As many of you may be aware, late last year whilst continuing my running regime to run my second half marathon, I aggravated and then tore my achilles tendon. The road to recovery has been slow, but thankfully, I am finally back to running 5km and hoping to build that back up over time. So, keep reading below to learn more about what the achilles tendon is, how it may be injured, signs, prevention and treatment.

What is the achilles tendon?

The achilles tendon is the thickest and strongest tendon in your body. It is an extension of the calf muscle, that attaches to the heel bone. It provides the driving force in explosive movements including running, jumping and hopping. Virtually all the force when you push off through the toe is transmitted by the achilles, which can be as much as 3 times your body weight. The faster you run, the more strain you put on the achilles tendon, hence why many runners are prone to injury, accounting for 5-12% of all running injuries.

Types of achilles tendon injuries

An achilles tendon can partially tear or completely rupture, and are graded from 1 to 4 according to severity, with a complete rupture causing pain likened to a hit in the back of the leg, causing sudden loss of strength and movement. Most cases occur at the “midpoint”, a few inches above the heel, whilst the remainder are “insertional” within an inch or so of the heel bone. Insertional achilles tendonitis tends to be more difficult to heal as the bursa (small fluid-filled sac) behind the tendon can also become irritated.

Causes of achilles tendon injuries

The achilles is often damaged from excessive loading due to:

• A sudden increase in the intensity, frequency and duration of activity
• A decrease in recovery time between activities, with inadequate stretching
• Wearing inadequate or incorrect footwear
• Excessive pronation (foot rolls inwards)
• Running on hard or uneven surfaces
• Poor muscle flexibility (eg. tight calf muscles, weak calf muscles)
• Decreased joint range of motion (eg. stiff ankle joint)
• Bone spur - extra bone growth where the achilles tendon attaches to the heel bone

Signs and symptoms of an achilles tendinopathy

Damage to the achilles is a chronic, yet common condition, most likely due to a series of microtears (tendinosis) that weaken the tendon, rather than due to inflammation.

• It typically starts off as a dull stiffness, which gradually eases as the area gets warmed up.
• Mild ache above the heel after running or activity, becoming more severe.
• Severe pain the day after exercising.
• Swelling that is present all the time and gets worse throughout the day with activity.
• Thickening of the tendon over time.
• Rupture causes sudden loss of strength and movement.

Treatment options

If you just rest an achilles tendon, this will reduce the pain in the short term. However, as soon as you return to activity, the pain will simply return. This is because the tendon does not have the capacity to take the loads required of it. I suggest the following:

• RICE protocol should be followed for 48–72 hours; rest, ice, compression, elevation; to reduce the bleeding and damage within the joint.
• No HARM protocol should also be applied – no heat, no alcohol, no running or activity and no massage.

Once the pain has settled, a program of rehabilitation exercises may be prescribed to gradually strengthen the achilles, in order to be able to return to activity. Some ideas include:

• Warming up, stretching and cooling down prior and after workouts.
• Allowing adequate recovery time between workouts or training sessions.
• Wearing appropriate shoes for the activity.
• When returning to activity, a heel raise or taping may be used to reduce the load on the weakened achilles tendon.

Which exercises are effective for achilles tendon injuries?

Tibialis anterior stretch (standing)

• Begin by standing up straight and bending both knees slightly
• One foot should remain on the ground while the other foot curls.
• The curled foot’s toes should press against the floor.
• Hold for 30 to 60 seconds

Tibialis anterior stretch (on all 4s)

• Kneel down, top of your feet on the floor
• Sit back on your heels, should feel a stretch along your shin
• To increase the stretch, use your hands to lift your knees off the floor
• Hold for 30 to 60 seconds

Shin release with massage ball

• Feel your tibialis anterior muscle running along the outside of your shin bone
• Place the ball against the muscle and hold it in place with your palm.
• Apply firm pressure, and slowly roll along the muscle for 30 to 60 seconds, this should not be painful, but maybe uncomfortable.