Q & A: How Do I Treat Achilles Tendonitis?

In order to prevent a reemergence of the injury, determine what the problem is.

Q: Hi Gale, I'm currently a runner and an aspiring triathlete. I had a great running season last year, but unfortunately I now have chronic Achilles tendonitis. I was wondering if you have any miracle cures or exercises?

Thanks,
D.K.

A: D.K., sorry to hear about your tendonitis. Achilles tendonitis is the inflammation of the tendon attaching your lower leg muscles to your heel bone. This inflammation causes the normally smooth gliding motion of the tendon to become painful.

Interestingly, people with tendonitis usually say the symptoms are worse after inactivity, such as first thing in the morning or after sitting for long periods of time. I will address possible treatments for tendonitis later in the column; but first I want to discuss possible root causes of the problem.

There are definite solutions to treating tendonitis; however if you don't determine what is causing this problem for you, it is likely to reappear. Here are some of the common causes:

Overtraining
When eager athletes include too much volume, too much intensity, or too many hills in a training program, there can be problems such as tendonitis. Look back at your training before the problem developed to see if you had any sudden increases in training volume, hills or intensity. Also look back to see if you included intentional periods of rest into your training plan.

Athletes that do not include periods of reduced volume and intensity, often have problems that begin with a "little stiffness" and build into a full-blown injury.

Shoes
This category includes workout shoes and your everyday shoes. Several footware issues can cause injuries:

  • Recent changes in any footwear can cause tendon issues. If you recently started wearing new work or daily wear shoes, they might be the cause.
  • Some women experience Achilles aggravation when they wear high-heeled shoes for a good portion of the day and then switch to running shoes for workouts.
  • New models of running shoes, even if they are the improved version of an old model, can cause problems.
  • On the flip side, running shoes that are old can cause problems. Shoes that have too many miles on them need to be replaced. If the shoe is broken down and no longer supporting your foot, an injury can creep up.
  • Running shoes that are not appropriate for your foot can be an issue. You want a shoe designed for your foot-strike pattern and your particular running needs. (A lightweight race shoe is not a good training shoe. If you overpronate, there are shoes designed to help that issue.)

Feet
Your particular foot anatomy may require that you have orthotics. This is an issue that needs the attention of a foot doctor that has experience working with athletes or a specialist in a sports medicine clinic.

Overtraining, shoe issues and biomechanical issues are the most common causes of Achilles tendonitis. You don't want to let this condition continue to be chronic because it can lead to small tears, weakening your tendon. Weak tendons are susceptible to rupture.

Tend to Your Tendon

How can you get rid of tendonitis? The first step is to make an appointment with a knowledgeable doctor that can help you, preferably someone associated with a sports medicine clinic. Your primary care physician can give you a referral.

Your medical expert will help you sort out the cause of the problem and help you eliminate the pain so you can be active again. Some of the potential solutions may include:

  • Rest—Reducing or eliminating some of your training.
  • Ice—Icing the injured area to help reduce the inflammation.
  • Eliminating Troublesome Footwear—If you are wearing a shoe or a boot with a substantial heal all day long, you may need to give it up.
  • Anti-Inflammatory Medications—Over-the-counter or prescription anti-inflammatory medications get rid of the inflammation and the pain. Know that some people experience stomach issues when taking these medications.
  • Physical Therapy—This typically includes a stretching and strength training regimen. If you have been overdoing the training, some amount of rest or cross-training will be prescribed. Often, icing and anti-inflammatory medications are included in the physical therapy protocol. They may also use ultrasound or electrical stimulation in the treatment.

If you are uncertain about the advice of one medical expert, don't be afraid to get a second opinion. The sooner you seek some professional help, the faster you will be back on the road and pain free.


Gale Bernhardt was the 2003 USA Triathlon Pan American Games and 2004 USA Triathlon Olympic coach for both the men's and women's teams. Her first Olympic experience was as a personal cycling coach at the 2000 Sydney Olympic Games. Thousands of athletes have had successful training and racing experiences using Gale's pre-built, easy-to-follow training plans. For more information, click here. Let Gale and Active Trainer help you succeed.

Related Articles:

      • Solving the Puzzle: 4 Tips for Injury-Free Running

      • Breaking It Down: Physiology, Running and Recovery

      • How to Tell When You're Over-Reaching or Over-Training

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