Achilles Pain Part 2

How to tackle Mid-Portion Achilles Pain

We’re back for discussion number two about achilles tendon injuries. This week, it’s all about mid-portion pain.

What most people don’t know is there is a difference between how you treat achilles injuries! It all stems from where the pain sits in the tendon. 

There is no one size fits all prescription for achilles tendon injuries. That is why recognizing the location of your discomfort is extremely important!

If you’re dealing with pain right where the tendon attaches to the bone, go check this out.

If you’re dealing with pain a bit higher up, you’re in the right spot. Keep reading on.

For Reference

Achilles tendon pain is not difficult to take care of. It does, however, require patience, diligence, and a limited understanding of pain science. 

Some simple reminders:

• Rehabilitation may be like a rollercoaster ride. You will have good and bad days along the way. 
• Rest is usually not best. Tendons like graded exposure to load. Stopping all activity away usually won’t make the problem go away! 
• Pain 0-4 is okay to work through during exercise tasks. If you experience increased pain or stiffness after exercise that lingers into the next day, you know you’ve done too much!
• Tendon injuries can take 12+ weeks to heal. For some less, others more.

Mid-portion achilles pain is treated differently than insertional pain. Why? The mid-portion of the tendon, unlike the insertional region, likes extra tension from time to time. 

So, what do you do? Where do you start? Here are 5 (plus a little extra) exercises to perform to get on top of your mid-portion achilles pain. Remember, pain 0-4 is okay to conquer through as long as it does not get progressively worse, and returns to baseline by the next day.

1. Isometric Single Leg Calf Raise: Stand at a wall or counter and hold on. Perform a double leg calf raise and remain in the position. Shift your weight to your affected leg and lift your opposite leg off of the ground. Hold this position for 10 seconds before returning your opposite leg to the ground. Once your opposite leg is back on the ground, lower both heels and stand normally. Repeat for 2 sets x 10 reps. (If it is too difficult to perform this single leg at first, perform a double leg hold and progress as able).
2. Wall Sit with Calf Raise: Stand at a wall and drop into a wall sit position at ~90 degrees! Perform a heel raise in this position and hold. Time can vary, but give 5 x 20 s a shot!
3. Heel Drops: The Alfredson protocol has been a known standard for treating mid-portion achilles pain. What does this include? Performing a single-leg eccentric heel drop off of the edge of a step for 3 sets of 15 reps, 2x daily. This can be performed in two different manners, with your knee straight or bent. Doing both will target different muscle groups. Stand on the edge of a step and perform a two-legged calf raise. Shift your weight to your affected side and slowly lower back down to a count of 6, letting your heel drop below neutral.
4. Single-Leg Heel Raises @ Edge of Step: After mastering the heel drop exercise, it’s time to test yourself. Perform a single leg calf raise off of the edge of a step (holding on, of course) for 3 sets x 10-12 repetitions.
5. Pogo Jumps: Perform small bilateral hops for 3 rounds of 30 seconds. Your knees should remain slightly bent throughout. Most shock absorption is through the ankle complex.

Just a reminder, these are a progression of exercises. If you are experiencing pain >4 with any of these exercises, I would recommend consulting your local physical therapist to evaluate your specific injury! You may need a progression or regression that is not included in this list.

Remember, achilles injuries take time. While walking it produces force 3.5x our body weight. With running, over 12x! Pain may linger and normally doesn’t dissipate in the blink of an eye. Just give it time.

Happy Rehabbing!

Cheers,

Ashley