Thanks to my former patient, Maria More Grant, for your continued running of 50 mile plus weeks, for your inspiring achilles inquiry. Hope this answers your questions! PS. I'll blog some exercises with pictures to help as well.
What’s the deal with Achilles tendonitis
Throughout my history treating athletes including yogis, runners, cyclists, and general weekend warriors, I’ve seen Achilles tendonitis quite a bit, especially in runners.
Generally speaking, the symptoms are heel or Achilles tendon soreness (especially in the am), pain with walking, specifically either when the heel strikes down or the toes push off. Swelling and hardening may occur with more persistent cases. It’s also typically worse after activity.
WHY does it happen?
The traditional answer is an increase in activity or intensity of activity and tight calves.
My answer, core/hip weakness and/or foot position.
The Achilles tendon is the largest in the body, connecting the gastrocnemius/soleus muscle complex (the calf muscle) to the foot. At the foot, these muscles are primarily responsible for plantarflexion or push off, which is what you are doing if you stand on your toes and lift your heels. Most people, who suffer from Achilles tendonitis, don’t stand on their toes and lift their heels all day, so why do they have pain?
Plantarflexion occurs during running, which is essentially jumping from one foot to the next and lifting your heel repeatedly.
CORE AND HIP ROLE
Now imagine, that you just started running, and your core and hips aren’t strong. Every time you land on your foot to push off, that hip hikes up or drops down, because your leg is connected to your hip, it will change the way your foot hits the ground for push off, causing increased stretch along the Achilles tendon, which after 6,000 steps (or 3 miles) can cause inflammation and pain.
Why does this happen? Because your core muscles, namely your abdominals and hip girdle isn’t holding your pelvis and hips level. This leads to more motion, which can lead to tight muscles, and poor leg and foot alignment.
Another reason is foot position…Ground the big toe. This is super important.
When we walk or run, push-off occurs. It happens with optimal foot, leg, and hip alignment when we hit the ground correctly. Many people who suffer from Achilles tendonitis do not strike the ground correctly. The correct way is to push off from the ball of the big toe and 2nd toe. The incorrect way is to strike on the outside of the foot. Sometimes, we turn our feet out and we may have to slightly turn them in to strike on the big toe and 2nd toe mound.
FATIGUE OR HILLS
Fatigue can cause over striding, which can tire out the Achilles. Try to keep your strides short and use your butt muscles to help push-off. When we run on inclines, if we over stride our Achilles can get very strained.
SO WHAT’S THE FIX?
-Stop running, the tendon is injured, and it’s trying to heal. Imagine skinning your knee and a scab forms. You keep opening the scab, and the knee never heels. That’s the deal with tendonitis; you need to not re-open the scab. Try to avoid anything that hurts, that will stop the reinflammation or reinjury.
-Wait, use ice, anti-inflammatories, and gentle stretching. Bike/swim or ellipticize to keep up your aerobic endurance.
-Do core and hip strengthening that doesn’t hurt the Achilles. More on this coming!
-Treat your feet. Grab a lacrosse or similar type of firm ball, and roll your foot over it while standing. Finding tight or sore spots and working them out with gentle pressure and back and forth motion.