New Research Pinpoints Why Your Achilles Might Always Hurt—and How to Fix It

Achilles tendinopathy can sabotage running, but physical therapists offer advice on how to work through it.

achilles tendinopathy exercises, risk factors
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  • A recent study in Physical Therapy in Sport found significant differences in strength and other fitness factors in those with Achilles tendinopathy compared to those without the condition.
  • In addition to seeing a physical therapist to address Achilles pain, experts suggest focusing on calf strengthening exercises, along with assessing your running schedule and doing cross-training activities.

    Any type of injury could sabotage running performance, but a recent study in Physical Therapy in Sport suggests issues with the Achilles tendon—the thick band of fibrous tissue connecting the calf muscles to the heel bone—could be problematic in several notable ways.

    Researchers looked at 44 runners with Achilles tendinopathy (AT) and compared them to 44 runners without the issue, matching the control group to the tendinopathy group by age, height, and weight. They found significant differences between the two groups.

    Compared to the control group, those with AT had:

    • Less hip abduction (leg moving away from the midline) and hip extension ability
    • Weaker knee extension strength
    • Weaker calf strength
    • Pain during hopping and leg curls
    • Less plantarflexion (pointing the toes)

      Quick terminology note: The term tendinopathy refers to any issue involving a tendon, according to Carol Mack, D.P.T., C.S.C.S. She told Runner’s World that problems used to be split into categories indicating acute inflammatory conditions, called tendinitis, or chronic issues that change the tendon’s structure, termed tendinosis, but now tendon issues lie under that single term.

      All of the factors associated with AT are an important part of endurance and power during running, so presence of AT would negatively affect performance in a number of ways, while also upping your risk for more serious injury. If the issue becomes chronic, all of those measures could worsen, leading to less movement, more pain, and muscle imbalances.

      Like any strategy for addressing a running injury, prevention is key. Mack said that calf raises—both seated ones with weight (in which you hold two dumbbells on top of your knees for resistance and raise heels off the floor) and standing raises with or without weight—tend to be ideal in preventing Achilles tendinopathy because they strengthen the two muscles that connect with the Achilles tendon, the gastrocnemius and soleus muscles.

      Calf raises in those two positions work both calf muscles. Seated raises are especially important, she added, because those strengthen the soleus muscle, which was highlighted in the recent study as particularly weak in those with Achilles tendinopathy.

      If you’re already struggling with Achilles tendinopathy challenges, Mack said taking shorter, quicker steps may also help, but it depends on how painful the condition is for you. It’s possible that switching the location of your run could be a boon—she noted there’s evidence treadmill running puts more strain on the Achilles tendon, so switching to outdoor runs could be beneficial.

      “The biggest strategy that should be in play here is being mindful about the amount of running someone is doing, and how gradually they’re able to increase their frequency or intensity,” Mack says. You don’t want to build up mileage or speed too quickly only to get sidelined.

      “Also, finding ways to cross train is important because it’s difficult to take time off and then have to build back up again,” Mack adds. Cross training can help you maintain your fitness when you need to hang up the running shoes for a bit (and you should hang up your shoes if you’re regularly experiencing pain).

      Speaking of footwear, that’s another crucial element in avoiding or addressing Achilles tendinopathy, Jason Kart, D.P.T., told Runner’s World. Not changing shoes after 300 to 400 miles of wear could decrease support and change the mechanics of how you run.

      An assessment by a physical therapist is always helpful, particularly if you’re experiencing pain or soreness in the Achilles regularly and have a history of ankle sprains, which means the tendon could be overworking.

      “Whenever you have recurring or chronic issues like Achilles tendinopathy, it’s important to look at joint mechanics and how tendons and muscles are affected,” Kart said. “If your tendons aren’t adapting to how you move, you need to find out why.”

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