Are you starting to feel soreness in the back of your ankle with running? Does it feel stiff when you wake up in the morning or at the start of your run?
In this episode, We are uncovering the myths and providing you the latest research on how to get rid of your Achilles pain and get rid of it for good!
Spoiler alert…you won’t need to stop running to start feeling better..
Don’t forget to listen to Part 1 of this topic in Episode 60 of the Healthy Runner Podcast!
Listen to the Podcast Episode during your next run!
We cover the following in regards to treatment…
Let’s get into it with the blog!
Believe it or not, the answer is YES. You absolutely should able to run with Achilles Tendonitis based on what stage of injury you’re in.
Rehabilitation of soft tissue injuries can be complex. When treating patients, athletes, and individuals health care professionals utilize acronyms to guide the treatment process.
Over the years, acronyms guiding their management have evolved from ICE to RICE, then to PRICE and POLICE. Although widely known, the evidence for these treatments is limited.
I – Ice
C – Compression
E – Elevation
R – Rest
I – Ice
C – Compression
E – Elevation
Recently, research has shown that two new acronyms can optimize recovery. These acronyms work to optimize recovery in immediate care and in subsequent care.
In immediate care we’re going to use the acronym PEACE.
Avoid Activities and movements that increase pain during the first few days after injury
Elevate the injured limb higher than heart as often as possible
A- Avoid Anti- inflammatories
As they reduce tissue healing, avoid ice (maybe)**
Use elastic bandage or taping to reduce swelling
Your body knows best, avoid unnecessary passive treatments and medical investigations and let nature play its role.
** Anti-inflammatories reduce your body’s effectiveness at tissue healing. They can prevent healing especially if used in doses that are too high. A little bit of inflammation is ok! It tells our bodies that something needs healing. Ice hasn’t been proven to assist in healing of soft tissues and it may actually work to prevent collagen synthesis which is necessary for healing.
In Subsequent Management, the acronym is going to be LOVE.
L – Load
Strengthen your tendon! Mechanical loading, without overloading, stimulates collagen formation & aids in healing.
O – Optimism
Condition your brain for optimal recovery by being confident and positive
V – Vascularization
Choose pain free (or less than 3/10) cardiovascular activities to increase blood flow to repair tissues
E – Exercise
Restore mobility, strength, and proprioception, neuromuscular control and balance by adopting an active approach to recovery—–Treat the whole runner.
So basically, we’re following PEACE & LOVE. We will discuss these both in more depth in the following sections.
Please see the full FREE paper in the BJSM here.
Tendonitis can happen chronically or acutely. Think of a high school age runner who takes the entire summer just having fun, being a kid and not training at all. They go back to school in the fall and start their cross country season and immediately start to feel achey in their Achilles. This is that idea of doing too much, too fast.
This is acute Achilles Tendonitis. In this stage we’re going to wanted to follow the PEACE protocol.
The runner is going to want to give the Achilles a few days to decrease inflammation. As much as we say you can run while healing, with acute tendonitis, it’s okay to rest for a few days.
We’ll want to compress and elevate the area to assist in decreasing swelling and inflammation in the area. Remember we want to avoid anti-inflammatories as well.
Educating is the last step. There’s no quick fix or modality that will make this injury go away or suddenly be healed. Nature has to take it’s course and your body has to heal. After the first week, we can begin the next stage of healing and work towards getting back out on the pavement, trail or track.
Your initial aim is simply to calm it down and settle symptoms. The most important treatment is simply load management. Reduce the stress on the achilles to a level that the tendon can manage and the tendon may settle in as little as 5-10 days. For mild cases you may be able to continue some running as long as you’re able to keep it pain free. Bare in mind though that a tendon may take 24 hours to respond to load so may not hurt until the next day. If you can’t find a way to run pain free then it’s usually sensible to rest for a few days until you can. Other treatments may also settle symptoms like gel heel lifts or kinesiology taping.
You can offload the tendon with a gel heel lift in your shoe for a short period of time may be helpful as a temporary measure in the early stages but not for the long term! You can also offload the tendon with kinesiology taping. The goal is to reduce load on the tendon in the early stages, we mentioned above that this can be used when running but, like the heel lift, you may need to use it when walking if things are very sore. However, you want to wean off it as you gradually increase the load on the tendon.
Lastly, you can massage or foam roll the calf muscle to reduce tightness. Avoid massaging the tendon itself if it’s sore. Check out this video for my TOP FIVE foam rolling exercises.
In this phase of healing, we’re going to be utilizing the LOVE protocol.
We’ll start with L. Loading the Tendon. There are specific types of exercises to do to get the biggest bang for your buck and really load the tendon in a safe way that will lead to optimal healing.
The most beneficial way to load the tendon is through eccentric exercises. Eccentric means that we’re contracting the muscle and then coming out of the contraction slowly, and lengthening the muscle. Eccentrics are theorized to disrupt abnormal collagen cross link patterns and assist in reorganizing collagen into proper healing patterns.
Check out the following video to see the best eccentric exercises to do for Achilles Tendonitis.
Throughout this whole phase, we want to stay Optimistic! This is our “O” in LOVE. Getting into the right mindset and having a goal that you will heal is very, very important.
Then we’ll work on introducing cardiovascular exercises into our rehab. This will allow our bodies to have great circulation – therefore bringing nutrients and the necessary cells to the area to assist and optimize healing.
Finally, we’ll add in exercise in general to help restore mobility in the ankle, strength, and balance in the individual as a WHOLE. We’re not simply treating a tendon… we’re treating the whole runner.
Avoid Doing Too Much Too Soon! (Spike in training load)
The majority of running-related injuries are due to spikes in load, beyond your body’s ability to cope. When we consider the achilles tendon, increasing speed & uphill terrain will require enormous demands, especially if combining the two together. This is the easiest factor to identify and modify. However, we do not want to completely eliminate these variables because this only results in the tendon becoming weaker. So, keep running intervals and hills but be careful and stay within your adaptation zone…….This is where a coach and PT on your side can help guide you in your decision making between good discomfort and not good. I am an athlete just like you are an athlete and this is the benefit I get with my 1:1 coaching clients because I can guide them in making the proper decisions when they are feeling a little banged up and we determine if this is normal training/ running pain that the body is adapting or is this not so good pain and detrimental to the tissues.
Consider changing strike pattern or footwear
Lastly, you may need to consider changing your strike pattern or footwear. Runners who first make contact with the ground towards their toes will demand more of the achilles compared to heel strikers. Similarly, those who run with zero drop shoes or minimalist shoes require the same high demand. Under the right guidance, making a few tweaks in your running approach may shift some load away from the achilles and toward other stronger sections.
In the video version of this episode, I also mentioned our brand new high touch coaching program…
SPARK Back Coaching Program. To learn more about this program click this link to jump on a 30 min strategy phone call: https://calendly.com/duanescotticoaching/30-minute-strategy-session
Thank you (running friends) for taking the time to read and I hope you enjoy the podcast episode!
Duane Scotti, PT, DPT, PhD, OCS
⚡️ SPARK Physical Therapy and the Healthy Runner Podcast Helping Active Adults Be Able To Run Without Aches and Pains So You Can Feel Good About Yourself Again…
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I’m so thankful for the Healthy Runner program, community and the entire coaching team for all the support!
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I highly recommend Duane Scotti and the Healthy Runner training programs.