Categories: Foot and Ankle

Achilles Tendonitis: Best Treatment to Fix Pain and Weakness

Achilles Tendonitis: Best Treatment to Fix Pain and Weakness

by | Foot and Ankle

Introduction:

The Achilles tendon plays a crucial role in our ability to move, allowing us to propel ourselves forward when walking or running. Unfortunately, Achilles tendonitis is a common condition that can cause pain along this vital tendon. In this article, we will explore the causes of Achilles tendonitis, common symptoms,  its impact on hunters, and most importantly, effective strategies for preventing it.

Understanding Achilles Tendonitis:

Achilles tendonitis is typically diagnosed when an individual experiences pain along the Achilles tendon. It’s important to note that inflammation may or may not be present with this condition. The underlying cause of Achilles tendonitis often lies in poor healing after small tears occur along the tendon, leading to stiffness and impaired mobility in the ankle and foot.

How do you know if you have bad ankle mobility?

Limited ankle mobility is a common issue that contributes to conditions like Achilles tendonitis. By recognizing the signs of ankle mobility issues and conducting self-assessments, hunters can identify potential risks. A useful self-assessment technique is the “knee-to-wall” test. Kneel in front of a wall, place your foot about a hand-width away, and lean forward, attempting to touch your knee to the wall while keeping your heel on the floor. By measuring the distance and assessing tightness, you can gauge your ankle mobility.

No pain or a hand-width distance between the foot and wall is considered a normal test.

How to Improve Ankle Mobility:

The knee-to-wall test itself serves as an ankle mobility exercise. However, if you experience ankle mobility issues or tightness, targeted ankle mobility and strengthening exercises can help improve the situation. Pinching in the anterior ankle may indicate a restriction within the ankle joint and can be addressed by frequently performing the knee-to-wall test. Calf muscle tightness or tightness along the Achilles tendon may improve with stretching and strengthening exercises.

At the end of this post, we will explore exercises to address ankle mobility concerns.

Symptoms of Achilles Tendonitis Ankle:

Recognizing the symptoms of Achilles tendonitis is crucial for early intervention and effective treatment. Common symptoms include:

1.  Calf and Ankle Tightness:

One of the initial signs of Achilles tendonitis is a feeling of tightness along the Achilles tendon and calf muscles. This tightness often leads to stiffness and restricted mobility when attempting to move the foot and ankle, particularly when pulling the foot and toes up. This movement puts strain on the muscle and Achilles tendon, exacerbating the discomfort.

2.  Heel Pain while Walking or Running:

A distinct symptom of Achilles tendonitis is pain in the backside of the heel, particularly when weight is placed on the toes during walking or running. This pain is often significant enough to cause individuals to develop a limp to alleviate pressure on the affected area.

3.  Visible Nodule or Lump in the Achilles Tendon:

In moderate-to-severe cases of Achilles tendonitis, a physical and palpable nodule may be noticeable along the Achilles tendon. This nodule is a visible manifestation of the inflammation and can contribute to the discomfort experienced.

4.  Sharp, Radiating Pain in the Calf or Heel:

Localized pain at the point where the Achilles tendon inserts into the heel bone or in the middle portion of the tendon itself. 

5.  Pain when Walking on Tip-Toes:

Contracting the calf muscle and putting stress on the inflamed area can elicit pain in individuals with Achilles tendonitis. Walking on tip-toes, which engages the calf muscle, can exacerbate the discomfort and further highlight the presence of this condition.

The Impact on Hunters:

Hunters, who regularly participate in activities like hiking across uneven terains, face an increased vulnerability to achilles tendonitis. This condition often manifests with symptoms after engaging in pursuits such as elk hunting in mountainous regionds or upland hunting. In order to minimize the risk, hunters should prioritize physical preparation to decrease the liklihood of developing this painful ailment

The varied terrains encountered during activities like hiking, elk hunting in the moutnains, or upland hunting can exert added pressure on the Achilles tendon. The repetitive motions involved in these pursuits, such as climbing, descending, or traversing challenging surfaces, can result in overuse and strain on the tendon.

The Importance of Preparation:

Many hunters who experience Achilles tendonitis share a common factor: a lack of preparation before their hunting trips. Physical preparation is key to reducing the risk. Hunters should engage in regular physical activity, maintaining strength and flexibility in their calf muscles through exercises like calf raises and eccentric heel drops. Incorporating a variety of activities like hiking, running, and strength training will provide a comprehensive approach to fitness and injury prevention.

Taking Prompt Action:

If you experience any signs and symptoms of Achilles tendonitis, it is crucial to take prompt action to prevent the condition from becoming chronic. One of the first steps you should take is to rest the affected area. Avoid activities that aggravate the symptoms and allow your Achilles tendon time to heal. Additionally, applying ice to the area can provide initial relief by reducing pain and swelling. Use an ice pack or wrap ice in a towel and apply it to the Achilles tendon for approximately 15-20 minutes at a time.

Remember to always seek professional advice from a physical therapist or healthcare provider who can provide a comprehensive treatment plan tailored to your specific needs. They will guide you through the appropriate steps to manage and recover from Achilles tendonitis effectively.

Remaining active by performing pain-free activities is critical. Total rest, inactivity, is not recommended. 

PT Exercises for Achilles Tendonitis

Jill Cook, a renowned expert in the field of tendinopathy, emphasizes a progressive loading program as her recommended approach for Achilles tendonitis. As a physical therapist who has worked with numerous clients and patients, I have developed an exercise program based on this principle. It’s important to note that while this program generally works well for patients with Achilles tendonitis, modifications to exercises and parameters may be necessary based on each individual’s symptoms.

Research has shown that exercise is the most supported treatment option for Achilles tendonitis. When performing exercises, it is crucial to manage pain levels. Ideally, the pain should remain at a 4-5 out of 10 or lower and should not worsen the following day. It is actually a positive sign if the pain improves or lessens after the first set or two of the isometric exercises.

If the pain and soreness become more severe the following day, it indicates that there may have been excessive stress or load on the tendon. In such cases, I recommend regressing the exercises by adjusting the sets, repetitions, or load. Once the pain subsides, I gradually progress the sets, repetitions, and load while always monitoring pain levels and the following day’s soreness.

Below is an Achilles Tendonitis protocol that I follow with many clients and patients who experience pain along the Achilles tendon.

Phase Exercise Description Repetitions/Sets Frequency
Phase 1: Isometric Exercises (Weeks 1-2) Isometric Calf Raises Stand near a wall or a stable surface for support. Push both feet into the ground, rise up onto your toes, and hold the position for 45 seconds. 5 sets 3-5 times daily
Eccentric Heel Drops Stand on a step with your heels hanging off the edge. Rise up onto your toes using your uninjured leg, then transfer your weight to your injured leg and slowly lower your heel below the step. 8-12 repetitions 3-5 times daily
*By the end of week two, pain should be substantially better. One should be able to progress their activity level with normal activities of daily living, as well as in the gym.
Phase 2: Heavy Slow Resistance Training (Weeks 3-6) Calf Raises Stand on both feet near a wall or a stable surface for support. Rise up onto your toes using both legs, then slowly lower your heels below the step. 3 sets of 12-15 repetitions Twice a day
Eccentric Heel Drops Stand on a step with your heels hanging off the edge. Rise up onto your toes using both legs, then transfer your weight to your injured leg and slowly lower your heel below the step. 3 sets of 12-15 repetitions Twice a day
Phase 3: Plyometric Exercises (Weeks 7-10) Double-Legged Calf Jumps Stand on both feet with your knees slightly bent. Jump off the ground using both feet, propelling yourself upwards. Land softly and repeat. 3 sets of 10 jumps Twice a day
Single-Legged Calf Jumps Stand on your injured leg with your knee slightly bent. Jump off the ground using your injured leg, propelling yourself upwards. Land softly and repeat. 3 sets of 10 jumps Twice a day
Phase 4: Sport-Specific Exercises (Weeks 11+) Sport-Specific Drills Gradually incorporate activities related to your specific sport or activity that caused the Achilles tendonitis. Start with low-intensity drills and gradually increase the intensity and complexity over time. 3 times a week

General Guidelines:

    • Perform these exercises 4-5 days a week, allowing for adequate rest and recovery on the remaining days.
    • Monitor your pain levels during and after each session. Mild discomfort is acceptable, but avoid exacerbating pain.
    • Focus on maintaining proper form and technique throughout each exercise.
    • Progress gradually by increasing the number of repetitions, sets, or intensity level as tolerated.

Remember, this is a general exercise program based on Jill Cook’s recommendations. To ensure your safety and optimize your recovery, it is important to work with a qualified healthcare professional or physical therapist who can assess your specific condition and provide personalized guidance and adjustments.

Additionally, do not neglect the other muscles of your legs. There are numerous exercises that can benefit the entire leg while putting minimal stress on the calf and Achilles tendon. A comprehensive physical therapy or strengthening program should incorporate exercises for the entire leg and core to build a solid foundation and enhance the recovery process.

Exercises to Improve Ankle Mobility:

1.  Half Kneeling Ankle Dorsiflexion with Mobilization:

Assume a half-kneeling position with one knee on the ground and the other foot positioned in front of you, flat on the floor. Keep your heel on the ground and gently lean your body weight forward, focusing on bringing your knee towards your toes. This exercise targets ankle dorsiflexion, which brings the top of your foot towards your shin and improves mobility in that direction.

2.  Kneeling Ankle Plantarflexion Stretch:

Start by kneeling on the floor with your toes tucked under and the tops of your feet flat on the ground. Slowly sit back onto your heels, feeling the stretch in your ankles and the front of your feet. Hold this position for 20-30 seconds and then release. This stretch focuses on ankle plantarflexion, which is the movement that points your toes downward and helps increase flexibility in that direction.

3.  Ankle 4-Way Movement:

This exercise involves moving your ankle in different directions to enhance its range of motion. Perform the following movements:

      • Dorsiflexion: Lift your toes towards your shin, aiming to bring your foot towards a 90-degree angle.
      • Plantarflexion: Point your toes away from your shin, trying to achieve a full downward pointing of the foot.
      • Inversion: Turn your foot inward, towards the midline of your body.
      • Eversion: Turn your foot outward, away from the midline of your body.

Perform 10-15 repetitions, 2-3 sets each, in each direction while focusing on smooth and controlled movements. A resistance band may be used to progress the load and elicit further strength and mobility improvements.

Conclusion:

As a physical therapist, strength and conditioning specialist, and avid hunter, I understand the challenges that hunters face when it comes to Achilles tendonitis. By prioritizing physical preparation, maintaining an active lifestyle, and promptly addressing any symptoms, hunters can significantly reduce the risk of developing this condition.

The provided exercise program, based on the recommendations of renowned expert Jill Cook, focuses on progressive loading and includes isometric exercises, heavy slow resistance training, plyometric exercises, and sport-specific drills. Additionally, improving ankle mobility through exercises like half kneeling ankle dorsiflexion with mobilization and ankle 4-way movement can further reduce the risk of Achilles tendonitis.

Remember, prevention is key. Stay active, eat well, and enjoy your hunting adventures pain-free. If you experience any symptoms or concerns, consult with a qualified healthcare professional or physical therapist for personalized guidance and treatment.

About the Author

Taylor Kuhlmann, PT, DPT, CSCS

Taylor Kuhlmann is a licensed physical therapist in Kansas, a certified strength and conditioning specialist accredited by the National Strength and Conditioning Association, and the founder of High Caliber Health. With a passion for guiding hunters and outdoor enthusiasts, Taylor focuses on enhancing their overall health and wellness, enabling them to experience the outdoors with reduced pain and enhanced performance.

Taylor Kuhlmann, PT, DPT, CSCS

Father x2, husband, physical therapist, strength and conditioning specialist, hunter, golf

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