Achilles Tendinopathy and the return to exercise, recreation, and activity

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As COVID dynamics are improving around the country, more and more people are returning to exercise, recreation and activity. It is not uncommon for people to hit the floor running, unfortunately ramping up too fast and too soon, after not doing too much can prompt injury. A common injury seen with return to activity is Achilles Tendinopathy.

According to, the Achilles tendon stores and transmits force from the calf muscles down the foot when the foot pushes off the ground (walking, running and jumping) and helps control the position of the ankle when the foot touches back down on the ground (landing). Tendinopathy refers to any problem with a tendon, either short- or long-term.

Achilles tendinopathy occurs when the work imposed on the tendon is beyond its functional capacity/ability and the tissue becomes inflamed. This can be prompted by a single event, repetitive stress or a substantial increase in activity beyond a recent normal. Irritation of the tendon can be at the mid-level of the Achilles or near the insertion.

When dealing with an Achilles tendinopathy, or looking to prevent it from occurring, there are several considerations to review and implement.

Pain management: If the Achilles is inflamed, emphasis on decreasing inflammation is important. Ice can be helpful in acute situations, yet non-weight bearing cardiovascular activity, like biking, can also be helpful. Other treatment interventions include taping and soft tissue mobilizations. Stretching too aggressively early on can promote a compressive force on the Achilles, which can irritate the tendon.

Footwear: Footwear that doesn’t compliment your foot morphology or running mechanics are factors that can compound Achilles tendinopathy. Asymmetrical walking and running mechanics can also lead to repetitive stress of the Achilles. Heel lifts can dampen down stress into the Achilles by limiting the dorsiflexion (foot pointing up) moment we experience when we stand, walk and/or run.

Range of Motion: Lack of mobility in the foot, ankle and knee joints can increase strain on the Achilles. If the joints are not able to move through enough range during a given activity, adjacent tissue can take an increase in strain. Stretching and soft tissue work, like foam rolling the calf, can compliment mobility by making tissue more pliable.

Core and lower extremity strength: Loading the Achilles through exercise is beneficial and essential for recovery from Achilles tendinopathy. Improving tensile strength of the Achilles will help increase its capacity for work. Strengthening of the core and other lower extremity muscles like the abdominals, hips, quadriceps and hamstrings will help promote efficient running and walking mechanics as well.

Functional or sport specific training: Once your pain eases and your strength and motion improve, you will need to gradually and safely transition back into more demanding and preferred activities. To minimize the tension placed on the Achilles tendon and your risk of repeated injury, it is important to train the movements you will be participating in for your given activity.

Returning to exercise, recreation and activity is exciting and fulfilling. The better we have an understanding of the stresses on our body, we can modify and implement sound considerations to our activity so we can keep ourselves on the move.

About the Author:

Michael Marcello earned his Bachelor of Science degree in Kinesiology at San Jose State University and his Doctorate in Physical Therapy at the University of the Pacific in Stockton. Michael is experienced in sports medicine, orthopedics, and concussion exertional physical therapy. Michael appreciates and utilizes current evidence-based treatment/interventions, continuing education courses and exercise to promote optimal function and performance. Michael, a Bay Area native, enjoys exercising, watching sports and spending time with his family and friends. Michael is a 49ers, Giants, Warriors and Sharks fan as well.

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