It’s time to kick heel pain in the butt!
Let’s find out how to prevent & help back of heel pain.
Achilles tendonitis is a common reason for back of heel pain and is characterised by inflammation of the Achilles tendon and typically occurs due to over use or repetitive activities.
The Achilles tendon originates from the heel bone (calcaneus) and is the common attachment for your calf muscles (gastrocnemius and soleus).
These muscles are important to assist in push off in walking, running, standing tiptoe and ascending hills or stairs.
Symptoms which may be an indication of Achilles tendonitis are if you feel any pain in the back of the heel with activities such as walking, running, jumping and/or have proximal swelling and tenderness at the back of your heel bone.
Symptoms can vary dependent on the degree of severity. If symptoms present as stiffness initially when starting activity or first thing in the morning and pain arising during activities or successive. Then, it is likely a mild case of Achilles tendonitis.
However if you experience these symptoms and there is swelling or a palpable nodule in the tendon it would be considered moderately severe. In severe cases, any use of the Achilles tendon or weight bearing through the tendon can cause pain and restriction. There are also rare cases where the Achilles tendon can rupture.
If you are coming into preseason for your sport or are considering starting to be more active here are 5 tips to prevent the occurrence of Achilles tendonitis…
1. Ensure thorough stretching of the calf muscles with the knee extended and slightly bent as demonstrated below. Incorporate these stretches into your warm up and cool down for any physical activity. Each stretch should be held for at least 30 seconds.
(Dot to Trot, 2018)
2. Be intuitive to your body. Back of heel pain does not always indicate there is damage to any structures, however it is a guide to relatively rest the area. Trying to push through the pain may potentially make it worse.
3. Slowly increase your training load so there aren’t sudden fluctuations in volume or drastic changes in training surfaces or incline.
4. Shoes! There is a definite no no… high heels should be avoided, as they shorten the muscles and tendon. Also ensuring you have supportive footwear, especially if you have flat feet as in this circumstance you may require increased arch support or orthoses.
5. Do CALF RAISES, strengthening of the calf muscles can assist in adaptations to support increased training loads. Simply coming up on to your toes and slowly lowering down is an effective strengthening exercise, with progressions doing calf raises on one leg and off a step. Do 3×10 reps every few days.
This doesn’t help if the heel pain is already niggling though.
Treatment for acute Achilles tendonitis or back of heel pain is:
- modified rest
- avoiding aggravating activities
- ice daily and after activities for 15-20 minutes
- non-steroidal anti-inflammatory drug as prescribed by your pharmacist
- seek a Physiotherapist to assist in management
The early stage of rehabilitation aims to offload the tendon, which may include heel wedges in your shoes, taping and muscle release massage.
Then pain free loading of the tendon commences. Watch our best pain relieving back of heel exercise video here.
Additionally rehabilitation should be individualised to address other contributing factors identified in assessment, such as core strength or ankle mechanics.
Your Physiotherapist will guide you through progressions of exercises.
Rehabilitation in the later stages is focused on making the loading of your calf muscles and tendon functional. Then it may include transitioning into power, agility or whatever exercise modality is specific to the demands of your specific sport or activity loads.
There are other conditions that can present as heel pain and have different management. Therefore if you are unsure if it is Achilles Tendonitis or need assistance to help manage your pain, seek support from your myPhysioSA Physiotherapist.
Feel free to ask me any questions you may via our myPhysioGuru page here.
Lauren Mutton, my Physio SA Physiotherapist Mount Barker Adelaide Hills
References: (Dot2Trot, 2018, Lots of Physical Therapy in My Future, Dot2Trot, Accessed 19/12/18, https://dot2trot.com/2018/02/08/lots-of-physical-therapy-in-my-future/)