Unfortunately, treatments for Achilles tendonitis and tears have not changed or improved much over the past 30 years. Depending on the severity of your tendonitis, you will be guided through the following “solutions” or “cures”. I’ll give you the treatment and my opinion and experience with it.
Pain be your guide. This will be the first admonition. If it hurts don’t do it. Stop. If it doesn’t hurt, proceed with caution until there is no pain. Then gradually reintroduce your full training regimen. The “no pain – no gain” philosophy is absolutely out when dealing with this condition. If you tend to push your body to limits and not listen to discomfort, this guidance will be next to useless.
Rest. This is usually the first words out of most health practitioners. Since you caused this by overdoing it in some way, backing off is reasonable. However, I would recommend reviewing your training logs and first eliminating the specific type of workouts that most likely caused it. If removing the suspected workout doesn’t lead to relief, then lighten up elsewhere in your schedule.
Ice. Absolutely helps with discomfort and may help with inflammation. It is a poorly vascularlized area so don’t expect miracles. In ifrst 24-48 hours ice several times a day 2-3 times of 10 minutes on with 10 minutes off. Early on in treatment, ice after all workouts even if you don’t have discomfort. You can decrease icing if all symptoms are gone.
Stretch. Oh My! Take One. This is a very touchy issue. Stretch after the initial injury is well on the way to recovery. Don’t stretch a cold muscle ever. Don’t over stretch calves because it can CAUSE tendontitis to worsen. No deep heel drops. No ballistic stretching – ever. Remember, stretching for males has been correlated with an increase in injuries! Not decrease! Also, stretching a muscle decreases strength and power output of that muscle. Anecdotally, I experience more discomfort when doing stretches. I have found that strengthening exercises are far superior (see physical therapy below).
Orthotics. I’m not an advocate of putting anything unnatural in your shoes. if the cause is due to a structural foot-plant abnormality and it can be corrected by an orthotic – this is a viable intervention. This intervention requires a diagnosis by a trained sports medicine, podiatrist, physical therapist – footstrike analysis trained specialist. These are not over the counter shoe inserts. I have my first pair of orthotics. They take some getting accustomed to. I actually believe they are helping. After four months off for my recent Achilles tendon tear, I’m now running about 15 miles a week. Anecdotally, some runners will swear by their orthotics and others will swear at them. The upside is that orthotics are at least addressing an underlying cause of tendonitis and not just symptoms. It still ends up an experiment of one.
Heel lifts. See comments above on orthotics. I don’t recommend over-the-counter heel lifts. They are not tailored to your foot. They tend to move around inside your shoe. They caused me forefoot pain after very short use. They may cause other foot-plant problems because it affects the rest of your foot and therfore will affect the entire kinetic chain up your leg. Not a good thing.
New shoes. Sometimes, worn out shoes can contribute or cause Achilles tendonitis. The rule of thumb is to replace your shoes every four months or after 400 miles of running, regardless of how they appear. They lose their protective characteristics over time. You also should be fitted for the “right” shoes for you. That means going to a running specialty store and have a foot-strike analysis done. They will advise you what “family” of shoes are best for you. Do not succumb to buying what some friend or neighbor is the “perfect running shoe”. It may be for them, and it may not be for you. There is no such thing as a single best shoe. It depends on the person.
Anti-inflammatories. Over the counter drugs, NSAIDS, are most commonly advised. Ibuprofen leads that list. In a poorly vasularized region, the amount of actual inflammation reduction may be debateable. It will reduce discomfort. But that is not necessarily a good thing. Reduced pain may lull you into thinking it’s ok to go back to training. Think again! Pain is a warning sign. It is feedback to you.
Cortisone injections. Yes, these are injection directly into the tendon. The current advice is no more than two injections into a tendon. More than that correlates to a weakening of the tendon and an increased incidence of tendon tears or ruptures. These work great in conjuction with some rest and rehab. It will all be undone if you launch back into training without treating the underlying cause of your tendonitis. This treats symtoms and does not cure tendonitis.
Immobilization. Soft casts, walking boot/casts to immobilize the ankle are often prescribed. These are better than hard casts and reduce the muscle atrophy that is associated with hard casts. The goal is to stop using the tendon to allow your body to heel itself. This may be for weeks to months. I’ve had mixed results with these having been put in them on three occasions. I found in my most recent bout that it further irritated the location of my tendon tear. I booted the boot after a few weeks and started to improve a bit after that. Constant use of the tendon, even if it’s just walking, is irritation to the tendon and prolongs recovery. So, if you are at the point of having to completely stop running, I advocate trying these out to expedite recovery.
Accupuncture & Accupressure. These do not have scientific backing as treatments. My experience was that they gave me a temporary reduction in pain symptoms. Discomfort returned within 24 hours of treatments. Save your time and money.
Massage Therapy. It feels good for sure. There is no real scientific backing for this as a treatment for tendonitis. If it feels good do it. But don’t think it’s curing your tendonitis.
Surgery. Forget it. The invasive nature of surgery and the resultant scar tissue is simply to drastic a step to take for tendonitis and even minor tears. Only in very chronic, severe and tendonitis that is unresponsive to all other treatments would surgery be considered. Unless you have a complete rupture of the tendon I do not know any doctor who would do surgery. You’ll know your tendon is ruptured by sudden weakness of lower leg, calf bunching up in a knot and substantial pain. This will require surgical repair.
Physical Therapy. In order to reduce the chance of re-injury you must address the underlying problem. If it is training – change what you are doing. However, if is is biomechanical, it won’t be corrected by changing your training. The number one predictor of injury is past history of injury. That is because we never address or remediate the underlying causes. We just jump back into training after the pain goes away. There are numerous exercises for the lower leg. They work to improve coordination, strength, balance and range of motion. Optimal exercises are one-legged to isolate each leg independently (reduces cheating on the exercises and using a stronger leg to compensate). Often a balance board is used to These exercises work all the small muscles around your ankle, lower leg, up throughand including your quads, hamstings, glutes and lower back muscle groups. None of these act in isolation.
Barefoot Running. Oh My! Take Two. The theory is that this is natural some how. Unfortunately is is not for the western world. If you read the proponents of this technique they do state that it is for completely neutral foot strike runners with no history of injuries. I don’t know too many who fit that description. There is also very poor science behind it. The dramatic drop in heel height will cause tendonitis in short fashion for anyone predisposed to it. Therefore, please do not try this. By the way, though this has resurfaced recently as some “new” and “natural” approach to running, it was advocated back in the 70s. It is just recycled. I tried it back then, duped into thinking it would help me. It did very bad things for my tendonitis.
The Strassburg Sock. This sock is designed to give a gentle stretch while at rest or even sleeping to keep your calf muscle elongated. The theory is that by elongating the muscle it will reduce tension on the tendon. The sock is used to treat plantar fasciitis, Achilles tendonitis and calf tightness. Follow the instructions carefully if you use one. I tried it. It was neither comfortable nor convenient. My Achilles tendon seemed irritated after using it. I stopped. For now I put it in the category of stretching. (See above.)
Yoga. This can help some range of motion. If done correctly and very modestly it might help balance and coordination of muscles. It does not treat, cure or prevent tendonitis. If any yoga instructor urges you to stretch further and further beyond your comfort level (it should NEVER hurt) then run as fast as you can from that location. We are not all made to be bent into pretzels. Do not think that if “they” do it, then it must be normal. It’s not. Yoga and any other similar eastern disciplines should be gradual and always within your comfort range (not someone else’s comfort range). Bottom-line – if it feels good to you go ahead and do it.