ACHILLES, the Greek hero of the mythological Trojan War, had just one physical weak point – the area just above his heel. His name thus gave rise to our name for the strap-like tendon that runs from the lower end of the calf muscle into the heel bone:
The Achilles tendon is the thickest tendon in the body; think of it like a very, very thick elastic band. (Tendons connect muscle to bone; they are a bit like muscles but don’t contract and are usually stronger and stiffer). It allows us to point our toes and rise up onto our toes and therefore has an enormously important role to play in standing, walking, running and pretty much any form of movement that involves our lower body.
And because it is a frequent source of pain and disability across a wide range of ages and activity levels, though slightly more common in the 30 – 40 age bracket…
…and because it’s SO debilitating to not be able to move around comfortably or properly or as much as we would like and is so easy to take this easy movement for granted.
So be you young and healthy or unfit or old(er) and healthy or unfit, Achilles issues can come knocking broadly for three reasons:
This involves pushing your Achilles beyond what it is used to and beyond which it can cope and usually involves one or more of:
amongst other variables. Overuse/load is far and away the most common cause of Achilles issues.
Sudden overload of the Achilles tendon e.g. jumping off a too high wall, which usually results in immediate pain and hobbling. Far less common is an Achilles rupture where the whole thing snaps, resulting usually in very little pain but a complete inability to perform the tiptoe action. This is rare and is very hard to do without an underlying Achilles problem – I mention it only in the interest of keeping you informed!
Different or tighter footwear can put direct pressure on the Achilles and surrounding area and cause irritation. It’s usually pretty obvious if you’ve done this because you’ll remember the change in footwear!
These are largely self-explanatory, with PAIN in the Achilles area. Often this pain will INCREASE WITH USE e.g. rising onto tiptoes, walking, running, uphill walking. Often however the pain appears to REDUCE WITH USE, almost as if it can be ‘walked or run off’, though it generally (unfortunately) RETURNS once the walk or run is over. EXTRA PAIN AND STIFFNESS first thing in the morning is also an indicator.
There are a number of other causes of pain in this area so it’s worth, if you think that your Achilles is the problem, checking with a Physiotherapist that this is in fact the case and that it’s not a different structure at fault. Other culprits include:
A couple of other nearby tendons
Peritendinitis (irritation of the sheath surrounding the achilles tendon)
Impingement; pinching of the Achilles, usually more apparent at the top of the tiptoe position
Bony changes at the heel bone
Bursitis – irritation of any one of the friction-reducing pads in the area
Underlying conditions e.g. arthritis, obesity, gout, diabetes, amongst others
Keeping your Achilles healthy is largely influenced by keeping yourself generally fit and healthy. If you’re doing a reasonable amount of exercise (see here for recommended amounts) you’re likely working along the right lines. Carrying excess weight can be a factor – there is evidence that shows that increased body mass increases the likelihood of Achilles problems – ’nuff said.
And a VERY KEY POINT that I will stress in order to help avoid the ‘overuse’ injury mentioned above, is be mindful to:
and if you want to improve your fitness level:
These are a great three-in-one movement to strengthen, stretch and improve balance:
So vary via (a) speed of raise & lower and (b) alternating a bent knee position with a straight knee.
Then stand on one leg only and see how many you can do.
Pop some weight in a rucksack and get weight-training. Our Achilles take loads of up to 10 times body weight when running so you should theoretically be able to single leg lift twice your own body weight – repeatedly. Runners: if you can’t do this, get training!
Jumping, skipping, hopping, jumping from side to side, hopping from side to side – anything that loads your Achilles in a testing but manageable way. Try doing a few whilst out walking/running, or at home, or with kids… etc. Always remember to start small in terms of time, repetitions and difficulty level and build up gradually.
Also remember that working other parts of your body can have a beneficial effect on your Achilles – everything’s connected!
The first port of call for a painful Achilles tendon is PRICE: Protection, Rest (see below) Ice, Compression and Elevation. Often a small heel raise in your shoes (purchasable in Boots and online) can help ‘offload’ the tendon and give it a chance to calm down.
The REST Bit: This can be tricky. “A period of abstinence from your activity of choice is often recommended in the short-term.” I fully appreciate that for many of us exercise is a very necessary part of our lives. But if you’d banged your head and it hurt you wouldn’t pick up a hammer and keep on banging it would you? Feel free to swap in activities that don’t irritate your Achilles such as swimming, cycling and no or low impact pastimes. And take heart: form and stick to a good rehab plan and you will be able to return to your sport/activity in a better state than you left it.
If you think that your Achilles may benefit from more specific attention than described here then you can see your GP or a helpful Physiotherapist for more help and advice. This goes for if it’s very painful or disabling too, particularly if this came on very suddenly.
Achilles issues can take a while to settle but a comprehensive Physio-developed rehab plan with clear advice and information can help to get you back to your sport or activity…