As a runner, you are well aware of the stress on your joints and tendons as you progress through your training cycle. One of the more common areas we see this develop into pain is in the achilles. Many of us often describe this as achilles “tendonitis” with the assumption that the tendon is “inflamed”. However, this is often mislabeled and just because it hurts doesn’t mean that the tendon itself is inflamed or even the source of the pain. In this blog, we will talk about what we think achilles tendinitis in runners really is and why it occurs. We will also talk about things you can do to help prevent and manage achilles tendon pain.
What is the Achilles Tendon
The achilles tendon is made up of 3 muscles; gastrocnemius, soleus and plantaris. The gastrocnemius and plantaris cross both the knee and ankle joints, while the deeper soleus muscle only crosses the ankle joint. These 3 muscles come together distally into a single achilles tendon and insert into the calcaneus (your heel bone). Depending on how each of these muscles are functioning will change how force is distributed through the achilles tendon with each step. When force distribution is uneven, this can cause irritation to the tendon leading to pain
Achilles Tendonitis vs Tendonopathy
Tendonitis suggests that the achilles tendon itself is “inflamed”, whereas tendinopathy is a general term to define a problem associated with the tendon. To define something as “inflamed”, it must be red, hot, swollen and painful. The majority of achilles injuries don’t present with all of these cardinal signs of inflammation and therefore cannot be defined as achilles tendinitis. In most cases, achilles tendinopathy is a more accurate definition.
Why does this matter? The achilles tendon itself has little to no nociceptive (pain) innervation. This means that when you experience pain in the achilles region, it has little to do with damage to the achilles tendon itself. Instead, pain in your achilles is a result of irritation of the local nerves and the musculature that make up the tendon. Knowing this will help you target the right structures during your rehabilitation.
Exercises For Achilles Tendonitis / Tendinopathy
One of the most important and overlooked muscles to help prevent and rehabilitate pain in your achilles is the soleus. The soleus is involved with plantarflexion of the ankle (pointing the toes down) and more importantly helps to stabilize the foot when in an upright position (such as running). This bipennate muscle has short muscle fibers that are designed to efficiently stay active for long periods of time to stabilize our bodies in an upright position. Poor activation of this muscle requires significantly greater force to be generated from less efficient muscles such as the gastroc and plantaris that make up the remainder of the achilles tendon.
The soleus also serves a secondary function as it is highly involved with circulation of blood. Because of gravity, 60% of our blood flow is stored in our legs, and requires muscle contraction to circulate flow back up to the heart. Improving circulation helps bring healing nutrients into the local tissues for recovery, and also remove waste products that can build up from overuse. The lower leg structures together in our industry are often referred to as the “2nd heart”, referencing the importance towards circulation.
By performing exercises that activate the soleus, we have multiple benefits at once:
- Improving ankle and foot stability in an upright position
- Efficiently distributing force through the achilles
- Improving blood flow to bring healing nutrients to local structures
- Improving blood flow to remove inflammatory waste products that contribute to pain
Recommendations for Achilles Tendinitis in Runners / Tendinopathy
If you are continuing to train while having pain in your achilles, it is crucial to ensure your soleus is properly warmed up and activated so that your foot is stable during each step. We recommend picking 2-3 exercises to be used as a warm-up prior to starting your run.
It is important to note that the goal is to “activate” not “strengthen”. We do not want to overwork the muscle prior to running to the point of exhaustion causing poor activation during your session. This is why we also recommend limiting your static stretching to not relax the muscle prior to starting your run, however we acknowledge that this is highly dependent on the individual athlete. When dealing with achilles pain, it is important to assess the severity to ensure you will not cause any further irritation by continuing to train. Before using any of these recommendations, make sure you are properly assessed by your sports chiropractor or physiotherapist.
As a runner, you will without a doubt experience aches in pains in your joints and tendons as you progress your training. Knowing what injuries like achilles tendonitis / tendinopathy actually is will help you recognize how and when to recover so you can continue performing at the highest level possible. Through treatment, training and nutrition, our goal is to help our clients better understand their health so they can continue performing at the highest level and doing what they love.
Achilles Tendinitis in Runners