Achilles tendon pain, or really any tendon pain, can be very finicky and is often mis-managed.
This is a 3-part series where we’ll dicuss:
What Achilles tendon pain is, and possible reasons it happens
Rehab for Achilles tendon pain
How training can be modified when dealing with Achilles issues
So let’s kick it off with…
What’s Achilles tendon pain?
The Achilles tendon is the strongest tendon in the body and attaches your calf muscles to your heel bone. The calf muscles are able to move the foot and ankle via force transmission through the tendon. Your Achilles is particularly important in controlling ankle motion and storing & releasing energy to move you forward while running.
Achilles tendon pain can be classified in a few different ways. We’ve all heard of tendonitis, right? The -itis ending simply implies that there is inflammation in the Achilles tendon. However, this term can be really confusing and not tell the whole story of what’s going on in your tendon - in people with long-standing Achilles pain, you actually don’t see inflammatory cells in the tendon. So what does this mean? Many runners with Achilles issues don’t have an inflamed tendon, but instead are experiencing symptomatic Achilles tendinopathy. Tendinopathy just means there are changes in the tendon such as thickening and/or stiffening that are the body’s way of actually protecting it from even more stress. When these tendon changes are accompanied by pain and impaired performance, we get Achilles tendon pain.
Why does Achilles tendinopathy happen?
Ultimately, a painful tendinopathy comes down to chronic overload, or inability of the tendon to handle the stressors placed upon it over time. In runners, the Achilles often becomes overloaded due to training errors. Increasing hill running or speed training, switching to treadmill running, and/or transitioning to a forefoot strike or barefoot running all put more strain on your Achilles tendon. If that strain is increased too fast, the Achilles can't adapt appropriately to the changes in workload and may become irritable.
Outside of training errors, there are a few factors that are associated with, but not necessarily direct causes of, Achilles issues. These include reduced strength in your calf muscles, issues with muscular control at the hip, and/or ankle joint stiffness. Regardless of the cause, once we have an irritated Achilles tendon, we gotta calm it down before building it back up. Just how we go about doing that will be discussed in the next part of this series!