The achilles tendon is the largest tendon in the human body. It connects the gastrocnemius, soleus and plantaris muscles to the calcaneus bone (the heel). The calf muscles perform plantar flexion of the foot (pointing toes) and slow down the movement of the body over the foot. In high impact sports such as running the tendon is subjected to loads of anything up to 9 times your body weight. Poor running form and over training can lead to a break down of the collagen fibres within the tendon leading to pain, inflammation and often reduced capability. Achilles pain is common runners and despite ongoing research into this frustrating condition it still remains a difficult injury to rehab.
Achilles tendinopathy has increased over the last few decades due to the increase in social, sporting activities such as running. It represents anywhere from 9-15% of running injuries and full ruptures are far more common in men than in women. https://breakingmuscle.com/fitness/men-more-prone-to-achilles-injuries-than-women-but-why
Research has found that the calf muscles are most active as the foot contacts the ground and begins to generate hip extension to propel us forward. The propulsion should come from the large gluteal muscles. Lack of hip extension and stability around the pelvis means the calf muscles have to then produce energy to push off from the toes. The lack of hip extension also means there may well be more movement at the ankle which loads the calf muscles even more and puts excess strain on the achilles. Lack of stability around the pelvis can also lead to greater degrees or changes in speed of pronation of the foot which again can load the achilles beyond what it can tolerate. So you can see its a very complex condition and requires several approaches when considering rehab.
A good rehab programme looks to reduce aggravating factors, strengthen the calf complex, improve any range of movement deficits or weaknesses such as lack of hip extension, improve ability of achilles to tolerate the load being put through it, educate the athlete to the condition and whats happening in the tendon and to make changes to the running style to help offload the tendon
Seeking treatment in the early stage of the condition has been shown to improve rehab outcome so as always my advice is dont ignore it!! Stop running and get it checked straight away. More chronic symptoms can take 3-12 months to rehab. There’s lots of conflicting treatment tips and it can be confusing to know how to manage this condition. Dr Peter Malliaris is a leading expert in managing tendon pain so I use lots of his research and advice when treating patients. I liked this simple infographic on his website for achilles tendinopathy, take a look
Over the next few days I’ll be giving some tips and advice on managing achilles pain using the latest research.
Please feel free to get in touch if you have any questions