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One of the more common types of injuries faced by runners and those who exercise primarily on their feet affect the Achilles Tendon at the back of the leg.

Did You Know?

The Achilles Tendon is the largest and strongest tendon in the body. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping.

There are three more common types of injury that can affect the Achilles tendon, all of which can be assisted by a trained Physiotherapist.

What is Achilles Tendinopathy?

Achilles tendinopathy presents as pain, stiffness or swelling in the tendon that runs down the back of the leg to your heel. It usually occurs in stages and if the early warning signs such as pain during or after a run are ignored. It can progress to swelling and daily tendon pain whilst going up and down stairs. Squeezing the tendon will also be painful.


What is Tibialis Posterior Tendinopathy?

Tibialis posterior tendinopathy presents as pain and swelling on the inside of the ankle, close to the Achilles tendon. It can occur when the posterior tibial tendon becomes inflamed or torn and may not be able to provide support for the arch of the foot.


What is Peroneal Tendinopathy?

Peroneal Tendinopathy is not as common and presents as pain and swelling on the outside of the ankle, mainly occurring after ankle sprains. The muscles and tendons involved in this type of injury move the foot in an outward direction and help point the foot and ankle downward.


How can you prevent these injuries?

Training errors account for as much as 60-80% of runners with tendon problems. Rapid increases in distance or speed, change of running terrain and not enough rest between training are quite often the cause.

To ensure you prevent yourself from stressing these areas, watch how much and how often you load the tendon. If you are planning on increasing your exercise safely then try to follow these guidelines:

• Only increase your weekly running mileage incrementally (by adding 10%).

• Work on either speed or distance, but not both together.

• Make sure to have rest days between runs.


About the Calf Muscles

Your calves are made from two muscles – the Gastrocnemius (the larger muscle) and the Soleus which is a flat muscle which sits underneath it. The two muscles work together to give you the push-off needed when running.

The Soleus muscle which runs from your calf to your heel is important for endurance running and posture while the larger Gastrocnemius is perfect for sprinting and speed.

Strengthening the calf muscles with these exercises is a good way to prepare your tendons for running and reduce the chance of injury


Exercises You Can Do At Home

To target the soleus muscle:

Seated heel raises with both legs

Seated single heel raise. You can progress this by doing it with a weight on the knee.


For calf muscle strength

Isometric Calf Raise

1. Start by going up on your toes and then holding at the top position
2. You can hold at the top for 45 seconds then take a 2 minute break and repeat up to 5 reps 2x daily

Short hold of less than 6 seconds, 5 reps 3-4 sets helps with force production

3. Increase load gradually by either doing them single-leg or wearing a backpack with weight

Heel Raise Wall Squat

1. Start with your back against a wall and your feet about a foot away, feet shoulder width apart.
2. Bend your knees until your thighs are parallel to the ground with your knees positioned over your toes
3. Raise your heels while maintaining this position.

Plie Calf Raises ( works your glutes as well!)

1. Start in a sumo squat position with your feet in a wide stance and toes pointing out to the sides, thighs parallel to the floor.
2. Raise your heels off the floor
3. Lower your heels and repeat until you complete the set
Walking a set distance with your shoulder back and your back straight carrying weights (Farmer walk)
Or walking a set distance on your toes with your feet turned out is also a good way to strengthen your calves and core and improve your balance.


Maintain Flexibility
Compare your ankle movement moving your feet up/down, in and out. Work on doing calf stretches in your post run cool down. Hold each stretch for 30 seconds.


Calf stretches

Gastrocnemius: This link demonstrates the correct way to do a gastrocnemius stretch

Soleus: This link demonstrates the correct way to do a Soleus stretch

The next instalment in this series will cover shin splints – and how to avoid them!

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First4Therapy are a Chartered Physiotherapy and Acupuncture Clinic based in Laindon. We also treat patients from the surrounding areas including Basildon, Horndon, Billericay, Brentwood and Stanford-le- hope.

We provide physiotherapy and acupuncture for a wide range of conditions. Our chartered and state registered physiotherapists will provide a comprehensive assessment and treatment that is tailored to resolve your particular problem.

First4Therapy are a member of the Chartered Society of Physiotherapy; Health Professions Council; Manipulation Association of Chartered Physiotherapists; Acupuncture Association of Chartered Physiotherapists; British Association of Hand Therapists.

Registered Physiotherapy provider for BUPA, AXA PPP, WPA, Exeter Friendly, Aviva, Cigna and Vitality Health.

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