If a patient feels the Achilles tendon begin to hurt, it may not necessarily lead to a rupture. This is usually not the case in my experience. In fact, most of my patients who tore their Achilles did not have any symptoms beforehand. They were unlucky and probably had a small defect in the tendon. It is rare for Achilles tears to occur on both sides.
This fear that patients have around the health of the Achilles, typically when it begins to get sore, is not justified. However, we do not know if we are beginning to feel just the tip of the iceberg with a bigger problem brewing.
There are probably three causes of Achilles injury and each may play a role in the injury. The most common causes of Achilles tendon pain are tightness combined with common overuse patterns (too much, too fast, too different) and possibly some technical issues (switching from normal heeled shoes to zero drop shoes, experimenting with lower heel drops in exercises, going to a shoe that is far too unstable). I have seen hundreds of combinations.
Athletes who have Achilles tendon pain need to cut their distance in half immediately as long as they have caught the problem early. If they haven’t caught it early and are limping from normal activity, they may need a two-week or greater period in a removable boot. After finding the amount of exercise they can do without flaring up the pain, they need to stretch the Achilles (even the plantar fascia) three to five times a day.
Occasionally, I will find the patient on the opposite end of the spectrum whose tendon is overly loose and stretching makes it worse. These patients should start thinking about what either overstretches the tendon or torques the tendon with pronation or supination forces, and then immediately try to remedy that aspect. Was the patient doing too many negative heel stretches with the heel falling off the edge of a stair? Could the patient change into some lighter, perhaps less stable shoes?
The Achilles is the most powerful tendon in the body. It is able to lift eight to 10 times a patient’s body weight under distress. However, it has relatively poor blood supply. (There are so many beliefs in how to get proper blood supply to the Achilles tendon but this is not the place for that discussion.)
Patients should attempt to control initial soft tissue swelling that occurs from day one to day five. They should use an ice pack over the tendon for 10 minutes three times a day.
Depending on the case, when patients present with initial Achilles tendon pain, conservative measures may include activity modification, stretching and icing. Elevating the patient’s awareness of the biomechanical impact of overuse issues, and changes in shoewear and training may be helpful as well.
Editor’s note: This blog originally appeared at http://www.drblakeshealingsole.com/2017/04/Achilles-tendon-pain-where-do-i-start.html . It is reprinted with permission from the author.