Achilles tendonitis refers to a condition where the tendon experiences chronic stress injury due to the accumulation of minor stresses that eventually cause damage. This ailment typically arises when there is an increase in the frequency or intensity of physical exercise, and various factors like inflexibility or overpronation can exacerbate it.
Named after the legendary Greek warrior Achilles, the Achilles tendon is a thick and cord-like structure that links the gastrocnemius and soleus muscles in the lower leg to the heel bone (calcaneus). Injuries to the Achilles can manifest in various regions, with strains happening nearer to the muscle’s top and mending more rapidly due to the greater blood flow in that area.
Injuries that occur at the muscle-tendon junction, about halfway down the back of the lower leg where the muscles form a V, tend to heal on their own but not as quickly as the muscular area due to limited blood flow. The most severe injury is damage to the tendon itself, which can cause inflammation (tendinitis) or chronic inflammation with fluid buildup (tendinosis). Pain is usually felt in the back of the heel, the tendon above it, or up to where the calf muscles form a V on the back of the leg.
Common symptoms of Achilles tendonitis include a dull ache or pain when pushing off the foot during walking or rising onto the toes, tenderness of the Achilles tendon, stiffness that lessens with warm-up, mild swelling or a bump on the tendon, and a creaking sound when touching or moving the tendon.
To treat Achilles tendonitis, dynamic rest is recommended. Activities like swimming and cycling can be done if they are pain-free, but running should be avoided as it can worsen the injury. Ice can be applied for 15 minutes four to six times a day to reduce inflammation and swelling while stretching should be done carefully and only when pain-free.
Achilles tendonitis, a painful condition that affects the Achilles tendon, can be caused by overuse or sudden and hard muscle contractions. To avoid or recover from the condition, experts recommend following a combination of stretching and strengthening exercises.
Isometric Exercises for Tendon Rehab
Research has shown that isometric exercises can provide pain relief for some patients with tendinopathy, but they are not always effective. Isometric exercises are no better than exercises with movement (isotonics) for reducing pain in tendinopathy. However, when used in a tendinopathy rehab plan, isometric exercises can improve the injured tendon’s ability to carry a load.
For Achilles tendinopathy, there has been a change in focus in rehabilitation. Research has found that pain is not detrimental to recovery and may even be beneficial to feel a small amount of pain while doing rehabilitation exercises. The key is to start at a level that is right for you and progress your exercises as your tendon’s symptoms improve and function returns.
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Isometric calf raises can be adapted to suit the individual patient. The support, load, position, hold time, number of repetitions, and frequency of the exercises will depend on what your tendon currently tolerates and how quickly your body can adapt to the load.
As you grow stronger and your tendon regains some strength, the isometric exercises should also be progressed to become more challenging. For instance, if your tendon is very sensitive, you may start with double-leg holds, which can then be progressed to single-leg holds or by simply adding weight while remaining on two legs.
The calf wall stretch is a simple yet effective stretch that can help relieve pain. Stand about 2ft (60cm) in front of a wall, place your hands on the wall, and lean against it. Shift your weight to your back foot until you feel a stretch in your calf. Hold the stretch for 30 seconds on each side, repeating twice for a total of three sets. This routine can be performed daily, up to three times a day if necessary.
To strengthen the muscles affected by Achilles tendonitis, try the exercises below once a day in addition to stretching:
- Eccentric straight-leg calf lowering: Stand with the balls of your feet on the edge of a step, rise up onto your toes, then take five seconds to lower your affected heel as far down as is comfortable. Do three sets of 15 twice a day.
- Eccentric bent-leg calf lowering: Sit on the edge of a chair with your legs bent in front of you, rise up onto your toes, then take five seconds to lower your affected heel as far down as is comfortable. Do three sets of 15 twice a day.
- Single-leg standing dumbbell calf raise: Grab a dumbbell in your right hand, stand on a step, block, or 10kg weight plate, cross your left foot behind your right ankle, and balance yourself on the ball of your right foot. Lift your right heel as high as you can, pause, then lower and repeat. Do the same number of reps on each side, aiming for three sets of 15 reps once a day.
- Single-leg bent knee calf raise: Grab a dumbbell and stand as you did for the single-leg standing dumbbell calf raise, but keep both legs bent at the knee throughout. Move your heel up and down using your calf muscle as before. Aim for three sets of 15 reps once a day.
- Split jump (with or without dumbbell): Stand in a staggered stance, your right foot in front of your left, lower your body as far as you can, then quickly switch directions and jump with enough force to propel both feet off the floor. While in the air, scissor-kick your legs so you land with the opposite leg forward. Repeat, alternating back and forth with each rep. Aim for three sets of 15 reps once a day.
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To prevent Achilles tendonitis, experts recommend watching your foot mechanics and shortening your running stride. Support or stability shoes and over-the-counter arch supports can help correct pronation (when the foot rolls inward as you walk or run). Count how many times your right foot strikes in 60 seconds while running, aiming for 85 to 90 per minute.
Remember, building limber lower legs can prevent Achilles tendonitis. Recovery time varies depending on the severity of your injury, from 2-10 days for mild injuries to 42-160 days for severe injuries.