Achilles Pain
From 'just tendonitis' to full rupture
Why care?
Tendonitis, in general, is an extremely common issue that is very simple to address, but has devastating consequences if allowed to go on. Unfortunately, it is shrugged off and ignored far too often. In soccer, the knee and ankle are the most common sites of injuries. The Achilles, being categorized as part of the ankle region in nearly all relevant studies, has been shown to be one of the most frequent sites for tendonitis, rivaled only by the knee (patellar tendonitis). If either continue to progress and become chronic (called tendonosis), the athlete is put at an exponentially higher risk for rupture, which is in itself a minimum of 4-6 months’ recovery. Minimum. So, pay attention now and prevent that whole headache later.
How & Why:
Tendonitis literally translates to “inflammation of the tendon”. It can present as pain over the tendon (usually over the bottommost 4-6 inches, when pain is present). It is often worse immediately following and up to a few days after activity. Due to the inflammation, it may also be red or flushed looking over the tendon following activity as well. The cause is typically just ‘overwork’, for lack of a better term. The problem is that many times pain is not experienced by individuals because the inside of the tendon itself is not innervated (in other words, there are no nerves within, thus no sensation of pain). As a result, a large percentage of people with Achilles tendonisis (or -osis) don’t know they have any problem until one day - pop! - they make a quick acceleration movement while playing and their Achilles tears.
So, what can you look for, if not pain?
Above: A bulge, visible in this individual's left Achilles, is evidence of Tendinosis
Simply feeling tenderness or pain when pressing on the tendon using your hand/thumb may be a sign. More specifically, find the most sensitive part and press or pinch it. Now, maintain pressure and flex your calf; if the pain is decreased, this is a sign that you may have Achilles tendonitis/-osis. This is called the Royal London Hospital Test.
One of the most tell-tale signs that you have a problem is the presence of a large ‘bulge’ in the middle of the tendon (see image right). When you plantarflex your ankle (toes point down), the bulge may move up/down as you flex/relax your calf, respectively. This is called a positive Arc Sign, and is highly characteristic of Achilles tendonosis.
O.K. So, what can you do?
Prevent it:
First of all, if any of the above ‘tests’ are positive, you should go see your doctor (MD). If your state regulations/insurance allows, you may also directly see a Physical Therapist.
Next, if the tendon is red, inflamed and painful (AKA tendonitis) during and after exercise and the above ‘tests’ are NOT positive, then relative rest is probably a good move. To address the inflammation, use R.I.C.E. (rest, ice, compression, elevation). Ice for 20 minutes on, 20 minutes off. Icing for longer periods of time can cause skin damage, and actually cause an undesirable reaction of increased blood flow to the area – which is not what you’re going for. The ‘rest’ part is only recommended for active, worsening tendonitis (inflammation) and a negative Royal London Hospital Test and Arc Test. For chronic Achilles Tendonosis (positive aforementioned tests with an obvious tendon bulge), rest is not the answer. This may seem counterintuitive, but recent literature reviews released as of 2018 show that complete rest may worsen the situation. See below for what to do in this case.
In terms of exercises, either slow concentric or eccentric exercises can be beneficial. Concentric: do a calf raise on both legs. Now do it again with as much resistance as you can do for roughly 8-15 reps without sacrificing quality or the range through which you can go. Do not compensate and try to ‘bounce’ or use your body momentum to do it. Slow and controlled is key. Eccentric, on the other hand: calf-raise going ‘up’ with both legs and slowly lowering ‘down’ on one leg. Again, as much resistance as you can handle for about 8-15 reps. Ice still may be beneficial after exercise (or when resting end of the day) for tendinosis. If anything, it’ll help with pain, should you have any.
Listen to your body;
Watch out for your body.
Take care of yourself.