Keep Achilles Pain from Nipping at Your Heels

Outrunning Achilles tendon discomfort or injury is a challenge many runners face. Long distance runners sometimes shirk post-warm-up stretching, figuring they'll just “work it out” on the first couple of miles. But one of the best ways to prevent Achilles tendinitis is by building limber lower legs apart from the distance run itself. An underlying lack of flexibility, especially in the calf muscles, can lead to Achilles injuries.

Calf muscles are primarily used to extend the ankle. The stretches and exercises here all target the lower leg and will keep the muscles in your calves (both gastrocnemius and soleus muscles) strong. Both the larger of the two (the gastrocnemius) and the smaller muscle (the soleus) attach to the calcaneus (heel bone) by way of the Achilles tendon. The larger muscle takes a greater workload when the knee is straight, and the soleus when the knee is bent. Stretching both is an important part of protecting the Achilles tendon.

If you suffer pain in the back of the heel, the tendon just above it, or as high as where the calf muscles form a V on the back of the leg, you might have an Achilles tendon injury. The highest Achilles injury is more commonly called a calf strain—these tend to heal quickly. Just below it are injuries that involve the junction of muscle and tendon, a spot about halfway down the lower leg. Neither of these are as serious as injury to the tendon itself.

When the Achilles tendon is inflamed (tendinitis) or chronically inflamed with fluid buildup (tendinosis), dynamic rest is called for. This means swimming and biking usually work well, but not if you are still feeling pain. In any case, running is contraindicated. Ice, stretching and eventually strengthening are the reliable components to the road back. But these training components should not only be deployed after injury; protecting the Achilles from injury in the first place involves the same exercises as getting you back up to speed after it. Apart from the well-known straight- and bent-legged calf stretches, here are some stretches and strengthening exercises to consider encorporating into your routine.

Split Jump

With or without dumbbells, stand in a staggered stance with right foot in front of left. Lower your body as far as you can. Quickly switch directions, jumping with enough force to propel both feet off the floor. Scissor kick in the air to land with opposite leg forward. Repeat, alternating.

Dumbbell Calf Raise

Standing with a dumbbell in your right hand on a step, block or even a 25-lb weight plate, cross your left foot behind your right ankle and balance on the ball of your right foot. Your right heel should be hanging off the step. Your left hand should be placed on something stable—a wall or weight rack. Lift your right heel as high as you can; pause, lower, repeat to desired number of reps. Switch dumbbell hands and repeat with the left leg.

Bent Knee Calf Raise

Follow the same directions as the above dumbbell calf raise, but this time bend your knee and hold it that way as you perform the exercise.

Calf Roll

With a thick foam roller under your right ankle, cross your left leg over your right (both legs should remain straight). Support yourself with your hands on the floor and roll your body forward until the roller reaches the back of your right knee. Roll back and forth to the number of reps you desire, then repeat with your left calf touching the roller.

Walk on Toes

With a pair of heavy dumbbells in your hands, raise your heels off the floor and walk forward or in a circle for one minute. Stand tall and stick your chest out, and use the heaviest dumbbells you can without breaking form for the full 60 seconds.

Running Tips
Pronation can contribute to Achilles injury so do try to watch your foot mechanics. Consider arch supports or motion-control shoes to help correct excessive inward foot roll. Another variable you have some control over is the pounding your feet take: less load per footstrike can help stave off Achilles injury. A shorter running stride combined with increased cadence often leads to better stride mechanics because each footfall carries less load (to not only feet and ankles but shins and knees too) than at wider/less frequent stride/cadence combinations. A common comfortable yet rapid cadence for many runners shooting for shorter strides is 85 to 90 right-footfalls per minute.

The Athlete's Book of Home Remedies by Jordan D. Metzl, MD, 2012, Rodale, New York, NY, pp. 5-11

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