Virtually all of the force generated when you \u201ctoe off\u201d the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon.<\/p>\n
As such, it\u2019s prone to injury in many runners, but particularly those who do a lot of speed training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of all running injuries<\/a><\/strong>, and occur disproportionately in men.<\/p>\n This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.<\/p>\n Achilles tendonitis typically starts off as a dull stiffness in the tendon, which gradually goes away as the area gets warmed up. It may get worse with faster running, uphill running, or when wearing spikes and other low-heeled running shoes.<\/p>\n If you continue to train on it, the pain in the tendon\u00a0will be more sharp and you will feel it more often, eventually impeding your ability even to jog lightly.<\/p>\n About two-thirds of Achilles tendonitis cases occur at the \u201cmidpoint<\/strong>\u201d of the tendon, a few inches above the heel. The rest are mostly cases of \u201cinsertional<\/strong>\u201d Achilles tendonitis, which occurs within an inch or so of the heelbone. Insertional Achilles tendonitis tends to be more difficult to get rid of, often because the bursa, a small fluid-filled sac right behind the tendon, can become irritated as well.<\/p>\n Here\u2019s the deal:<\/p>\n The causes of Achilles tendonitis all appear to be related to excessive stress being transmitted through the tendon. Weak calf muscles, poor ankle range of motion, and excessive pronation have all been connected with the development of Achilles problems.The upshot is that all of these factors, plus training volume and so on, result in damage to the tendon.<\/p>\n While the term \u201ctendonitis\u201d implies that inflammation (-itis<\/em>) is the root cause of the problem, in fact, the true cause is real, physical damage to the fibers of the Achilles tendon itself.<\/p>\n Much like a bungee cord is made up of tiny strands of rubber aligned together, tendons are comprised of small fiber-like proteins called collagen. Pain in the Achilles tendon is a result of damage to the collagen. Because of this, treatment options should start with ways to address this.<\/p>\n For a long time, researchers and doctors muddled about trying to address factors like calf strength & tightness, ankle range of motion, and pronation, assuming that the Achilles tendon would heal itself once these factors were corrected.<\/p>\n Unfortunately, it seems that the thick tendons of the body do not heal as rapidly or completely as we\u2019d like.<\/p>\n The cause of this seems to be the collagen fibers:<\/p>\n When a tendon is damaged, collagen fibers are ruptured. The body is able to lay down new fibers to replace the damaged ones, but it does so in a rather disorganized way. The new collagen fibers look much like a mess of spaghetti when viewed on a microscope, in contrast to the smooth, aligned appearance that healthy tendon fibers have.<\/p>\n Unfortunately, it gets worse:<\/p>\n While we might propose that runners do calf stretching to loosen up their calf muscles and increase their ankle range of motion, this often does more harm than good\u2014tugging aggressively on the damaged tendon fibers is much like pulling on either end of a knotted rope.<\/p>\n Instead, the main objective in treating Achilles tendon injuries should be healing the damaged tendon. The exercise of choice is the eccentric heel drop, which has an impressive research pedigree backing its use.<\/p>\n The strength protocol consists of two exercises: a straight-kneed and a bent-kneed eccentric heel drop.<\/p>\n The protocol calls for three sets of fifteen heel drops, both bent-kneed and straight-kneed, twice a day for twelve weeks.<\/p>\n Standing on a step with your ankles plantarflexed (at the top of a \u201ccalf raise\u201d), shift all of your weight onto the injured leg.<\/p>\n Slowly<\/strong> use your calf muscles to lower your body down, dropping your heel beneath your forefoot. Use your uninjured leg to return to the \u201cup\u201d position.Do not<\/strong> use the injured side to get back to the \u201cup\u201d position!<\/p>\n The exercise is designed<\/em> to cause some pain, and you are encouraged to continue doing it even with moderate discomfort. You should stop if the pain is excruciating, however.<\/p>\n Once you are able to do the heel drops without any pain, progressively add weight using a backpack. If you are unlucky enough to have Achilles tendon problems on both<\/em> sides, use a step to help you get back to the \u201cup\u201d position, using your quads instead of your calves to return up.<\/p>\n What\u2019s the bottom line?<\/p>\n The eccentric exercises are thought to selectively<\/em> damage the Achilles tendon, stripping away the misaligned tendon fibers and allowing the body to lay down new fibers that are closer in alignment to the healthy collagen in the tendon.<\/p>\n This is why moderate pain during the exercises is a good thing<\/em>, and why adding weight over time is necessary to progressively strengthen the tendon.<\/p>\n <\/p>\n In this picture, the injured side is the left leg. Note that the right<\/em> leg is used to return to the \u201cup\u201d position. This exercise is one of two used in cases of midpoint Achilles tendonitis. Once you can perform this exercise pain-free, add resistance using weights in a backpack.<\/p>\n <\/p>\n As with exercise 1, the opposite leg is used to return to the \u201cup\u201d position. This time, bend your leg at the knee and slowly lower yourself down. This is the second exercise for midpoint Achilles tendonitis. Add weight when you can do it pain free.<\/p>\n <\/p>\n Exercise 3: the flat-ground eccentric heel drop. This exercise is used for cases of insertional Achilles tendonitis, replacing exercises 1 & 2. Like the exercises for midpoint Achilles tendonitis, use the opposite leg to return to the \u201cup\u201d position and add weight once you can do it pain-free.<\/p>\n In the case of insertional Achilles tendonitis, the protocol is modified a bit: the exercise is done on flat ground, <\/em>and only the straight-legged variant is done. All other aspects are identical (3\u00d715 twice daily, adding weight, and so on).<\/p>\n Exclusive bonus:<\/strong> Download our full Achilles Injury Prevention Routine. It\u2019s a PDF with images and descriptions of the 10 most effective prevention and rehab exercises for runners with Achilles issues.Download yours for free here<\/a>.<\/p>\n While you are addressing the damage to the tendon fibers through eccentric heel drops, there are some steps you can take to help ameliorate some of the other contributing factors to your injury.<\/p>\n These are cheap, easy to perform treatments that you can do it home in your own time. You should try to do as many of these as possible each day.<\/p>\nThe common causes of\u00a0Achilles tendonitis in runners<\/h2>\n
How can I\u00a0treat my achilles tendon pain?<\/h2>\n
How does the eccentric heel drop help my achilles get better faster?<\/h2>\n
Exercise 1: The straight-knee eccentric heel drop.<\/h3>\n
![\"eccentric](\"http:\/\/runnersconnect.net\/wp-content\/uploads\/2012\/10\/eccentric-heel-drops-achill.png\" "\\"eccentric-heel-drops-achill\\"")
<\/a><\/p>\nExercise 2: The bent knee eccentric heel drop.<\/h3>\n
![\"eccentric](\"http:\/\/runnersconnect.net\/wp-content\/uploads\/2012\/10\/eccentric-heel-drops-bent-.png\" "\\"eccentric-heel-drops--bent-\\"")
<\/a><\/p>\nExercise 3: Modifications for insertional Achilles tendonitis<\/h3>\n
![\"eccentric](\"http:\/\/runnersconnect.net\/wp-content\/uploads\/2012\/10\/eccentric-heel-drops-inser.png\" "\\"eccentric-heel-drops--inser\\"")
<\/a><\/p>\nIs there anything else I can do to speed healing?<\/h2>\n
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Outline of treatment<\/h2>\n
Conservative treatments<\/h3>\n
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