“I started running a year ago and despite stretching before and after every run I always suffer from tight achilles. The worst Achilles pain is first thing in the morning when I get out of bed. The right one is worse so my I put ice on it after every run. I was told to rest but this has not helped. I love running but worry I am doing long term damage. Is there anything else I can do?”
Running Fitness Magazine, February 2015
Achilles pain is something many runners of all levels suffer from but it can be for different reasons. If the only piece of advice you have had so far is to ‘rest’, I suggest you book an appointment with a sports therapist or physiotherapist who specialises in running injuries so that they assess you properly, including a look at your medical history, current level of activity and running form. By discovering what the source of your issue is, they will be able to give you a suitable rehabilitation program.
Though ‘rest’ frequently sees a reduction in pain, it often fails to correct the source of an issue, so as soon as you start running again the pain returns. This is why the traditional recommendation of RICE has been replaced with POLICE, where the ‘P’ is for Protection (in case of severe pain) and ‘OL’ for Optimal Loading. By ‘optimal loading’ we are referring to performing carefully selected weight-bearing exercises that stimulate repair of the tendon. The key is doing enough to stimulate repair but not so much that sensitivity and pain is increased.
As far as stretching goes, although we often assume that when something hurts it must be because it is ‘tight’, achilles pain is actually a good example of where stretching could actually make things worse. Depending on what part of the Achilles is irritated, it may initially be a better idea avoid anything that stretches the tendon, e.g. don’t do calf stretches, lowering your heels over a step, walking uphill, or wearing flat shoes. You may be told to temporarily use a heel raise or wear shoes with more of a heel to relieve tension and to avoid shoes that press directly onto the tendon. Pain is not always down to ‘tightness’; very often it is actually more linked to ‘weakness’.
Talking of weakness, one thing that research suggests can really help restore tendons to a normal healthy state is resistance exercises, i.e. tendon loading. Subjecting a tendon to suitable load is thought to help stimulate structural repair and restore normal system sensitivity levels. You will need to be properly assessed in order to choose suitable exercises but common exercises include: holding a tip toe position for 30-60 seconds, slowly lowering your heels back down to the floor for a number of times, single leg balance. Daily massage or foam rolling of the calves is also commonly recommended. Anti-inflammatory medication like ibuprofen may be beneficial but as with all of the aforementioned suggestions this will be dependent on the nature of your injury so above all do get assessed first by a running injury specialist.
Matt Phillips is the in-house Running Injury Specialist for UK magazine Running Fitness. Buy your copy today in all good magazine outlets, e.g. WHSmiths.