Sock Doc: Treatment & Prevention of Achilles Tendonitis

Video Transcript

Hey. This is Sock Doc and today I’m going to talk about a common running injury called Achilles tendinitis. This is an injury that many people suffer from if they’re training hard, if they’re racing a lot. It’s a pain in the lower part of your leg, right where your Achilles tendon attaches to the heel of your bone. So your Achilles tendon is actually an extension of your two calf muscles, your gastrocnemius and your muscle, and they go down and form a tendon. Tendons attach muscles to bones and it’s called your Achilles tendon.

We’ll just get right to it. Your Achilles tendon is right here and many people will feel pain right where their Achilles tendon attaches to the calcaneus, their heel bone. Now you can see right there I have a very little bump that I had from when I had some Achilles tendinitis back in 1992 and 1993, when I was training hard in college. It’s the one time I actually got a cortisone shot right there in my heel bone and it basically calcified up. So to this day I still have a little bit of a bump.

Now some people might call that a heel spur and there’s actually a term called a pump bump, kind of a funny name, when that spur kind of flares up a little bit. There’s also a term called retrocalcaneal bursitis, which is when the bursa, which is underneath that Achilles tendon flares up and you have bursitis, another type of inflammation, -itis means inflammation, so inflammation of the bursa, tendinitis, inflammation of the tendon.

Many people say that the pump bump, that swelling on the outside, the lateral part of your Achilles is from scuffing against the back of a shoe or a walking shoe. I don’t agree with that at all. Typically you have the Achilles tendinitis or you have a calf issue resulting in a strain of the Achilles tendon, and then that flaring up, that inflammation of the Achilles causes you to approximate the distance between your heel and the shoe more, in other words you have less space, and that rubbing then creates that spur or the pump bump.

Here’s the important thing though. As I’ve talked about in the other videos it’s always more important to diagnose why you have a problem rather than what exactly you have. Whether you want to call this Achilles tendinitis, whether you want to call your pain a heel spur, a bone spur, retrocalcaneal bursitis, or a pump bump, ultimately it really doesn’t matter. Diagnosing what you have does very little, if anything, to fix the problem. So we’re going to diagnose why you have it and that’s the important thing, to hopefully prevent it from happening again and recover from this injury faster than you would otherwise.

One of the Sock Doc rules, as you know, is we don’t stretch any injuries. Stretching pulls muscle fibers away from one another and when you want to heal muscle fibers you want to approximate those back together. Even physical therapist today are starting to use methods such as scraping methods, very painful methods, when they go down the belly of a muscle and try to line those fibers up. And that’s now proven that lining those fibers up and approximating these fibers helps to heal injuries.

It’s actually, in my opinion, one of the most effective way you can heal an injury. And this is also known as trigger point therapy or origin insertion technique. So it’s very painful and I’m going to show you how to do that right now because the Achilles tendon is an extension, again, of your calf muscle. So we’re going to look for an injury here on the calf and you’re going to especially look right here, right where the meaty part of your calf muscle starts to narrow down and come to the more narrow part of your calf and then ultimately into your Achilles tendon. You’re going to look for tender spots, like right in there and push with your thumb.

See what’s tender, poke around. You can squeeze with your thumb and index finger too, down this soleus, the lower part of your calf, down to your Achilles here, and look for any tender spots. And if you find them either hold them or rub them out in a circular motion. They’re going to be very tender, very hot, compared to the other side that might not be injured and you can see what might really be painful. A lot of runners have tender calves anyway and sometimes it’s because there’s an injury that’s starting and you can possibly prevent it if you start to work those out.

So you’re going to work those out. Sometime they’ll wash away, we say, they sort of dissolve and feel better. And they might not, but they hopefully feel better the next day or even right now. If you work them out a little bit you might notice that as you walk or run more they don’t hurt as bad. Typically, as you may know, with Achilles tendinitis, if you have it, it hurts more when you walk or run up hill because of the plantarflexion aspect of using your calves while you’re doing that activity.

Another little device I like to use sometimes on people is the stick. You might have seen these at running stores or expos. They have these little movable beads in the middle and you hold it like this and then go up the back side of your leg so you’re working it up and down your calf like that, especially over, obviously, the tender area. I’m putting pressure towards my leg and my leg pressure towards the stick and you’re rolling that up and down. This is a nice little instrument to use for hamstring issues and calf issues where you can get right in there. So look for those injuries in the calf.

Second, remember, no stretching. And third, as usual, with any injury, as I’ve always said, no orthotics. Let’s get off those orthotics and those built up shoes. The more your foot can stay closer to the ground, the more you can walk barefoot, the more you can use minimalist shoes with a very low heel to forefoot drop, a wide toe box, and very little support or cushion, the more you’ll strengthen your feet and get over your injury quicker and prevent other injuries from hopefully occurring.

But there’s other reasons why injuries can occur just other than bad footwear and one of those reasons, again, as I’ve talked about before, is when you over train. Training at too high of a heart rate anaerobically, training too often, racing too often, or too high of stress levels which could even be from eating a poor diet, or from too much emotional stress like if you’re working too many hours, family stress, or any other mental stress you might have that’s basically too much that you can handle.

That tends to stress our bodies out and injuries result from that because there are certain links between stress levels in the body and cortisol levels, which are one of your stress hormones, like adrenaline, and these tend to provoke injuries in people. It happens basically from the way that they work with muscles, the relationship between your hormones and muscles. And I talk more about this on the Sock Doc website about eating better, about eating more appropriately, no hydrogenated fats, low sugar in your diet, and staying away from things like MSG, refined foods and monitoring stress levels, training aerobically rather than anaerobically, using heart rate monitors and that sort of thing.

So if your training properly, if you’re eating well, if your stress levels are in check, and you have the proper equipment, in this case, with a running injury, that usually just means footwear, and if your feet are strong from wearing the proper footwear, and not wearing orthotics and walking barefoot often, you’re going to probably never end up with an injury like Achilles tendinitis, or a pump bump, or a retrocalcaneal bursitis, or a heel spur, or a bone spur, whatever you want to call it, and your feet are going to feel very strong and you’re going to have strong calves and lower legs and great balance.

The other thing is, other than no stretching, no orthotics, is with the entire Sock Doc philosophy make sure you always stay off that injury, especially in the acute phase. It might be okay to ice it a little bit if you need to settle down the injury, if that makes it feel better, to cut down on some of the inflammation. But ultimately, to heal the injury, you need to look distant from the injury, as I’ve talked about in the other videos like plantar fasciitis and iliotibial band injuries. In this case, stay off your Achilles. Don’t be pushing around right where that Achilles inserts into your calcaneus, your heel bone. Go up towards the calf. You might even have to go all the way up towards where your calf actually comes over to the other side, behind your knee bone, the tendons of the calf muscles up here where it’s closer to your hamstring.

So focus on that area behind your leg, and not too much on the Achilles tendon area because often pushing on the Achilles and doing any strong techniques there, the trigger point therapy, or using the stick actually on your Achilles, will most likely just inflame it. You should be able to settle down a lot of it, hopefully all of it, by addressing the muscle further up. But don’t forget to address why you have the problem. And again, it might not be from the shoes. It could be from over training and those other aspects that quickly result in an injury. And that’s how you’ll go about getting over this injury much faster than anybody has every told you and hopefully preventing your Achilles tendinitis from happening again. I hope you enjoyed this. Thanks.

Achilles Tendonitis is a pain in the Achilles tendon often where it attaches to the heel bone. In this video I discuss the reasons for Achilles tendonitis – calf problems, anaerobic excess, improper footwear – as well as treatments you may want to consider, including those you should avoid such as stretching and orthotics.

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