How to Fix Achilles Tendinitis, Tendinosis, or Tendinopathy

By Jae Gruenke | Injury Recovery

Feb 19

The back of your ankle is sore to the touch, you hobble in your first few steps after sitting, and maybe your achilles tendon hurts when you run too. Back when I had this problem as a young dancer, I felt like a small mouse had sunk its teeth into each of my achilles and was hanging on there for dear life as I walked around. A sympathetic teacher said to me, “with achilles problems, you just have to assume you sinned horribly in a previous life.”

Know that feeling?

Achilles problems, like many running injuries, develop gradually as a result of the stresses of running and then suddenly reach a tipping point of pain, after which it gets hard to reverse the process and you can end up feeling it goes on and on.

And as I wrote about in my post last week on plantar fascia problems, the usual medical recommendations of stretching, ice, and anti-inflammatories makes matters worse by retarding healing.

Achilles tendon healing can be slow but when you keep inflicting the stress that caused the problem over and over again as you walk and run, you can end up in a holding pattern of chronic inflammation. The way out is to relieve those stresses, not by resting necessarily but by improving how you move so you aren’t placing destructive demands on that area of your body any more.

How to Cause Achilles Problems

A couple of years ago I was at a barefoot running conference and “achilles tendinitis” or a variant of that was in practically every other sentence anyone said. The conference was full of runners who’d switched from conventional running shoes into very minimalist ones (Vibrams, running sandals, etc.) within the past two years and nearly everyone was struggling with their achilles.

The reason for this is pretty simple: when people change their footwear they often also try to improve their form by switching from heelstriking to forefoot striking. Unfortunately, the whole-body movement patterns that had them landing on their heels haven’t been changed, only the foot positioning, and the achilles tendon is now handling a load from a direction it’s not suited to.

Hard/excessive heel striking is a result of running a bit flexed all the time–hip joints flexing too much and not extending enough, and a body that is either too flexed or held too stiff. Trying to “fix” an anteriorly tilted pelvis can be another cause of this.

If you put on thin shoes and run this way but also try to aim the fronts of your feet at the ground, you end up landing on a fairly stiff leg and foot. If you pay attention you can even sense the stiffness in your foot as it meets the ground. And to make matters worse, your foot is a bit too far in front of your pelvis.

Try tiptoeing around in your socks with your butt pulled way back behind your feet and you’ll feel the kind of demand I’m talking about. This is of course an exaggeration…and if your achilles are hurting a lot right now you might want to skip this little experiment.

While it’s common for runners switching to minimalist or barefoot running to do this, as well as runners just trying to improve their form by changing their foot strike, it can also happen that a runner simply develops this pattern out of their general movement habits. It might be quite subtle, but the stress can still accumulate to the point of injury.

How to Relieve Achilles Stress

The key to shifting out of the stiff leg and foot, hip pulled back coordination pattern that stresses the achilles is to land with more supple legs.

This idea alone, that you’ll aim for softer, more flexible legs, can be enough to really help.

Knowing the feeling you’re aiming for in midstance also can make a real difference. Though the achilles tendon stress tends to happen around footstrike, the same movement pattern that leads to landing with a stiff leg too far in front of you also tends to result in having your pelvis behind rather than directly over your support foot at midstance. Try this short lesson from the Mind Your Running Challenge to feel where your midstance is. You might be surprised.

To directly target the coordination of your torso, hip joints, legs, and feet and immediately relieve some of the pain and tension in the achilles, try this lesson which I created to help the folks at that barefoot conference with their achilles. (I also shared it last week for help with plantar fascia problems):

The deeper phenomenon underlying both a supple leg at footstrike and a hip aligned over foot at midstance is the phenomenon of your core action, or the movement of your pelvis, spine, ribcage, and shoulders. This action balances the effort between the flexor muscles that tend to fold you up into a ball and the extensor muscles that stretch you out and arch you backwards. When these sets of muscles are operating in a balanced, rhythmic, coordinated fashion your legs are naturally supple and your pelvis aligns well over your feet because you are executing the process of getting from one leg to the next correctly.

It’s tempting to get sucked into the trap of thinking of running technique as a set of positions you need to arrive at. The opposite is true: it’s a process of moving. If the process is happening right, certain hallmarks such as your pelvis alignment over your foot reflect that. Focusing on correct positions, on the other hand, will not bring about the correct process of moving between them. In fact normally the opposite happens, you just overwork, get tense, and interfere with what was working in your gait.

An easy, relaxed feeling of movement in your chest, hips, and legs as you walk and run is your best asset in relieving the stress on your achilles.

One More Thing: Timing

If your achilles are bothering you, you’ve probably been trying to avoid stressing them by avoiding using them, meaning you try to put your heels down when you climb stairs rather than lifting them up, and in general you try to avoid being on your toes with your heels in the air.

However that action of the feet is only a problem if your weight is in the wrong place–i.e. too far behind the feet. As you work on the things I’ve suggested and your weight moves more easily off your feet, you’ll find that you can lift your heels more easily when you time it right. At that point, trying to force your heels to stay down when they should come up does a lot more harm than good.

Back when I had achilles tendinitis (or so they called it then) as a dancer, I did everything my doctors told me and only got worse. Then I went to a Feldenkrais practitioner and got better…in fact better than before. But after I returned to dancing and got back in shape, I still had the tiniest little bit of a niggle in my achilles sometimes.

Then one day my ballet teacher took my hand during the petit allegro (the little jumps) and said, “follow me” and did the sequence of jumps with me, holding my hand. I could immediately feel we were out of sync. I tried to match her timing, and found myself with my weight further forward, taking off more quickly and landing more lightly.

My fear of re-injuring my achilles had caused me to try unconsciously to keep my weight on my heels, land firmly every time, and jump slowly and cautiously. When I switched to jumping the way my teacher showed me, that last bit of achilles niggle vanished completely. I had finally stopped trying to protect my achilles by fighting the way they were supposed to work.

To Sum Up

The keys to relieving achilles tendon stress are:

  • landing with a supple leg
  • learning where your midstance is
  • improving your core action
  • letting your achilles work properly

Although everyone’s personal situation is a bit different, taking care of these four things should help move you back towards not just running, but the kind of light, nimble, flowing movement you’ve always wished for.

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About the Author

Jae Gruenke, GCFP, is a running technique expert and Feldenkrais Practitioner. Known as a “running form guru,” she is the Founder and CEO of The Balanced Runner™ in New York City and The Balanced Runner UK. She has helped runners from beginner to Olympian improve their form to become pain-free, economical, and fast.

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