Achilles Tendinopathy: Get Back On Your Feet

As a physiotherapist, I encounter a lot of runners – those who can’t run anymore but would love to get back to it, and those that try to run despite persistent pain.

Foot, knee and hip pain can be debilitating to a runner.

Achilles tendinopathy can be a game changer, keeping a runner off the roads for months or longer.

Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon that joins your calf muscles to your heel. It often results from overuse of the tendon.

If you have an Achilles tendon problem how can we get you back running pain-free?

A comprehensive assessment is paramount.

Key factors in my assessment of someone presenting with Achilles pain include:

1. Where is your centre of mass? Looking at the inter-regional relationships of the head, trunk and pelvis over the feet – how do you stack up? Ideally, we want to see each region stacked evenly over the other. In those with persistent heel pain this often isn’t the case. Checking your wear pattern on your shoes may give you some insight into this!
2. How well do you control your foot and other regions when you transfer load onto the affected foot, step onto the foot or push off the foot? There is a predictable pattern of movement through the kinetic chain. Does each region shift and rotate as it should? Do you tend to carry more tension on one side of your body? Are you always rolling one ITB(iliotibial band)?
3. If we find that the foot or another region such as the neck, trunk or pelvis is not functioning optimally, what happens to the pain/symptoms when that area is manually corrected to function as it should?

The source of the Achilles tendinopathy often comes from altered trunk function, negatively impacting core stability.

This in turn impacts glute function, knee function…it’s a knock-on effect, down the kinetic chain.

Present long enough there will be adaptive changes to the local structures of the Achilles tendon, including weakness.

These need to be addressed with eccentric strengthening of the Achilles tendon.

But first and foremost, the primary source of dysfunction must be addressed first before one can learn to run again.

Do you have persistent heel pain? It is more than likely that there are issues beyond the foot that haven’t been assessed or addressed. Get yourself checked out!

#physiotherapy #achillestendinopathy #running