This blog discusses current trends around the treatment of runners with Achilles pain and does not constitute medical advice. If you have pain associated with your running activities, please consult with a clinician for a proper assessment.

Treating & Overcoming Achilles Tendinopathy

In the second (and final) part of this injury blog series, PWR Lab’s co-founder and resident running injury expert, Dr. Jeff Moreno, shares his three-phase plan for helping runners overcome Achilles Tendinopathy.

Let’s be honest, running injuries rank high on our list of things we strongly dislike. Unfortunately, injuries are fairly common in the sport. How common you ask? An average of 79% of runners suffer a running-related injury during the course of a year1. In part one of our Achilles Tendinopathy series, we introduced you to this stubborn injury, outlined common symptoms, and identified your personal risk factors so we can attack the root of the injury. Today in part two, we will help you understand pain in the sense of when it’s okay to keep running vs. when you should hold back. Then we will provide you with a three phase plan for mitigating your risk factors, building tissue strength, and overcoming Achilles Tendinopathy.

It’s important to mention that this guide should NOT be used as a replacement for a visit to your doctor. Every runner’s road to recovery will look slightly different. Consult your preferred physiotherapist to help personally guide you through each treatment phase and ensure a safe progression toward your desired goals.


Understand | How much pain is too much?

As you progress through our three phases, we want to clarify that experiencing some pain is completely normal. Think about our 'Wear & Repair' scale from Part One of this series - when a little bit of wear to the Achilles tendon is paired with proper recovery it builds stronger tissue, but too much wear and not enough repair is where we enter the injury danger zone. The same is true for pain. A little pain is a natural part of the healing process. But when pain becomes excessive, it’s time to adjust. Remember sometimes two steps back now means three healthy strides forward in the future.

So how do we decide when to run through pain, cross train, or take a rest day? Think about pain as your body’s internal traffic light for activity. The chart below will help you make an informed decision about when you should give the body stress and when you should give it rest throughout the phases of treatment:



Treating | Phase I: Decreasing Risk Factors & Discovering Current Capacity

Timing: Progress to Phase II once you are walking and waking up in the morning in the Safe Zone of pain.

Goal: Keep moving, but remain in the Safe Zone of pain during all activities. Decrease the risk factors you identified in part one of this series. Start by tackling the risk factors that are the easiest to accomplish. Follow our suggested actions below:



Prep for Phase II of this program by introducing Isometric Load and Holds into your routine. Trust us, this exercise is less complicated than its name and is used to jumpstart the healing process by decreasing pain and improving tendon health.

Directions: From a standing position, raise up on your toes, lifting your heels off the ground, hold for 45 seconds, and slowly lower your heels back to the ground.

Sets:
– Double Leg: 5 x 45 second holds
– Single Leg: 5 x 45 second holds
Recover 1-2 minutes in between reps

Frequency: Daily


Loading | Phase II: Building Dynamic Tissue Strength & Capacity

Timing: Progress to Phase III once you can complete 3-4 sets of Single Leg Bent Knee Heel Raises in the Safe Zone of pain.

Goal: Increase tendon capacity and resiliency through a running and injury specific strength program.




Weighted Isometric Load and Holds 

Note: Plate not necessary.


Weighted Isometric Load and Holds:

Directions: Same as the Load and Holds from Phase I, but this time we’re making it a bit more challenging by adding weight. Pick a dumbbell or kettlebell that makes the exercise challenging but completable.

Sets:
– Double Leg: 5 x 45 second holds
– Single Leg: 5 x 45 second holds
Recover 1-2 minutes in between reps

Frequency: Daily


Double Leg Heel Raise 
Note: Plate not necessary.

Double Leg Heel Raise:

Directions: Set an Assisted Squat Rack to a height that allows the bar to rest on your shoulders while standing. For both levels, select a weight that makes completing a full set challenging. Take 3 seconds to raise up on your toes, then take 3 seconds to come back down to the ground. Start by raising up to a moderate height and as you become comfortable with the exercise, increase the range while staying the Safe Zone of pain.

Sets:
– Beginner: 3 sets x 8-12 reps
– Intermediate: 4 sets x 6-8 reps
Recovery: 1-2 minutes in between reps

Frequency: 2-3 times per week with at least 48 hours in between sessions





Single Leg Bent Knee Heel Raise:

Directions: From a standing position, start by balancing on your right leg and holding the weight in your left hand, raise up on your toes, then come back down to the ground. Complete the set and then repeat on your left leg. For both levels, select a weight that makes completing a full set challenging.

Sets:
– Beginner: 3 sets x 12 reps
– Intermediate: 4 sets x 6-8 reps
Recovery: 1-2 minutes in between reps

Frequency: 2-3 times per week with at least 48 hours in between sessions



Overcoming | Phase III: Return to Running

Goal: During this phase, we will continue the exercises above, evaluate your readiness to run, and return to running. Each runner is unique and so is each runner’s return to training plan. So consider consulting a local physiotherapist for personalized help.
You’re eager to get back to running (and we’re eager to get you there). But before you lace up and run out the door, let’s evaluate your body’s readiness to run:

    □ All daily living activities with little to no pain
    □ Minimal to no morning pain
    □ Comfortably able to walk 1 - 2 hours
    □ Skipping in place for 4 x 30 second intervals in the Safe Zone of pain
    □ 3 x 10-15 Single Leg Hops in the Safe Zone of pain

Once you’re able to successfully check off the boxes above, it’s time to run! When increasing your training load start by increasing the frequency of short runs, next build up the length of these runs, and finally introduce intensity (speed, hills, workouts). Manage your training load and injury risk level by keeping a close eye on your PWR Lab Dashboard. Not a member yet? Sign Up today and your first month is on us.


PWR Pro Tip

Incorporate these three activation drills into your pre-run routine to improve the Achilles tendon's ability to store & release energy, and send a message to your Achilles that it’s time to run. Videos included:

  1. A-Skip 20-30 meters
  2. Switching Drill 5-8 x side
  3. Ankle Dribble 20-30 meters

References

  1. van Gent R, Siem D, van Middelkoop M, van Os A, Bierma-Zeinstra S, et al. (2007) Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. Br J Sports Med 41: 469–480.
Dr. Jeff Moreno
About Dr. Jeff Moreno

Jeff, co-founder of PWR Lab, is a Doctor of Physical Therapy and Board-Certified Orthopedic Clinical Specialist. Passionate about running and playing, Jeff fundamentally loves people and movement of any kind. He strives to raise the bar in sport by finding ways to proactively prevent injuries and prioritize the long term development of athletes. He has been successful in employing a data-driven, hands-on approach to physiotherapy with National, World & Olympic Championship medalists in Track & Field from USA, China, Canada, and Mexico as well as many NFL, NBA, MLB, NHL, Judo, and Triathlon athletes