This blog discusses current trends around the treatment of runners with Achilles pain and does not constitute medical advice. If you have pain associated with your running activities, please consult with a clinician for a proper assessment.
Defining & Identifying Achilles Tendinopathy
Achilles Tendino… what? PWR Lab’s co-founder and resident running injury expert, Dr. Jeff Moreno, breaks down the details of Achilles Tendinopathy.
Mythological origins would define the Achilles Heel as a point of weakness, despite overall strength, which can lead to the downfall of a great warrior. Similarly, we would explain Achilles Tendinopathy
as an injury that, if not treated correctly, could interfere with your ability to train and race consistently.
Today, we’re jumping feet first into a common running-related injury, Achilles Tendinopathy. In part one of this two-part blog series, we’ll introduce you to this stubborn injury (one you’ll read about here, but hopefully never meet IRL
) and identify common symptoms and causes. Before we get started, it’s important to note that while this feature may help you spot symptoms of Achilles Tendinopathy
, it is not a definitive guide and should NOT be used as a substitute for a visit to your favorite physical therapist. If you’re experiencing recurring Achilles pain or any consistent pain associated with your training, please consult with a trained physical therapist for a proper assessment.
Define | What is Achilles Tendinopathy?
The Achilles tendon is the strongest tendon in the human body that connects your calf muscle to your heel. This intricate bundle of fibers and tissue supports the calf and ankle during movement. Since the Achilles plays a major role in walking, running and jumping, it’s highly susceptible to wear. When we run, we cause a certain degree of damage or “wear” to the body’s tissues. But when paired with proper recovery and rest (sleep, sleep, sleep!) our bodies repair the damage, resulting in stronger and more resilient tissues. Runners enter the injury danger zone when the “Wear and Repair Scale
” is off balance and your body is enduring more wear and less repair.
You’ve likely overheard runners say, “Oh my Achilles Tendonitis flared up” or “Achilles Tendinosis is a real pain in the…” So why are we discussing Achilles Tendinopathy? Achilles Tendinopathy
refers to a problem with the Achilles tendon
. This painful injury plagues approximately 7-9% of runners annually1
. Depending on the severity and specifics of your injury, a trained physical therapist may further classify your pain as Tendonitis or Tendinosis, but for the purposes of this post, we will be focusing on the broader picture and defining the problem at the tendon as Achilles Tendinopathy.
Based on the location of your pain, there are two types of Achilles Tendinopathy2
- Mid-Portion Achilles Tendinopathy – isolated to the area above the heel bone. The most common form and often easier to treat.
- Insertional Achilles Tendinopathy – pain stems from where the Achilles tendon attaches to the heel bone, or what your physio calls the Calcaneus-Tendon Junction. This type is often more stubborn and requires extra tender care.
Identify | What are the symptoms?
Experiencing one or any combination of the following symptoms may be an indication of Achilles Tendinopathy:
- Gradual onset pain following a run and frequency of pain increases on following runs
- Pain when squeezing the tendon above the heel bone (type: Mid-Portion)
- Pain when pressing the location where the tendon inserts into the heel bone (type: Insertional)
- Swelling, and if chronic, thickening of the tendon
- Pain walking up and/or down stairs
- Pain walking up hills
- Pain walking on toes
- Pain squatting (type: Insertional)
- Pain when transitioning from prolonged period of sitting to walking or first steps in the morning
- Pain with hopping and/or jumping
Recognize | What are the causes?
Targeting and addressing the root of your pain, will allow us to optimize the longevity of your running career and lower your risk for an injury recurrence. Pinpointing the underlying issues causing your pain might seem overwhelming, but let’s start by taking a personalized inventory of your Achilles Tendinopathy Risk Factors
with the infographic below.3,4,5,6,7
When your eyes are set on running your longest race or clocking a new PR, it’s easy to crank up the intensity of your workouts or increase overall mileage too quickly. These risks or training load errors are the leading cause of most running related injuries, including Achilles Tendinopathy. Due to the multifactorial nature of running injuries, identifying with more than one risk factor is completely normal and fairly common. For example, you might realize your initial twinge of Achilles pain coincided with the week you completed your first speed workout
, sacrificed two hours of sleep to fit in your morning miles, and got a little lazy with you strengthening exercises (don’t worry, we’re all guilty of it!)
Overcoming | How do I treat it?
In part two of this series, we will help you adjust your training load, advise on extrinsic factors, and strengthen your underlying weaknesses to mitigate your overall risk level and get you back to running healthier and happier than before.
PWR Pro Tip:
In the meantime, sign up
for a 30 day free trial of PWR Lab to get an understanding of your training load risk factors and experience how easy it is to predict risk, prevent injury, and train more consistently. Simply sync your compatible GPS running watch
and watch your personal metrics transform into intelligent insights specific to your training. No credit card required for sign up, so what are you waiting for?
- Hartog D. Insertional Achilles tendinosis: pathogenesis and treatment. Foot Ankle Clin. 2009;639-50.
- Ogbonmwan I, Kumar B, Paton, B. New lower-limb gait biomechanical characteristics in individuals with Achilles tendinopathy: A systematic review update. Gait & Posture. 2018; 146-156.
- Alfredson H, Lorentzon R. Chronic Achilles tendinosis. Sports Med. 2000;29(2):135–46.
- Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. 1984;12(3):179–84.
- Gabbett TJ, Windt J. How do training and competition workloads relate to injury? The workload-injury etiology model. Br J Sports Med. 2016;0:1-9.
- O’Neill S, Watson P, Barry S. Why are eccentric exercises effective for Achilles tendinopathy. Int J Sports Phys Ther. 2015; 10(4): 552-562.
- Schache A, Dorn T, Williams G, Brown N, Pandy M. Lower-limb muscular strategies for increasing running speed. J Orthop Sports Phys Ther. 2014; 813-824.