The best way to clear up your Achilles Tendon problem may NOT include traditional stretching.
The Achilles tendon can be a problematic area for many runners and field athletes alike and it's often a stubborn condition to treat. It's the biggest, fattest tendon in our body attaching the powerful calf muscles to our heel bone and it really IS the thing that puts the spring in our step...... literally ! It acts like a giant spring both absorping shock as the foot impacts the ground and storing tension which can then be released in a burst to propel us forwards into a sprint or upwards into a jump. Problems can range from a sudden tear or rupture of the tendon itself or an overuse injury which builds, worsening gradually over time. The two injuries are very, very different and require completely different treatment regimes. Sudden ruptures generally fall into the clutches of the orthopaedic surgical team - not necessarily always opting for surgery - so for the purpose of this article we'll consider the latter of the two, an overuse injury which is far more common amongst even the moderately active or those on their feet a lot for their job..
What is Achilles pain ? What is damaged ?
Well there's a can of worms to open to start with !
Traditional thinking was that pain developed in the Achilles area because there was damage or inflammation to the actual structure of the tendon. However, modern research suggests this is simplistic and often the problem is far more complex, certainly for overuse injuries. More likely is that the tendon tissue struggles to produce enough collagen to withstand the forces placed through them especially when the change has been relatively quick. Occasionally certain long term medications or genetic conditions can mean that the tendons struggle to manufacture collagen fibres hence making the tendons more vulnerable to developing issues. Scanning is often inconclusive as it's the way the tissue functions that is the problem rather than the structure of the tissue itself. Remember MRI only shows structure, NOT function.
Pain felt in the Achilles region may not even be coming from the tendon itself - if we think about how ' busy ' this area is anatomically with a myriad of joints, ligaments, nerves and other soft tissues all with plenty of scope to be the culprit for any aches and pains. As with all injuries that are not resolving - get a proper assessment and diagnosis so you're not working in the dark. No point spending months on an Achilles rehab programme when actually you have bursitis or a joint problem instead. Pointless.
Loading the tendon.
When a Physio says ' load ' we specifically mean a force or weight being put through the tendon.
Imagine stretching an elastic band or your car suspension springs absorping the impact of your car going over a speed bump... well, our tendons act in pretty much the same way - like stiff, thick elastic bands absorping and transmitting the muscular force to the bones and moving them. This load going down through them stimulates new collagen fibres to be built and laid down so it literally strengthens the tendons and causes structural change. Rock climbers are a perfect example of how the tendon adapts and changes, regular climbers develop incredibly strong and physically thickened tendons to withstand the huge load being placed through them. In short - our tendons NEED load to stay healthy and resting too much causes them to weaken.
Don't be scared of loading tendons - they love and NEED load and impact to keep them healthy.
The biggest problem most recreational sports folk encounter is doing too much load too soon so the tendon doesn't have sufficient time to adapt . That couch 2 5k that quickly turns into entering a 10k race with a rapid increase in training volume, the change of job from a desk bound to a more active role. Adaptation of tissues takes time, particularly with tendons - we are talking weeks if not months - and it's often the mis-understanding of how the body functions that leads to problems starting and becoming persistant
So what is the best way to load the Achilles then ?
The key word here is slowly and carefully !
It often comes down to the Goldilocks approach..... Not too little. Not too much... just enough. When we emerged from lockdown in 2020 we picked up a LOT of Achilles and other tendon problems. Why ? Easy, having spent months doing as were told, sitting on our bums watching Netflix all of a sudden we were released and went back to running, sports, work etc.... Result was our tendons didn't know what had hit them and many developed pain as the tendons had become ' unfit ' during the down time in lockdowns - particularly the early winter 2021 lockdown when we didn't feel so inclined to be outside being active. The reverse is also true, during the Australian Open Tennis of 2021 the professional players all had to complete a two week hotel quarantine so were not able to do their usual training - result was a far higher incidence of injuries than usual, many of them abdominal tears.
The philosophy is always to train the tendons for the function that they need to perform. A distance runners tendons will need to do a very different job to a sprinters or a long jumper or a climber. Sounds obvious I know but you'd be surprised how many people turn up on our treatment couch using cycling as a training for their running !
To stretch or not to stretch ?
That is the question ?!
Calf stretches are probably the one stretch even the most exercise phobic of us have done from time to time. That traditional lunge position to get that delicious stretchy feeling in our calf muscles after a long car or plane journey or after a bout of cramp. Head towards any gym or running track and there is a sporting chance that you'll find some dude stretching his calves out after a big training session in an attempt to reduce the dreaded DOMS and that's entirely apprpriate but much of the recent research shows it is NOT the best way to go about treating Achilles pain.
Stretching reduces the stiffness of the tendon making it more flexible and less able to store energy and transmit that load. Remember earlier we said we want the Achilles to act like a big spring, storing energy and releasing it to allow a burst of energy to propel us forwards ? Well if the Achilles is too flexible this doesn't happen as efficiently and it can mean running economy is reduced - basically the Achilles can't store the energy to spring us forwards so it takes more energy to perform the same activity. In the case of a distance or endurance runner this can have a serious impact on their running economy and their energy reserves.
Best ways to treat Achilles pain .
Try to act early.
It's always easier to see something off in the early stages rather than waiting several weeks until the problem has become well established - most of the Achilles problems we pick up have been grumbling along for a while before clients ever present to us in clinic. Fair enough if the area is red, hot and sore to the touch then a period of rest may well be advised, along with K taping or maybe even a heel rise to offload the tendon whilst the initial soreness settles.
But in general our advice would be to load the tendon in a specific and controlled manner. Remember earlier we said that load through the tendon will stimulate collagen formation and build a stronger tendon. By loading we mean calf raises - there used to be a huge emphasis based on eccentric ( lowering ) exercises being the only way to exercise but most modern research has debunked this as not being really relevant - after all, what goes up must come down, right ? ....... basically calf raises ( up or down ) are the answer. Again Goldilocks principle.... not too many, not too few and not every day either ! Collagen takes a good 24-48 hours to form so patience is required. That's why rest days are so important for soft tissues to allow the body to actully physically manufacture new tissues. And just like Rome a good strong Achilles isn't built in a day !
Conclusion
Achilles Tendon issues needn't necessarily be a long term problem but they can easily become so with too an enthusiastic approach. As always make sure you have the correct diagnosis and with some local treatment, a guided rehab programme and some patience you can be pain free and end up with a strong tendon ready to spring you forward into your activity.