Today I am going to discuss Achilles heel pain.
Do you get sharp, piercing pain just above your heel bone as soon as you go to walk after getting out of bed in the morning? Or have you noticed the start of a run or walk can be painful but tends to ease (not always) the further you go on. Chances are you have a musculoskeletal condition called Achilles tendinopathy.
Your Achilles is a tough band of fibrous tissue that runs from your lower calf muscle to the top of your heel bone. Repetitive micro-traumas or tiny little tears to the tendon due to repetitive compression forces walking or running are linked to inflammation of the tendon sheath. When this inflammation occurs, most people experience pain and/ or swelling on the point it attaches to the heel bone or 2-3 inches above it.
Why do we get these micro- traumas that cause the pain in the first place?
The Achilles structure interacts with the calf muscles, the hamstrings, the glutes, the pelvis, your lower back, in fact pretty much everything! Understanding how everything is connected is the key to unlocking why this pain has started in the first place and how to get you out of pain.
This takes a comprehensive knowledge of the human body and biomechanics, but I am just going to give a simple explanation. For example, how the ribcage and pelvis may cause the hamstrings and glutes (buttocks) muscles to not work efficiently.
Your pelvis and ribcage act as the engine room in your body when running or walking. Your ribcage needs to be able to protract (move forward) and retract (move back and down) to allow your pelvis to tilt in all directions. This allows your hip joint to flex and extend (getting your leg in front and behind you) during these activities.
We too often see runners and walkers in our clinic unable to do this efficiently, this is invariably down to being in poor positions a lot, like too much sitting or driving.
If you can’t propel yourself forward via hip extension and flexion when running or walking your hamstrings and glute muscles can’t ‘switch on’ or work properly. When this happens, your body will compensate. This means you will tend to use your calf muscles in your lower leg a lot more to propel you forward. They then become overworked, and you end up with pain above your heel, under your heel or even under the arch of your foot.
Remember this is just a simple example of how one weak part of the body may cause pain in another part. You may be totally different; it may be something completely different at the root cause of your problem. A good physiotherapist will be able to identify what your specific root cause of the problem
What can be done to alleviate the pain?
Quite a lot, there are many soft tissue techniques and joint mobilisations that can be performed to help alleviate the pain. These involve massage to the calf muscles, dry needling and cross friction on the sore spots.
Although these treatments will help, injuries like this will return or stay persistent if the root cause of the issue is not addressed. This is the case with all injuries, when you want to fix an injury you have to look beyond the site of pain. Addressing it locally is a great place to start but a skilled physiotherapist will look beyond the site of pain, they will see how you move, breath, understand you posture and how previous injuries can affect you.
In a nutshell, you need to find the compensations and you will find the solutions.
Below are some of the exercises that you need to be doing to alleviate the pain. These consist of both isometric and eccentric exercises. These types of exercises help load the tissue in the area which is exactly what is needed to fix this problem. It is important to remember stopping the exercise that you feel is causing the problem in the first place does not work. Yes, you may have to reduce the amount you are doing on it. But, going cold turkey and stopping completely will have detrimental effects on the tendon. The tendon still needs to be loaded.
Soleus and Calf stretch
1. Place 1-2 books up against a wall.
2. Curl your toes upwards.
3. Bring your knee into towards the wall.
4. Repeat this 6 times holding for 5 sec - do 3 sets.
5. You should feel this between your calf muscle and your heel.
Eccentric loading exercise
1. Go on you tip of your toes using both feet.
2. Take away the non-affected leg off the step.
3. Slowly lower your sore Achilles down slowly for a count of 5.
4. Repeat process over again 15 times and do 3 sets, if its pain free.