Achilles tendon pain in runners is a very common overuse injury. It causes pain and stiffness in the Achilles tendon below the calf muscle. The most up to date description of this condition, is actually Achilles tendinopathy. This more accurately describes the condition as it is most often not an inflammatory condition as the name tendinitis would suggest.
Generally speaking, there are 2 separate types of Achilles tendinopathy. Mid-portion Achilles tendinopathy causes pain within the tendon about 2 cm above the heel bone and insertional tendinopathy causes pain on the back of the heel bone itself. They are treated in different ways, so for this blog we will be focussing on mid-portion Achilles tendinopathy.
What causes Achilles tendon pain in runners?
Achilles tendinopathy is most commonly caused by a repetitive overload of the of the tendon. If the tendon is repetitively stressed beyond its capabilities, the tendon becomes irritated, stiff and painful. This is common in new runners or runners who have been increasing their training load. Other factors such as biomechanics and muscle weakness also play an important role in this condition developing.
What are the symptoms of Achilles tendinopathy?
- Morning pain and stiffness in the Achilles tendon
- Pain in the tendon which worsens with activity
- In some cases, the tendon will have a lumpy or thickened appearance
- In more severe cases, there may be pain at rest
- The tendon will be painful to touch or squeeze
How is Achilles tendon pain in runners diagnosed?
The diagnosis is normally made from a good history taking and clinical examination. When you come into the clinic, we will spend time to understand how your symptoms first presented, what irritates them and what makes them better. We will also try and ascertain whether there were any changes to your training, footwear or running style, that may have contributed to your pain. Using either 2D video or our state-of-the-art 3D gait analysis, we can begin to truly understand the biomechanics of why you developed the problem in the first place. Imaging such as ultrasound and MRI scans are not normally required but are sometimes used if the pain does not respond to first line treatments.
How is Achilles tendinopathy treated?
It is important that we manage your training load appropriately. This may mean that we need to reduce your running load in the short term, but rarely do we need you to stop running completely. We believe it is very important to keep you running where possible to maintain your conditioning. We may also advise some cross-training which may include swimming, cycling or rowing. Reducing your running mileage can also be an excellent opportunity to work on your strength and flexibility. Rest will help your symptoms but only in the short term.
Resting completely will only see your symptoms return when you start to run again. The good news is, the most evidence-based treatment for Achilles tendinopathy is exercise. However, we must get the exercise ‘dose’ at the correct level, or your symptoms may worsen, rather than improve.
By understanding the mechanism of your injury, and the stage of recovery you are at, we can then prescribe a bespoke exercise plan. This will be emailed to you and follow-up appointments will ensure you are doing the correct ‘dose’ at the right time in your rehabilitation. We can also advise on whether orthotics/insoles may help and advise you on the best running shoe for your issue. Another treatment option we regularly utilise is Extracorporeal Shockwave therapy which has been shown to be very effective in managing the pain associated with Achilles tendinopathy.
The long-term outlook of Achilles tendinopathy is good, and most people make a full recovery with the correct rehabilitation and training modifications. This will take some time and perseverance but the long-term results will be worth it!