If you have pain in the back of your ankle, you may have injured your Achilles tendon — ouch! While this injury can be debilitating (mostly because of its impact on your ability to walk), the good news is that proper treatment is successful in relieving these symptoms in the majority of cases.
According to a 2017 study published by Current Reviews in Musculoskeletal Medicine, the Achilles tendon is one of the most important tendons in the entire body. That's because it's connected to both the gastrocnemius, which helps bend your knee and point your toes, and soleus muscles, which are also involved in raising you up on your toes.
Achilles tendon pain typically develops from exercise activities that overuse the calf muscles. And while exercises that increase pain — such as running or jumping — should be avoided, there are some stretches and exercises you can do to help alleviate pain (as long as you get the OK from your doctor or physical therapist).
Is It Safe to Exercise With Achilles Tendon Pain?
Since the pain from an Achilles tendon injury can be severe, you might wonder if you should even attempt to work out. As with most injuries, that mostly depends on the cause of the pain and your doctor's assessment of the severity.
According to a 2015 article published by Journal of Orthopaedic & Sports Physical Therapy, you might be able to resume running and jumping after just a few weeks, but in some cases, it can take several months. Specific recovery time depends a lot on how long it takes for you to be able to perform your rehab exercises without pain.
Gentle stretching can be performed to reduce stiffness after the acute phase of healing. And you may be able to add strengthening exercises within one to two weeks after injury and slowly progress as your pain subsides. For best results, though, it's best to perform these exercises under the supervision of a physical therapist.
Why Is It Important to Strengthen Your Achilles Tendon?
Your Achilles tendon endures a significant amount of physical stress through your day-to-day activities. In fact, during running and jumping activities in particular, it's subjected to loads that are six to 12 times your body weight!
With so much force onto such a small structure, you can see why it's vital to strengthen your Achilles tendon appropriately. You'll not only help facilitate the healing process, you'll prevent further issues once you return to your normal exercise routine.
Tips for Dealing With Achilles Tendon Pain
In addition to exercise, there are a few home remedies can help you manage Achilles tendon pain. During the acute stage — the first two to three days after injury — apply ice to your tendon for 15 to 20 minutes at a time, every few hours. Elevate your leg when resting to allow gravity to assist with reducing swelling that can occur. Wrapping your ankle with an elastic bandage can also help.
After the acute stage, apply heat to your ankle for up to 20 minutes, particularly before you exercise. This will increase blood flow to the area and help reduce muscle tension and joint stiffness.
Achilles Tendon Stretches and Exercises
Once you've gotten the green light from your doctor (usually after the initial/acute phase of healing), you can start incorporating some gentle stretching and easy strengthening exercises. Here are a few options to start with, but always make sure you double check with your physical therapist to tailor a program to your specific injury.
1. Standing Gastrocnemius Stretch
HOW TO DO IT: Stand facing a wall with your feet staggered. Keeping your back knee straight, bend your front knee and lean in toward the wall until you feel a stretch along the calf of your back leg. Hold for 20 to 30 seconds, and then relax. Repeat three times and switch legs.
2. Standing Soleus Stretch
HOW TO DO IT: This stretch is the same as the gastrocnemius stretch described above but is performed with your back knee bent.
3. Stair Stretch
HOW TO DO IT: Stand with the ball of your foot on a step, the heel hovering over the edge. Hold onto hand rails or another sturdy object for balance. Slowly lower your heel down until it's lower than the step. Stop when you feel a strong pull along your calf. Hold for 20 to 30 seconds, and then rest. Repeat three times on each side.
NOTE: Repeat the stair stretch with a slight bend in your knee to target your soleus muscle.
4. Plantar Flexion With Resistance Band
HOW TO DO IT: Sit with your legs straight out in front of you. Hold one end of a resistance band in each hand and loop the middle of the band around the ball of your foot. Point your foot down as if you're pressing a gas pedal. Hold for two to three seconds, and then relax. Repeat 10 times, working up to three sets of 10. Progress by using a stronger band once you can complete 30 repetitions.
5. Toe Raises
HOW TO DO IT: Stand with your feet hip-width apart, holding onto a chair or railing for support and balance. Raise up on both toes as high as possible and hold for two to three seconds. Lower back down and repeat 10 times, working up to three sets. You can modify by performing this exercise while seated in a chair.
Eccentric Exercises for the Achilles Tendon
Focusing on the eccentric movement (in this case, lowering portion of an exercise) is a specific rehabilitation protocol that's experienced quite a bit of success when it comes to recovering from Achilles tendon injuries.
"It's designed to gradually increase the stress going through your tendon in a controlled way; this should gradually reduce swelling and pain," according to a guide from Oxford University Hospitals.
Though these exercises often increase pain initially, the pain should be no higher than a three to four on a scale of zero to 10 — zero being no pain, 10 being the worst pain imaginable. Perform each of the following exercises 15 times, working up to three sets in a row. Repeat twice per day.
1. Eccentric Calf Raise
HOW TO DO IT: Rise up on your toes, using your non-injured leg to lift the majority of your body weight up. Shift the majority of your weight over the injured leg and slowly lower yourself back down. You can also do this exercise with both knees slightly bent to target your soleus muscle. And as your strength improves, stand only on your injured leg while lowering.
2. Heel Drop
Progress to heel drops once you can easily perform three sets of eccentric calf raises on your injured leg. And once you're able to complete both of these eccentric strengthening exercises without pain, you should be able to gradually return to your normal exercise.
HOW TO DO IT: Stand on the edge of a step on the balls of both feet. Rise up on your toes with the non-injured leg doing the work, and then lift that leg off the ground to shift your body weight onto the injured side.
Slowly lower yourself down as far as possible, allowing your heel to drop below the edge of the step. This will increase the amount of stretch on your Achilles tendon significantly. Hold for two to three seconds and repeat. You can make your heel drops harder by wearing a weighted vest or backpack or holding dumbbells.
Is This an Emergency?
- American Academy of Orthopaedic Surgeons: Achilles Tendinitis
- Current Reviews in Musculoskeletal Medicine: Achilles tendon injuries
- Oxford University Hospitals: Achilles Tendinopathy: Advice and Management
- Journal of Orthopaedic & Sport Physical Therapy: A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation
- Mayo Clinic: Tendinitis