This question is from Tom, who visits the Valley from New York. He began having Achilles tendon pain when he came here this fall. He was walking a lot, more with more hills than he does at home. He began with a bit of pain which he thought he bruised his heel walking down hill. He rested for a bit. Felt better. But, the pain returned as soon as he resumed his walks.
This is a common scenario. First he really had ramped up his walking quickly. From doing a couple miles to 6 or 7 and almost daily. When you don’t have an obvious trauma the first thing you should look at is change in activity. Whether its time, distance, intensity, or frequency. I have talked about grading and building load capacity. A lot. Because this is frequently one of the biggest contributors to pain and injury. Many people can get talked into believing that they are walking wrong, or need orthotics, or their muscles are out of balance or something along those lines. This means you need someone or something to fix you.
Keep it simple. Basic rehab is to calm down the area and then build it back up. Tom did the calm down part just right. But, when he returned to walking he went right back to his previous level that got him in trouble in the first place. He will be able to do this just fine. It will take a bit of time and building capacity.
When you have tendon pain, you frequently have what is known as tendinopathy. A part of the tendon has gotten unhealthy basically. We now know that this can cause pain, and even when it gets better and doesn’t hurt any more, it can still look unhealthy. We think that getting the tendon better around it and building its capacity can help. The program isn’t always easy. Many people with more severe or longer duration pain can have trouble returning. It can also be frustrating as frequently it means modifying an activity that you love like running or hiking. But it worked for Tom.
We did just as I said above. Calmed it down and built it back up. To calm it down we found out how much Tom could walk with little lingering pain. You don’t have to be pain free, but what we don’t want worsening pain during an activity or pain that lasts a long time after. Tom was able to walk some, but less than he had. Some people will modify a little, some a lot, some will have to lay off totally for a bit. We also started loading his tendon to build capacity. For an achilles tendon, this was heel raises on both feet together, progressing to single heel raises, to raises off a step, to lunges, to weighted raises, to jumping and hopping. Any exercises that load the tendon will help. Heel raises are easy to do without a lot of equipment. The important thing is finding a dose that will challenge you without flaring your pain.
Again we are listening to his tendon trying to stress it without aggravating it. As he does these we are gradually upping his walking. In a few weeks he was walking 5 flat miles and after 6 weeks was back to normal. Everyone is different though in how their pain will respond.
If you have questions about Achilles pain drop a comment, give us a call at 970-949-9966 or ascent-pt.com.