June 10, 2021
Achilles Tendinitis| Ask the physical therapist

Todd Shropshire, PT

Achilles tendinitis/tendonitis is inflammation of the Achilles tendon. It's one of the most common running injuries that physical therapists see. It's also common in middle-aged people who play sports like tennis and basketball.


What is the Achilles tendon?

Located at the back of the lower leg, your Achilles tendon is a thick tendon that connects your calf muscles to your heel bone. The Achilles tendon is the body's largest and thickest tendon.


Achilles Tendinitis vs. tendinopathy

Often when people begin or return to running, they do too much too soon. That includes running at a higher frequency or running more miles than they are accustomed to. 

Ramping up your running routine can flair up the Achilles tendon and cause an inflammatory response (Tendinitis). If left untreated, the inflamed tendon can begin to break down (Tendinopathy) so that anytime a runner pushes up on their toe, they tend to experience increased pain at the posterior heel / lower leg.


How is Achilles tendInitis treated?

Achilles tendonitis treatment depends on the acuteness and severity, or the chronic nature, of the injury. 

With a painful but new flair-up, treatment revolves around trying to appropriately load the Achilles tendon in a pain-free manner. This type of treatment approach promotes healing in the tendon but also re-trains the tendon to bear that load again. 

An example of this type of progressive therapy is to have a patient lay on their stomach on a table or bed, with their feet off the table, and push their toes toward the ceiling. 

Once this is can be done pain-free, individuals can progress the loading of the Achilles tendon – sitting with feet off the table and pushing down into a resistive band, then standing heel raises on both feet and then single leg heel raises. The progression should be pain-free.


How can I avoid Achilles tendinitis?

To avoid Achilles tendinitis altogether, start small and start conservatively. Build up your run distance and frequency over time and see how you feel. Make sure to properly stretch before and after your workouts and to take necessary rest days for your muscles to recover.


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Todd Shropshire, PT, is a physical therapist and PT manager at OrthoCarolina Ballantyne Physical & Hand Therapy.

This article was originally published on September 26, 2018, and has been updated on June 10, 2021.

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