Dear Alice,

Two months ago, I went out jogging and injured my Achilles tendon. I was told that I had stressed the muscle and was told to stay off of it. At this point, the pain is gone and I'd like to start exercising again. Do you have suggestions as to what would be low stress on that part of my foot? Do you have exercise recommendations to stretch it out beforehand? Finally, when I get home and feel sensitivity in the region, what can I do to alleviate potential problems?

Dear Reader,

While he may be known best from his role in Greek mythology, Achilles is also the name of a tendon that connects the calf muscles to the heel bone. The calf muscles and the muscles along the shin are strong and used constantly due to the critical role they have in acting as shock absorbers for the body in high-impact physical activity. Consequently, your Achilles tendon is put under a lot of pressure as you use it just about every time you use your foot. When it's overused, or if you continue to use it when it’s injured, inflammation of the tendon could lead to weakening of the area and recurrent injury — which may result in partial, or even complete, tearing. Based on your description, it sounds like you haven’t torn your Achilles, but you may be experiencing inflammation (more on these distinctions later). In any case, when you’re experiencing pain, it’s good to take heed — it’s your body’s way of letting you know its limits — and take a break before gradually resuming certain physical activities. Once you’ve rested and have gotten the green light from your health care provider to get moving, there are a few stretches and low-impact exercises you can do that will allow you to stay active while not aggravating your injury.

Injuries to the Achilles tendon may begin as tendonitis (inflammation of the tendon caused by overuse) which could, if not allowed to heal, result in a rupture (a partial or complete tear of the tendon). Treatment will be different based on whether you’ve torn your tendon or if it’s just inflamed. For a rupture, treatment could include wearing a cast or walking boot, or surgery to repair the torn tendon. For tendonitis, a health care provider may encourage you to use over-the-counter medications to relieve inflammation and pain. Trying out the R.I.C.E technique (the details of which are outlined in a Q&A about sprained ankles — a condition that also may warrant its use) can also be included in the treatment plan. With either condition, you might also be advised to do some physical therapy to strengthen your leg muscles and tendons as part of your recovery process.

Now, how can you stay active while you rest your tendon? To help prevent re-injury, consider exercises that put less stress on the Achilles tendon, such as bike riding and swimming. For additional low impact exercise ideas, check out Exercising while injured in the Go Ask Alice! archives. But, before you get back to it though, it’s wise to first follow-up with your health care provider or a physical therapist to be certain that you aren’t doing any more damage to your Achilles tendon. S/he may also recommended fancy footwear for you: there are shoes and orthotics (shoe inserts or wedges that elevate the heel) that may be recommended to provide extra support and help diminish stress on your tendon and calf muscles.

Stretching and strengthening exercises can certainly play a role in taking care of your body as well. Remember that it’s best for all stretching to be slow and static. Make sure to be listening to your body, too — feel your muscles stretching, but stop if you feel pain. Specific to the Achilles tendon and surrounding muscles, consider the following calf stretch:  

  1. Stand about a foot from a wall with your hands flat against the wall.
  2. Keeping both feet flat on the floor, extend one leg behind you, toes pointed straight ahead. Your rear knee should be straight and your front knee bent.
  3. Move your hips forward toward the wall, keeping your lower back flat.
  4. Lean into the wall until you feel tension in the calf muscle of the extended leg.
  5. Hold for ten seconds, and then stretch the other leg.
  6. Repeat 20 times for each foot.

Adapted from the American Academy of Orthopedic Surgeons.

You might also be wondering how you can prevent this type of injury in the first place. Consider the following information:

  • If you’re just starting a new physical activity regimen, increase the intensity and duration gradually over time. This will help your body to adjust appropriately.
  • Wearing shoes with cushioning in the heel and firm arch support will give your Achilles tendon more support.
  • Try to stretch every day.
  • Strengthen your calf muscles, as this will help your tendon handle stress.
  • Alternate activities. Rather than running every day, try lower impact activities like swimming to give your tendon a rest.
  • As you’re being active, if you feel pain, stop and rest!

Adapted from the Mayo Clinic.

Lastly, keep in mind that while you may want to get moving again right now, it may be helpful to stretch and allow your body to heal so your tendon doesn't become your Achilles heel. 

Alice!

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