Understanding and Managing Common Achilles Tendon Injuries in Runners

Achilles tendon injuries are among the most frequent problems runners face. These injuries often cause pain and frustration, disrupting training and daily life. Understanding the types of Achilles tendon issues, how they develop, and the best ways to manage and rehabilitate them can help runners recover more effectively and reduce the risk of recurrence.

Achilles tendon inflammation in a runner's ankle

Types of Achilles Tendon Injuries

Achilles tendon problems are not all the same. They can affect different parts of the tendon and surrounding tissues, each with unique symptoms and treatment needs.

• Insertional Tendon Pain

This pain occurs where the tendon attaches to the heel bone. It often feels sharp and can worsen with activity or pressure on the heel.

• Mid-portion Tendon Pain

This affects the middle section of the tendon, usually 2 to 6 cm above the heel. It often presents as a dull ache or stiffness, especially after rest or in the morning.

• Musculotendinous Junction Pain

This pain happens where the calf muscle meets the tendon. It can feel like a deep ache or tightness and is sometimes linked to muscle strain.

• Tendon Sheath Inflammation (Paratenonitis or Tenosynovitis)

The tendon is surrounded by a sheath that can become inflamed, causing swelling, warmth, and tenderness around the tendon.

Each type requires careful assessment to tailor treatment and rehabilitation.

Why Achilles Tendon Injuries Happen

Most Achilles tendon injuries in runners come from what experts call a "training error." This means the tendon is exposed to too much stress too quickly. Common causes include:

• Sudden increase in running volume (mileage)

• Sharp rise in intensity (speed or hill work)

• More frequent training sessions without enough recovery

• Running on steep inclines or uneven surfaces

• A combination of these factors

  
  

When the tendon is overloaded, tiny tears and inflammation develop. Without proper care, this can lead to chronic pain and reduced tendon strength.

Initial Management: Settling the Pain

The first step in managing Achilles tendon pain is to reduce inflammation and allow healing to begin. This usually involves:

• Rest

Avoid activities that increase pain, especially running or jumping.

• Ice

Applying ice packs for 15-20 minutes several times a day can reduce swelling.

• Anti-inflammatory Medication

Over-the-counter options like ibuprofen may help, but only use them as directed and for a short period.

• Supportive Measures

Manual therapy, compression socks, and kinesiology tape can assist in reducing pain and improving blood flow.

While rest is important, too much time off can weaken the tendon and surrounding muscles, making recovery harder. The goal is to balance rest with gentle stimulation.

Rehabilitation: A Step-by-Step Approach

Rehabilitation for Achilles tendon injuries is a gradual process. Progress is rarely smooth, and setbacks can happen. A structured plan helps the tendon adapt and regain strength.

Particular attention needs to be paid to the Gastrocnemius, Soleus and Plantaris muscles

1. Isometric Exercises

These exercises involve muscle contraction without movement, which helps reduce pain and maintain strength.

• Example: Wall push with toes pressing down but no ankle movement.

• Benefits: Low load on the tendon, pain relief, and early strength maintenance.

  
  

2. Isotonic Exercises with Eccentric Focus

Once pain is manageable, dynamic exercises that lengthen the tendon under load are introduced.

• Example: Heel drops off a step, lowering the heel slowly.

• Benefits: Stimulates tendon remodeling and increases load capacity.

  
  

3. Plyometric Exercises

These involve quick stretch-shortening cycles, like hopping or jumping.

• Example: Small jumps or bounding drills.

• Benefits: Improves tendon elasticity and prepares for running demands.

  
  

4. Sport-Specific Training

Finally, exercises that mimic running patterns and speeds are added.

• Example: Gradual return to running with controlled intensity and volume.

• Benefits: Prepares the tendon for real-world stresses.

  
  

Understanding Pain During Rehabilitation

Pain is a natural part of tendon rehab. It signals the tendon is being stimulated to adapt. The key is to keep pain within safe limits.

A simple traffic light system helps guide exercise intensity:

• Green (0-1/10 pain): Safe zone, no concern.

• Amber (2-4/10 pain): Acceptable during exercise but should settle quickly.

• Red (5+ /10 pain): Stop or reduce intensity.

  
  

Pain should not increase significantly during exercise or worsen in the 48 hours after. Staying in the amber zone during rehab sessions and green afterward helps balance progress and safety.

Managing Expectations and Staying Consistent

Achilles tendon injuries take time to heal. Recovery often lasts several weeks, not days. Patience and consistency with rehab exercises are vital.

• Avoid rushing back to full training too soon.

• Monitor pain and adjust activity accordingly.

• Seek professional advice if pain worsens or does not improve.

  
  

Practical Tips for Preventing Achilles Tendon Injuries

Prevention is better than cure. Runners can reduce their risk by:

• Increasing training load gradually, no more than 10% per week.

• Incorporating strength and flexibility exercises for calves and ankles.

• Wearing appropriate footwear that supports foot mechanics.

• Including rest days and cross-training to avoid overuse.

• Paying attention to early signs of tendon pain and acting promptly.