Ever hear of the story of Achilles, the great Greek warrior? So the story goes, he was invincible after he was dipped in the River Styx with the exception of the area he was held by, his heel. At the end of the Trojan war he was finally killed when an arrow struck his heel. The proverbial Achilles’ Heel. Nowadays, we don’t often walk around having been struck by an arrow but many of us do develop heel pain termed “Achilles Tendonitis”.
The problem is that Achilles Tendonitis is a bit of a misnomer. The suffix “-itis” refers to inflammation and for years was taken to mean that the origin of pain and dysfunction was purely inflammatory in nature. Therefore, Achilles Tendinopathy is now the preferred term as inflammation is now understood to only be present in the first few days. As the symptoms persist longer, the evidence shows that it is more likely caused by degeneration, or breakdown, of the tendon structure.
Unfortunately, one third of missed work days are a result of musculoskeletal problems. Furthermore, 65% of those missed days are a result of these tendon-based overuse injuries. This could mean that something like Achilles Tendinopathy could result in quite a few lost days from work, costing you valuable time and money.
Now that we know what Achilles tendinopathy actually is, what causes it? Usually, it is the result of performing a repetitive task to the point that the tendon cannot repair itself quickly enough. This then causes a degenerative process to occur within the tendon fibers which leads to pain and loss of function. Think of it as an overuse injury: A runner who typically runs 10 miles a week suddenly decides to up his training to 40 miles per week. For the first week he feels okay but after 2 weeks his achilles tendon begins to hurt when he tries to run or hike.
Another example is a middle-aged adult whose made a new year’s resolution to get in shape. “New year, new me”. They were previously pretty inactive, but decide to try the fun HIIT class at the gym that includes lots of plyometrics, jumping, and running. This is a big change in their activity level and after a few weeks they begin to feel the symptoms of posterior heel pain. Their body responds by activating an inflammatory process in those first few days. This means things that follow the RICE principle (rest, ice, compression, elevation) are probably helpful. However, if things persist for several weeks to months then these are no longer effective strategies for pain relief.
So what do you do? It has been several weeks, the pain is annoying and keeps you from walking, running, hiking, or playing sports. Taking ibuprofen doesn’t seem to help anymore and you’re getting frustrated. This is where a physical therapist comes in handy. We’ll help figure out where your starting point is and come up with a plan to help get you back to the activities you’re missing. Typically, just avoiding the activities that hurt will not get rid of the problem. It will feel better for a while but then will just creep back as soon as you start again! Your physical therapist should help you put a manageable load on the tendon through exercise to help stimulate changes at the cellular level. This allows the tendon to become more resilient and tolerant to your painful activities. This process may take some time but remember, we’re changing the structural integrity of your tendon! Rome wasn’t built in a day. If you are currently experiencing pain similar to this, see below for some exercises that you can try depending on your current level of activity.
While these exercises may help, nothing substitutes for an evaluation by a physical therapist. Luckily, we have locations in Shelburne, South Burlington, and Hinesburg to better serve you. Let us help you feel good again!
Heel Raises: Rise up onto your toes, pushing equally with both feet. Try to avoid turning ankles in/out as you push up. Perform 3 sets of 10 repetitions.
Eccentric Heel Raises: Start by standing on a step with your heels off the edge and lift one leg up. From this starting position, rise up onto your toes and lower back down as far down as you can while keeping your toes on the step. Perform 3 sets of 10 repetitions.
Single Leg Hop: While standing on one leg, hop side to side, landing soft and controlled. Repeat 3 rounds of 10 alternating hops.
Box Jump: Start in front of a box/step in a squat position, jump up and emphasize landing as quietly as possible. Knees should be bent to help absorb force. Step down and then repeat 2 sets of 10 repetitions.