When Your Achilles Tendon Becomes Your Achilles

The most common source of heel pain comes from the Achilles tendon. There’s Achilles tears, full ruptures, tendinitis, tendinopathy, tenodesis, and more. While the type of Achilles injury can vary, the treatment plan typically follows a similar pattern. The goal is to improve the strength and flexibility of the Achilles while decreasing the symptoms.

How Do You Know It’s Your Achilles?

Before we jump into how to fix your Achilles, it’s important to make sure it’s actually the Achilles that is injured. Correctly identifying the injury is the most important step. If the injury isn’t correctly diagnosed, all the exercises in the world won’t fix your problem (unless you get incredibly lucky). So, let’s take a small detour and discuss what Achilles pain looks like.

Here’s a quick list that you can compare your symptoms to.

• Location of pain is anywhere from directly on the back of the heel to 1-3 inches above the heel
• Pain increases with a simple calf stretch
• Walking, stairs, running, jumping – anything using your calf muscle is painful
• The tendon and/or the calf muscle in the back of your leg hurts when you poke it
• Discomfort is worse in the morning or after sitting for a bit

There’s different degrees of Achilles injuries. Some individuals get pain simply walking, others need to run for a mile or two to bring on symptoms. The three most important things we look for are – location of pain, discomfort when pushing on the tendon or calf muscle, and pain when using the muscle. If those three things are present, it’s safe to say you’re dealing with an Achilles issue.

Fixing the Achilles – Resolving Mobility

There’s two things that we address when it comes to Achilles injuries – decreased mobility and decreased strength. Mobility limitations can present due to joint stiffness or muscle stiffness. Discerning between these two is tricky to do unless we have our hands on an ankle, but there’s a couple things you can do to help navigate your way to an answer.

Joint-related stiffness typically feels like a ‘stuck’ feeling. When stretching your calf, you may not experience a normal stretching feeling. Put another way, you may not feel the stretch in the muscle. You may feel it more in your ankle and it could feel like a pinching sensation. Some individuals describe it as “it just won’t go forward but I don’t really feel anything.” If that’s the case, the mobilization shown below will be helpful in loosening up your ankle.

If you stretch the muscle and you get a feeling of stretching in the muscle, odds are the muscle itself is tight. When this is the case, we typically recommend a slow progression of strengthening instead of simply stretching. This is because most muscles that are tight are tight because they are weak. (For a more detailed explanation of why this is the case, click here).

Lastly, if you aren’t sure if your ankle, calf muscle, or either is tight – just try mobilizing it or stretching it. If it feels good, it’s not a bad thing to do. If it doesn’t feel good, odds are it isn’t the right thing to help your Achilles heal at the moment.

Fixing the Achilles – Resolving Strength Deficits

Between mobility and strength, strength is the more important deficit to address for long-term resolution of symptoms. A lack of strength is usually the reason why the Achilles became injured in the first place. This may seem counterintuitive, because it’s rare that people are aware of Achilles weakness in daily life. That is because the body is really good at compensating and working around Achilles weakness.

If you aren’t sure if your Achilles is strong enough, try doing 20 single leg heel raises off a stair (heel goes all the way down and all the way up). If you can’t complete those 20 and you’re an athlete (that includes any sort of recreational sports, light jogging, or playing with your kids), your Achilles isn’t strong enough to adequately do its job.

Here is a progression of Achilles strength exercises that you can work your way through. They are listed in order of easiest to hardest. We advise starting at the level that you can do about 10-15 repetitions with mild or less discomfort. It is time to progress when you can hit 20-25 reps confidently. If you aren’t sure how much discomfort is acceptable (and yes some discomfort is okay!) while doing the exercises, check out this blog post.

Ankle Plantarflexion

Double Leg Heel Raise

Eccentric Single Leg Heel Raise

Single Leg Heel Raise

The Two Achilles Components – Gastrocnemius and Soleus

The Achilles tendon is composed of two muscles: the gastrocnemius and the soleus. The gastrocnemius is the two tear-drop shaped muscles located on top of the soleus. It tends to be what people think of when they think about the calf muscle. The soleus lies underneath the gastroc and is typically forgotten about but is often more important to treat than the gastroc.

There is a key difference to note in the location of the muscles and their corresponding function. The gastroc starts above the knee and inserts on the heel. In contrast, the soleus starts below the knee and inserts on the heel. Because of this, heel raises or stretching with the knee straight will target the gastroc, while heel raises or stretching with the knee bent will target the soleus.

Soleus Heel Raise

Minor technicality here – there are truly three muscles in the Achilles. The plantaris is the third and final muscle. However, it’s a very small muscle compared to the gastrocnemius and the soleus and it doesn’t really do a whole lot. Because of this, we’re not discussing it more than this small blurb here.

Wrapping Things Up

That was a lot of info! To condense it down, Achilles issues present with pain on the back of the calf muscle or heel while you’re using the muscle. To eliminate pain from the Achilles tendon, you’ll want to address any flexibility or strength deficits that exist.