A common cause of pain behind the heel when running or walking is an injury to the Achilles tendon. Poor running form, footwear and the terrain you are running on can all cause overuse of the Achilles tendon. Other factors include weak leg muscles, decreased flexibility, and a high or low arch. This requires the calf muscles to work even harder while running or walking, leading to pain in the back of the calf or heel. When the stress placed on the Achilles tendon is more than it can tolerate, Achilles tendonitis can result.
The Achilles tendon is a fibrous band that connects your calf muscles to the back of your heel. Your calf muscles are involved in pointing your foot downward or when you stand on your toes. Walking, jumping, sprinting, and running all involve using your calf muscles. When these muscles contract, they pull on the Achilles tendon. The pull on the Achilles tendon is even greater when your calf muscles are tight or weak or when you are running/walking uphill. Injury to the Achilles tendon can be caused by a strong contraction of the calf muscle, such as running/sprinting or landing after a jump. These actions force the foot upward, placing excessive force and stretch on the tendon. Persistent overuse can lead to breakdown and thickening of the Achilles tendon due to repetitive microtrauma. In this case, the injury is referred to as Achilles tendinopathy, since there is minimal to no swelling. If this condition is left untreated or in severe cases, the Achilles tendon can rupture or tear.
Symptoms
With this type of injury you may feel:
- Pain/tenderness in the back of the heel or higher up the Achilles tendon
- Stiff/tight calf muscles
- Stiffness or discomfort with walking or running, especially during the first few steps
- Increased swelling at the back of the ankle
Diagnosis
Imaging such as an X-ray or MRI are usually not needed to diagnose simple cases of Achilles tendonitis/tendinopathy. Your physical therapist will ask you questions about your activity level, exercises or running routine, and what type of footwear you are using. They will also observe your movement while walking, running, while performing a squat, stepping up on a stair, and your balance. Testing the strength and flexibility of your legs will also help diagnose and determine the cause of your injury.
How Can Physical Therapy Help Me?
Your physical therapist will work with you to develop an individualized treatment program and discuss what goals you would like to achieve during therapy. Physical therapy has been shown to help relieve symptoms related to Achilles tendonitis/tendinopathy. Your therapist will gradually incorporate more demanding activities into your routine without overstressing the Achilles tendon, allowing you to get back on your feet again. Your treatment will include:
Stretching The muscles that surround your ankle foot and knee need to be at their appropriate lengths in order to move properly and reduce any excess stress at the Achilles tendon. Your therapist will show you specific stretches and foam rolling techniques in order to help restore proper motion of the leg during your activities.
Strengthening If any muscle in your lower leg is weak, this causes more demand on the rest of the leg muscles. These muscles imbalances can also lead to increased demand on the Achilles tendon. Your therapist will instruct you on how to properly perform exercises for your lower leg, starting with low intensity and safely progressing you to more demanding exercises specific to your sport or activity.
Pain Relief In order to help control your symptoms, our therapist may suggest ice and compression in order to minimize any swelling and calm down any irritation.
Hands on Therapy Manual therapy will be provided by your therapist to help address areas that are hard to treat on your own. Hands on therapy will help decrease your pain and improve the motion of your lower leg, encouraging proper movement and decreased strain on your Achilles tendon.
Your physical therapist can also integrate functional training or sport specific activities, to ensure you can get back to your daily activities safely. They can also discuss possible mistakes in your training program and suggests better approaches you can take to minimize the risk of reinjury. Do not be alarmed if your therapist is looking at your hip or knee as the origin of your pain may lie somewhere else other than your ankle. The joints and muscles of the leg all work together when you move and are not separate entities. Your therapist will work to find the origin of your injury, to make sure your body as a whole is moving properly and preventing any further injuries. If you ignore the pain at the back of your heel, your symptoms will persist, the tendon will become weaker and damaged, and may lead to a complete rupture of the Achilles tendon. This is often treated with surgery, and is a significantly longer road to recovery. See your physical therapist today to help relieve your pain and get back to your normal routine! For more information on physical therapy visit Total Performance Physical Therapy website.
