Achilles Pain Running: How to Treat, Prevent and Heal for Good

Achilles pain running goes right along side IT Band pain and knee pain of super common issues from too much, too fast and too soon. The cardinal sins of any runner.

Fortunately, just like the other two it can be resolved with a little bit of knowledge and a few changes to your routine (and possibly gear!).

Can You Keep Running with Achilles Pain?

Errr maybe, but should you…well let’s consider what’s happening here.

Every time we push off the ground during a run, the force can amount to 500-600 pounds of pressure. The Achilles tendon takes the brunt of that force, meaning like our knees or IT Band, tightness, poor form and overuse are going to quickly take their toll.

• The Achilles tendon is the largest tendon in our body and comprised of a thick band of tissue that connects the calf muscles to the heel bone.
• This tendon is responsible for every step we take, whether walking or running.
• It also permits us to point our toes, push off our feet, jump up and down, and stand on our tip toes.

Basically anything we do with movement can be credited to the Achilles tendon.

No wonder it can get so cranky so easily. A sore Achilles in the morning is often the first sign that you need to hold up and pay attention before it becomes something more.

If you’re already experiencing Achilles pain, then stop running until you can complete the toe raise exercise listed in step 3 without pain.

What is Achilles Tendonitis?

Runners are prone to Achilles tendon injuries because of the constant pushing off we do with each stride. The more and faster we run, the more susceptible we are to injury. Speed and uphill training can aggravate the Achilles thanks to the additional strain placed on the tendon.

When the Achilles is overworked, the tendon tightens and causes inflammation, voila la Achilles tendinitis.

Signs of Achilles tendonitis include:

• A stiffness which goes away as you warm up
• Pain and swelling close to the heel
• Limited ankle flexibility
• Redness along the tendon
• A burning sensation along the tendon
• Scar tissue build up (this will feel like lumps)
• A cracking or popping sound with ankle movement

With rest and proper care (which I get into below) most runners can usually recover from Achilles tendinitis fairly quickly. Left untreated, however, it will lead to more severe injuries, such as tearing or rupturing.If you hear a pop followed by intense pain in the back of the ankle and lower leg then you’ve pushed this inflammation too far and now have a major injury to recover from, a torn Achilles.

You likely won’t be able to walk normally after this occurs. Often, Achilles tendon ruptures require surgery, but this is not always the case. None the less, we’re not going in to that here because you’re going to be a SMART runner and stop pushing through pain.

Returning to Running After Achilles Injury

Whether you want to prevent an Achilles injury or are trying to comeback to running after tendonitis, these are the tips that will get you there.

Following is a three step plan to help prevent Achilles tendon pain from running, meaning you won’t resolve it once only to have it reappear on you again later.

Step 1: Reduce Swelling and Inflammation

If you’re in the midst of a major flare, then DO NOT run. You need to first allow the swelling to subside and help your body to cull the inflammation. As recently reported, do not ice the area, unless you’re in pain and need some numbness!

Try these tips for reducing inflammation, which I used after knee surgery and I remain a big fan of compression socks. If the medical community loves them for healing, why wouldn’t we take advantage too!

And like those other common injuries I mentioned, once you’ve reduced swelling get moving and start with step 2 and 3. Continued rest won’t resolve the issue. Graphic from Road Runner Sports

Step 2: Implement Smart Training

First up is to stop the things which got you in to a mess.

Jumping mileage too quickly, adding in too much speed work or skipping out on rest days which is when our body truly rebuilds from the hard work. After that, make sure you’re doing these things as well:

• No barefoot time for you. You want to keep everything supported while you fully recover.
• Warm up. Exercising on tight, cold, or fatigued calf muscles transfer too much of the load onto the Achilles. A quick dynamic warm up will get that muscle ready to run with less risk of injury.
• Cross train with lower impact activities while returning to running.
• Vary running surfaces. Hard surfaces can aggravate it more, so consider more trails – but do not run on the treadmill as one study showed this actually required a 12% higher load on the Achilles.
• Regular foam rolling will help keep your muscles flexible and supple, which means less pulling on tendons!
• Rotate your running shoes to help eliminate muscle imbalances which can affect your stride and cause pain.

While we’re on the topic of shoes, there are some things to consider if you’re running in to Achilles issues. In general, I’m a fan of the lower heel drop for most runners, but the best running shoes for Achilles pain are actually those with a slightly higher heel drop because it reduces stress.

Additionally, you may benefit from a stability shoe if your foot is falling inward as that will further stress the Achilles.

• 10-12mm heel drop
• Or try adding a heel lift to your existing shoes if you love the fit
• Stability shoe
• Cushioned heel collar
• Brooks Ravena and Asics Gel Nimbus are often recommended

Once you’ve resolved your issue and are completing all the things below, I recommend moving to a lower heel drop as you can. There’s enough research to show it prevents heel striking and other injuries.

Step 3: Achilles Stretch and Strengthening Exercises

Now that you’ve culled the initial pain, it’s time to keep working on your Achilles. We want to keep this injury from recurring with my favorite thing PRE-HAB…though if you’re currently injured this is re-hab, but keep doing it long after the pain goes away!

Achilles Stretches

To stretch or not to stretch? While some experts recommend stretching to help heal an Achilles injury, other sources suggest that the pull on the muscles can worsen the injury. This for me is a two pronged issue:

1. See what feels good to you. If stretching hurts, STOP.
2. Remember that often what we need to do is loosen the muscles AROUND the tight one.

Use a foam roller to loosen those calf muscles and a massage ball to loosen the plantar fascia in your feet. Notice we aren’t rolling right on the injury, but instead working the muscles around it to ensure that nothing else is pulling on it.

Eccentric Strength Training

This is a form of exercise that lengthens certain muscles under weight load.

Heel Drops
Stand on a step with your heels hanging off and switch the weight to one leg. Slowly lower your body and then use your other leg to help you return to the starting position. The help is especially important on the injured side. Do three sets of 15 on each leg twice daily, incorporating both the straight leg and bent knee versions.

Heel Raises
Creating a stronger calf is going to help as well, so once the drops cause no pain it’s time to start with raises.

Standing flat footed raise up on to the ball of your feet and hold for a few seconds before lowering back down. As always three sets of 15 reps is a good baseline.

Alphabet
Drawing the alphabet with your foot is another great way to increase total ankle strength and flexibility, which is going to help prevent injury.

Skaters
Once you’ve eliminated pain while doing the heel drops and calf raises, you can start to up the ante a bit. Try doing skaters to help improve your total foot, ankle and leg strength. These can be a great warm up or addition to your strength day.

Taping an Achilles Injury

K Tape, or Kinesiology Tape can be kinda magical for injuries, including Achilles tendinitis (I mean it’s the only thing that allowed me to run after my knee injury!). The tendon notoriously has poor blood flow, which is one reason it is so susceptible to overuse and stress injuries. Kinesio Tape lifts the skin away from the muscle, stimulating circulation and helping alleviate pain.

There are a few different ways you can tape for Achilles pain.Aresports provides a few examples of how to tape!

Example 1:
Sit in a chair and cross the injured leg over the other, resting it just above the heel. With your heel flexed, anchor the tape starting in the bottom center of your foot and stretch the tape over the back of the heel, stopping about a ⅓ of the way up your calf. Rub the tape to create a strong bond.

Fold a second strip in half and round the corners and cut it at the fold so you have two pieces. Take the first piece and tape it around the point of pain. If you have pain higher up in the calf, apply the second strip at that point in the same manner.

Bonus Trivia: How does the Achilles tendon get its name?

As the Greek mythology goes, Achilles’ mother, Thetis wanted to make her son immortal, so she dipped him in the River Styx. However, the strong current meant that she held onto him by his heels, so his feet never touched the water. Thus his feet remained the one weak part of his body.

Achilles grew to be a strong warrior, defeating the leaders of nearby kingdoms. Paris, the brother of a man killed by Achilles set out for revenge, directing a poisoned arrow right into his heel, killing Achilles shortly after.

The first recorded connection with Achilles to the tendon occurred in 1693 by Dutch anatomist Philip Verheyen.

Have you ever experienced Achilles tendinitis?

What tips do you have to keep the pain away for good?

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