4 Simple at Home Exercises for Achilles Tendinopathy in Runners

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Written by: David Burnett, BScH, MScPT, Registered Physiotherapist

What is Achilles Tendinopathy?

Characterized by pain, stiffness, maybe some swelling or thickening of the Achilles tendon
Common running injury – prevalence varies but may make up 6-8% of all running injuries
58% male to 42% female
Important to note the following differences but generally treatment remains the same:
- Insertional tendinopathy vs mid tendon tendinopathy – best determined by a physiotherapist
- Different stages of tendinopathy exist – best determined by a physiotherapist
Tendinopathy is tendon tissue disorganization – not tissue damage

Unmodifable Intrinsic Risk Factors:

Previous lower limb injury
Previous lower limb tendinopathy
Age
Gender

Modifiable Intrinsic Risk Factors

(*Best evaluated by a Physiotherapist*)

Reduced muscle power/strength
Reduced ankle dorsiflexion
Weight (Increased BMI)
Biomechanical abnormalities – foot alignment/pronation
Muscle imbalance and inflexibility

Extrinsic Risk Factors

(*Best evaluated by a Physiotherapist*)

Change in loading – return to running/activity after a break
Training errors
- Increased volume/intensity too quickly
- Change in pace
- Change in training type (i.e. increased hills)
- Change in training duration
- Increased training frequency
- Change in weekly distance
Footwear – Achilles load is higher in minimalist shoes/barefoot compared to standard shoe regardless of where the foot strikes
Running style – A forefoot strike increases Achilles load by 15%
Training surface – Running on a treadmill has been shown to mildly increase Achilles load

Treatment Principles

Despite different areas of Achilles tendinopathy and stages of tendinopathy the general treatment principles remain the same
Identify and address potential causes (i.e. intrinsic and extrinsic factors)
Reduce Pain
Improve load capacity of muscle-tendon unit
Improve load capacity of kinetic chain as a whole
Gradual return to training
Advise on long term management

Pain Reducing Tips for Runners

Initial relative rest and ice
NSAIDs (anti-inflammatories) – discuss with family doctor
May need to avoid ankle dorsiflexion initially which can contribute to tendon compression
Change type of training – bike, swim, walk
You may still be able to run!! BUT avoid training/activity that pushes pain past a 2-3/10 and does not settle within 24 hours
Potential running modifications to decrease pain during rehab
- Run every other day
- Increase cadence by 5% and build up to 10%
- Cut down on hills and speed work
- Perform strength training and running on separate days
- Gradually increase training as pain allows
- Monitor response of tendon after activity – keep pain below 2-3/10 – find the sweet spot between no activity and too much
Wear good standard running shoes
Long hold isometrics – 5 x 30-45 second holds mid-range 70% max voluntary contraction

Exercise Progression – Improving Load Capacity

***Note: These are not recipe exercises but rather examples – see your Physiotherapist for an individually tailored, appropriately graded exercise program!

Above table taken from Tom Groom Running Repairs course

Sample Isometric Exercises

Focus will be on tendon loading in a position that limits tendon compression (plantar flexion). These exercises should have an analgesic effect but make sure pain is never above 2-3/10 and settles within 24 hours. Start with 5 sets of 30-45 sec at 70% max voluntary contraction. Repeat as needed throughout the day.

Standing Isometric Calf Raise

With straight knees, push up onto your toes around mid-range focusing weight through your big toe. Use support if needed initially. Hold for 30-45 sec. Can progress to one leg only.

Knee to wall press

Place knee against wall with a towel in between. With a bent knee push up onto your toes around mid-range focusing weight through your big toe. Use support if needed initially. Hold for 30-45 sec. Can progress by putting more weight through affected leg.

Sample Isotonic Exercises

Focus will be on the eccentric movement and heavy slow load (HSR) meaning exercise will be performed at a slow fatiguing pace – pain never above 2-3/10 and should settle in 24 hrs. Start with 3 sets of 15 max reps (MR). Increase load gradually until 3 sets of 8 max reps (MR) is achieved. Repeat Daily.

Eccentric Calf Raises – Straight Knee

Place both feet on the front of a step. With straight knees, push up onto your toes focusing weight through your big toe. Use support if needed initially. Hold for 2-3 sec at the top. Take ‘good’ foot off the step. Slowly lower affected foot to a count of 5 sec.

Eccentric Calf Raises – Bent Knee

Similar to a straight leg calf raise but bend your knee to around 30 degrees. Hold for 2-3 sec at the top. Take ‘good’ foot off the step. Slowly lower ‘bad’ foot to a count of 5 sec.

Plyometrics

Depending on individual goals, further rehab may be required. Be sure to see your physiotherapist for a specific and personalized plyometric program.

Long Term Management

Takes time to resolve – slow to settle and quick to aggravate
Continued improvements up to 12 months into rehab
Rehab relies on consistent, continued self-management from the patient

David Burnett, BScH, MScPT
Registered Physiotherapist

David joined GRSM in July 2016. David graduated with his MScPT from Leeds Beckett University and B.Sc. Biomedical Sciences from the University of Waterloo, while playing for the Warriors Men’s basketball team.

He has been working in hospital and multi-disciplinary clinic environments in the UK since graduating.

Dave previously worked as a Sport and Fitness Director in Sydney, Australia. In his free time, Dave enjoys keeping active through the gym, playing any and all sports and enjoying the outdoors.

Resources

Almonroeder, T., Willson, J. D., & Kernozek, T. W. (2013). The effect of foot strike pattern on Achilles tendon load during running. Annals of Biomedical Engineering, 41(8), 1758-1766.

Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine, 43(7), 1704-1711.

Esculier, J. F., Dubois, B., Bouyer, L. J., McFadyen, B. J., & Roy, J. S. (2017). Footwear characteristics are related to running mechanics in runners with patellofemoral pain. Gait & posture, 54, 144-147.

Lyght, M., Nockerts, M., Kernozek, T. W., & Ragan, R. (2016). Effects of foot strike and step frequency on Achilles tendon stress during running. Journal of applied biomechanics, 32(4), 365-372.

Rice, H., & Patel, M. (2017). Manipulation of foot strike and footwear increases Achilles tendon loading during running. The American journal of sports medicine, 45(10), 2411-2417.

Tam, N., Wilson, J. L. A., Noakes, T. D., & Tucker, R. (2014). Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med, 48(5), 349-355.

Taunton, J. E., Ryan, M. B., Clement, D. B., McKenzie, D. C., Lloyd-Smith, D. R., & Zumbo, B. D. (2002). A retrospective case-control analysis of 2002 running injuries. British journal of sports medicine, 36(2), 95-101.

Willy, R. W., Halsey, L., Hayek, A., Johnson, H., & Willson, J. D. (2016). Patellofemoral joint and Achilles tendon loads during overground and treadmill running. Journal of orthopaedic & sports physical therapy, 46(8), 664-672.