Preventing Achilles Tendinopathy: Tips for Athletes and Active Individuals
No athlete ever wants their training to be interrupted by injury. One common injury that can occur in the lower leg is Achilles tendinopathy. This condition can be debilitating and cause significant pain, making it difficult to continue participating in your favorite activities. However, by including certain strategies in your training program you can minimise the risk of suffering an Achilles tendinopathy. In this article, I will provide tips for preventing Achilles tendinopathy, including strengthening exercises, appropriate training loads, and incorporating rest and recovery into your training plan.
What is Achilles Tendinopathy?
Achilles tendinopathy is a condition that occurs when the Achilles tendon, the largest tendon in the body, becomes overloaded and painful. This can result in pain, weakness, and swelling in the Achilles, making it difficult to perform activities such as running, jumping, or even walking. There are several types of Achilles tendinopathy, including insertional Achilles tendinopathy, mid Achilles tendinopathy, and Achilles tenosynovitis. Each type of Achilles tendinopathy has its own unique set of symptoms and treatment options, making it important to accurately diagnose the specific type of injury.
Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy occurs at the point where the Achilles tendon attaches to the heel bone. This type of tendinopathy is often the result of repetitive stress on the tendon including tensile and compressive loads. Poor footwear and change in running surface can often be a contributing factor. It is best to avoid footwear which compresses the back of the heel at the point of the Achilles insertion to the calcaneus. Symptoms of insertional Achilles tendinopathy include pain and stiffness in the back of the heel, swelling, and tenderness.
Mid Achilles Tendinopathy
Mid Achilles tendinopathy occurs in the middle portion of the Achilles tendon, a few centimeters above the heel, and is often the result of overuse or sudden increases in activity. A change in footwear or running surface can increase the stress on the Achilles and if this occurs too rapidly can contribute to the development of this type of tendinopathy. Symptoms of mid Achilles tendinopathy include pain and stiffness, swelling, and tenderness in the mid Achilles, a few centimeters above the heel.
Achilles Tenosynovitis
Achilles tenosynovitis is a condition that occurs when the sheath surrounding the Achilles tendon becomes inflamed. This type of tendinopathy is often the result of overuse or sudden increases in activity, and can be exacerbated by poor footwear, compression or can occur concurrently with mid Achilles tendinopathy. Symptoms of Achilles tenosynovitis include pain and stiffness in the lower leg, swelling, tenderness. Crepitus can also be present which is a squeaky sensation or sound with movement of the tendon.
Causes and Symptoms of Achilles Tendinopathy
Achilles tendinopathy can be caused by a number of factors which result in change to Achilles tendon loading. A rapid change in the amount of load that you place on your Achilles tendon can lead to tendinopathy.
A change in Achilles tendon load can be as a result of:
Running more volume, frequency or intensity.
Change in footwear
Change in run technique
Change in running surface
Introduction of plyometric exercises
Symptoms of Achilles tendinopathy include pain and stiffness in the lower leg, swelling, and tenderness. The pain may be worse in the morning or after periods of inactivity, and may improve with activity as the tendon warms up. If you're experiencing these symptoms, it's important to seek attention from a Sports Physiotherapist to accurately diagnose the type of Achilles tendinopathy and develop a treatment plan.
Prevention of Achilles Tendinopathy - Tips for Athletes and Active Individuals
Strengthening Exercises for Achilles Tendinopathy Prevention
Strengthening the muscles in the lower leg can help prevent Achilles tendinopathy by reducing the amount of stress placed on the Achilles tendon. Exercises such as calf raises and doming can help strengthen the muscles in the lower leg and reduce the risk of injury.
Calf raises are a simple exercise that can be done anywhere. Simply stand on one foot and slowly raise up onto the ball of your foot, then slowly lower back down. A more advanced version can be performed on the edge of the step so that your heel can come down below the height of the step taking your ankle into dorsiflexion. This version on the edge of a step should be avoided if you have an insertional Achilles tendinopathy.
Doming can be performed by standing with the heel and ball of the foot on the ground, then lifting the medial arch of your foot slightly without rolling the whole foot out. You can challenge this doming position further by standing on one foot or holding the doming position whilst performing a squat.
Training Loads and Incorporating Rest and Recovery in Your Training Plan
Rest and recovery are essential components of injury prevention. It's important to listen to your body and take rest when needed, particularly if you're experiencing pain or discomfort. You should always ensure that your training is being performed at a comfortably adaptable load. In other words the amount of training should be within your body's capabilities.
It is really common to see people develop an Achilles tendinopathy when they have progressed their training loads before their connective tissue has had a chance to adapt to what they are doing. It may take one to two months for your body to become accustomed to a new level of training stress. It is best to avoid increasing training every week or even every fortnight, take your time and be patient. Also try to avoid progressing your training load in more than one way at a time. For example, it is best to avoid increasing running mileage at the same time as adding in hills. Although this gradual approach may seem to provide only slow progress, it is far better than breaking down with injury and suffering a large setback.
Incorporating low-impact activities such as swimming or cycling can be useful as these do not place stress on the Achilles tendon and can be used to cross train when dealing with an Achilles tendinopathy.
For further information on training loads, read my blog post on Training Load.
Prioritizing Achilles Tendinopathy Prevention in Your Active Lifestyle
Achilles tendinopathy can be a debilitating injury that can significantly impact your ability to stay active. By incorporating strengthening exercises, using appropriate training loads, and including rest and recovery into your training plan, you can help prevent Achilles tendinopathy and maintain an active, healthy lifestyle. If you're experiencing symptoms of Achilles tendinopathy, it's important to seek attention from a Sports Physiotherapist to accurately diagnose the type of injury and develop a treatment plan. Remember to prioritize injury prevention in your training plan to stay healthy and active for years to come.