I recently ramped up in mileage, now my Achilles hurts, why?
Countless runners, triathletes, and weekend warriors experience this pain each year, and it usually starts with the goal of running a marathon, participating in a triathlon, or simply getting back into shape with a work out routine. Many inexperienced exercisers aren’t keen to the fact that in order to minimize risk of injury, one must build up a tolerance to exercise gradually. When the body is exposed to a new load, whether it be a short 3 mile run or squatting 50 pounds, the body experiences microtearing in the muscles and tendons, which may initially sound like something detrimental. It is in fact just the opposite. The body is an amazing machine in the sense that when muscles and tendons are loaded, the body responds by healing the muscle and tendon and in the process, actually makes them larger and stronger for the next time they perform the action. This is the reason experienced athletes train for months prior to a marathon, triathlon, or the start of a sporting season, stimulating muscle hypertrophy to improve their strength and endurance. Tendinopathies and pain rear their ugly head when people perform too difficult a task too soon in their training regimen and/or don’t allow for healing to take place between bouts of exercise. Remember, people are unique in their response to exercise, so even if you use a pre-formulated guide for exercise, you still may be susceptible to injury.
- Mild pain or ache at the Achilles after activity.
- Tenderness or stiffness in the calf and Achilles, common with the first few steps out of bed in the morning.
- Swelling or bump along the Achilles.
- Crunching or creaking sounds when using the Achilles.
What to do if you have pain in this area:
Immediately, prior to seeing a doctor, you can use the PRICEMEM acronym to help alleviate pain. This stands for:
- P – protect
- R – rest. Avoid painful activities including running, stairs, jumping, sprinting, etc.
- I – ice. Apply ice for 10 minutes to the affected area up to 3 times daily.
- C – compress. Apply an ACE bandage to help prevent swelling and alleviate pain.
- E – elevate. Elevate the leg as much as possible as swelling is difficult to control in the gravity dependent position.
- M – medication. If your doctor allows, an NSAID may help alleviate pain and inflammation.
- E – exercise. See below.
- M – massage. Massaging the calf for 5-10 minutes a few times per day may help alleviate tension on the Achilles and reducee pain.
Exercises and stretches to help:
- Gastrocnemius Stretch – Stand with your feet parallel to each other and shoulder width apart. Place the leg you want to stretch behind you. Lean forward until a stretch is felt in the calf, making sure to keep your heel down. Repeat 3 times for 30 seconds.
- Soleus Stretch – Stand with your feet parallel and shoulder width apart. Place the leg you want to stretch behind you. Keep both knees bent and slowly lean forward until a stretch is felt in the lower part of your calf/achilles. Repeat 3 times for 30 seconds.
- Calf Strengthening – Stand on both feet, rise up on toes. Lift uninjured foot off the floor, and then slowly lower the heel of the injured leg to the floor. Use a wall or rail for balance. Do 2 sets of 10.
If your pain persists greater than a week or two despite simple management techniques listed above, scheduling an appointment with your physician is recommended. They can perform any necessary tests (X-rays, MRI, Ultrasound, etc) and can write a prescription for Physical Therapy if deemed appropriate. Usually, more prompt initiation of conservative treatment helps reduce the duration of Achilles tendinopathy.
The author of this article is Ryan Mertz, PT, DPT from Athletico – South Loop.