Dr. Zatrok's blog
Dr. Zatrok's blog

Dr. Zatrok's blog

Achilles tendinitis: Symptoms, Causes, Treatment

by Dr. Zsolt Zatrok

You get out of bed, feeling tired and stiff in the calf. Every day, you’re increasingly haunted by the feeling that something is wrong. You wonder if you should start today’s distance or if it’s time to suspend your runs until the discomfort subsides. You need to move, you think, and so you start. The Achilles pain gets worse as you run and you finally change to walking. But it’s still no better, your hamstrings are stiff and aching. I wonder what it is?

Did you know Achilles tendon injuries account for 5-12% of all running injuries? And that they are more common in men?

How does Achilles tendinitis develop and what can be done about it?

Let’s start at the beginning. It connects your calf muscles to your heel bone. You use it every step of the way, all the time: when you walk, run, climb stairs, jump, or even stand on tiptoe.

Achilles tendon is the body's strongest tendon

Despite the fact that it can withstand very high loads, it can sometimes become overstretched. Its irritation can lead to degeneration and inflammation. The Achilles is like a bungee-jumping cord made up of thin rubber strands, except that it is made up of elastic protein fibres. When the Achilles tendon is injured, these so-called collagen fibres are damaged. Healthy tendons run alongside each other in a nice, even, smooth bundle. However, if any abnormalities are observed, these fibres become tangled and untidy.

Another problem, in addition to heavy use and strain, is that the blood supply to the Achilles tendon is “inherently” poor, making it particularly vulnerable to injury, and when injured, it is slow to heal.

Achilles tendinitis – What causes pain in the Achilles?

Achilles tendinitis is not usually due to a specific injury but to micro-injuries from repetitive bad movement or overuse. It can also be triggered by sudden increases in load intensity, poor equipment, overly tight muscles or even an aggressive exercise programme.

Symptoms are most common in people who are actively involved in sports. It’s most common in runners, triathletes, footballers, handball, basketball and volleyball players. In the mornings, pain and stiffness in the Achilles tendon or heel area can be felt, which may improve with little movement. The tendon may thicken, potentially swelling, with the possibility of worsening as the day progresses or at the end of a training session. Achilles pain can be categorized into two types: either the middle of the tendon is painful (66.6%), or the point where it attaches to the heel bone (33.3%). In the latter case, bone growth may develop under the tendon attachment point (in case of persistent inflammation), which can rub the tendon and cause a lot of pain. So-called bursa inflammation (bursitis) can also occur, which can aggravate the symptoms. The bursa is a fluid plug whose normal role is to reduce friction between the tendon and bone. In both cases, the cells are observed to calcify, i.e. deposit calcium and therefore harden.

What can you do if you notice these symptoms?

First and foremost, get it seen by a doctor. Since Achilles pain can lead to a more serious injury – even a rupture – you should let a professional diagnose and guide your treatment.

Treatment options for Achilles pain

Achilles pain can be treated using a variety of methods, either individually or in combination:

  • Nonsteroidal anti-inflammatory drugs
  • Non-steroidal anti-inflammatory drugs
  • Physical therapy treatments

The main aim of these treatments is to relieve pain, reduce swelling and help and support the anti-inflammatory (healing) process.

The choice of rehabilitation protocol depends on the severity of the condition and whether the athlete is a professional athlete. Total weight relief is now considered an outdated method, but all interventions should be done carefully! Rest should not be taken to mean lying on the couch. Reduce the intensity, and try to relieve the load on the injured limb (for example with kinesio tape). Switch from running to exercises that help increase blood circulation but do not overstretch the calf and Achilles tendon: cycling or using an elliptical trainer (these are less demanding on the Achilles).

Replace your bad running shoes! If you notice that the heel is worn out, or the back of the shoe is very hard, or the insole is too soft, you should replace it. In many cases, a simple heel lift can solve the problem.

Loosening the calf

The simplest, but big issue is the condition of your calf muscles.tools to help Calf Stretching and reduce achilles pain The tension of the calf muscles exerts a constant pull on the Achilles and contributes to overuse and inflammation.

So, if your muscles are stiff and tight, stretching and relaxing them alone can solve your complaints. For example, the Fit Stretch device is specifically designed to relax leg muscles and improve ankle movement. Just a few days of exercise can reduce the strain.

Another tool for relaxing the calf muscles is the foam roller.


rolling to perform on calf muscles

The FoamRoller foam roller can help relieve muscle soreness, alleviate muscle stiffness and knots, facilitate stretching, warm up the muscles, and enhance muscle recovery.

The greatest benefit of the foam roller is that it provides many of the benefits of physiotherapy and massage. Meanwhile, a foam roller is cheaper than a single gymnastics or massage but can be used for years. Of course, it is not a substitute for either exercise or massage. But for someone who can afford a few treatments, it is well worth choosing and using a foam roller.

When you roll, your muscles stretch and relax. The foam roller squeezes the blood out of the muscles, while fresh blood flows into place, bringing vital nutrients such as oxygen and glycogen to the muscles, fasciae and tendons. You can control the “pressure” of the foam roller, and the intensity of the massage. The more you put your body weight on it, the less pressure you apply.

Muscles with a better blood supply and looser muscles are less sore when moving. Increased blood circulation flushes out accumulated waste products. Muscles get the nutrients they need more quickly, resulting in better recovery.

[message title=”I recommend getting a foam roller” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

ergonomic foam roller

  • To loosen the calf, I recommend the 3-in-1, Hollow, Spiky foam roller.
  • The foam roller in the 3 in 1 kit is the softest and gentlest.


Physical therapy treatments for Achilles tendinitis

Thankfully, if we are looking at how to heal Achilles tendinitis, we get a variety of answers. I listed the below treatments that are either pain relief or a helping hand during the healing process and beyond.

TENS treatment:

Mainly a pain relief method. The device transmits impulses through the skin to the nerve endings in the body part undergoing treatment. In most cases, this stimulation significantly reduces or eliminates pain. It also slightly stimulates blood circulation, which may contribute to the healing process, but TENS alone is a temporary pain relief.

EMS treatment, i.e. muscle stimulation:

It relaxes stiff muscles, aids in strengthening the calf at a stage when exercise is not possible, and accelerates blood circulation, thereby removing waste products and delivering essential nutrients.

[message title=”Globus Triathlon Pro – With Muscle, TENS and microcurrent therapy” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • 23 microcurrent programsGlobus Triathlon pro - with microcurrent and TENS treatment programs
  • Pain reduction, anti-inflammatory treatment and healing stimulant
  • Extensive fitness and sports programs
  • Recovery, warm-up, endurance and strength muscle stimulation programs


NEMS, or microcurrent treatment:

The latest and one of the most effective electrotherapy methods. It powerfully reduces pain, restores the membrane potential of damaged cells and thus triggers ATP and protein production and healing processes. The advantage of the aforementioned devices, capable of performing these treatments, is that they can address Achilles pain and provide support for strength exercises after healing. Additionally, conditions like tennis elbow, lumbago, and sciatica can be similarly treated. So these devices are quite versatile and good to have around.

Therapeutic ultrasound:

The tissues absorb ultrasound directed into the body, which accelerates blood circulation to the treated area, stimulating the healing process.

Soft laser treatment:

Performing it is very easy, as you simply direct the laser beam to the painful area and hold it there for a few seconds or minutes, depending on the device’s laser class. The laser beam penetrates the tissue and stimulates cell regeneration, thus accelerating the healing process.

[message title=”Personal Laser L400 Soft Laser” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • Laser Power Class 3Soft Laser Personal Laser L400
  • 808 nanometer laser beam
  • 400mW power
  • 12.5 seconds / 5 Joule


Manual therapies:

It is worth visiting a manual therapist who can use a variety of techniques to promote faster recovery.

Movement therapy:

A movement therapist can help your ankle joint to work with a greater range of motion- at home, use appropriate exercises to relieve tendon overuse.

You can reduce your risk of Achilles tendinitis by following these steps:

  • Increase intensity gradually, whether it’s speed or pace.
  • Choose your shoes carefully. Be comfortable and cushion properly. Get rid of worn, worn-out shoes. If you wear heels often, do stretching and mobilisation exercises regularly.
  • Do ankle mobilisation exercises to avoid straining your Achilles tendon and calf.
  • If you have an ankle impingement or flat feet, deal with it. Do proper physiotherapy.
  • Strengthen your calves with eccentric exercises.

If you delay in dealing with the problem, it can have more serious consequences: the Achilles tendon can rupture, requiring surgery and taking you out of training for a long time. So as soon as you notice the symptoms, take the advice and take action for your recovery.

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