The causes and cures of Achilles Tendinitis

The causes and cures of Achilles Tendinitis

The next question on the Ask Coach Parry Podcast comes from Mark in Cape Town, and he says he had been battling with Achilles Tendinitis for the last few weeks and wants to know what causes it, what can be done to prevent it and how does one treat it?

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Brad Brown: The next question on the Ask Coach Parry Podcast comes from Mark in Cape Town, and he says he had been battling with Achilles Tendinitis for the last few weeks and wants to know what causes it, what can be done to prevent it and how does one treat it?

Lindsey Parry: Achilles Tendinitis is a very common  running injury particularly in novice runners and it’s because it can be caused by so many things. I will try and cover (and remember) as many of them as I can because there really are a lot things that cause Achilles tendinitis.

The most common causes of Achilles Tendinitis

Probably the most common cause of Achilles tendinitis is having very tight Soleus calf muscle – the calf is divided into the Gastroc and Soleus. The Soleus muscle is the one that you stretch when you bend your knee, if you have very tight Soleus it means that there is very little ‘give’.

That means that the Achilles tendon has to take a lot of strain, so typically that would be your Achilles would get irritated. And with the move over to more natural running, and even the shoes that aren’t really in the natural range have changed their heel to toe drop from 12 to 8 or 12 to 10, that does place a greater stress on the Soleus which in turn causes it to get a bit tighter and then in turn puts stress on the Achilles – which is part of the reason why we are getting so many Achilles now.

Similarly, if there is a problem with the angle at which your Achilles is being pulled on, so if there is a problem with Glute weakness (as an example), and your knee caves in because you can’t support all your weight properly because the Glutes are weak – then you will create an angle where the Tibia comes into the ankle and that will mean that there is angle where the Achilles is being pulled on the Achilles which can irritate it and cause Achilles tendinitis.

The shoes you are running in could also be the problem. If you are running in the inappropriate shoes, either you are not made for running in so-called ‘natural’ running shoes, or you make the change too quickly, or the shoes that your running in are not the right pair of shoes – they are too hard or too soft. And finally if your shoes are really just done and need to be replace, that can put excess stress on the Achilles.

Doing too much hill work, or doing too many of your runs on hills, can also place a stress on the Achilles. And then obviously if you have any of the other factors or more than one factor, you put yourself at a risk for increasing the Achilles tendinitis issues.

How do you treat Achilles Tendinitis?

The first thing to do is to stop the pain. Even though one of the causes is shortening the Soleus, we’re going to shorten it further by putting something in – an insert, a gel cup, a slightly harder insert or folding up a sock to put beneath your insole – but what we’re really looking at doing is just to reduce the actual stress on that Achilles and that can be anything from 3 -4 mm’s.

That’s often enough to reduced the pain or sometimes take it away and even allow us to train with that insert in the shoe. BUT, you then need to work on lengthening that Soleus, strengthening the Soleus so that it can help the Achilles with that shock absorption, strengthens the Glutes so that there is no ducking in of your Femur which is then causing a stress on potentially the knee and the Achilles.

Ensuring that you are in the right pair of shoes and that your shoes aren’t too old is important too. If your Achilles tendinitis has flare up because you are making the move to more natural running you need to transition much slower.

Then, if the wedge does not work, it probably means that you need to have some sort of intervention like physiotherapy. This is the one injury that doesn’t respond particularly well to ice. Especially if you are planning to do a little bit of training through it, because then all that ice will do is cause that tendon to shorten further and put more stress on it.

Finally, once you have removed that pain and you are running well again, I would really encourage you to address any bio-mechanical issues that are being cause by weak Glutes, Hamstrings, Quads, Soleus, or any particular inflexibility that could be causing those issues.

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