methods to reduce force and impact to your achilles tendon while running.

Physio performing calf stretch for achilles tendonitis
Physio performing calf strengthening for achilles tendonitis

Can you train through achilles tendonitis?

Training through an injury can be challenging, and it is highly recommended to consult a medical professional if you are experiencing pain or discomfort while exercising. Identifying a problem early will aid in limiting its impact on your training, and can get you back to running as quick as possible. Under the guidance of a qualified Physiotherapist, you will be directed down the path to recovery, and will hopefully be back to running with an appropriate training schedule to help you hit your goals!

Physio Domenic Simeoni assessing the leg and achilles tendon
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