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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!


Getting fit and losing weight are usually high on the list of New Year’s resolutions.  

While exercising to get fit is fantastic, it should not be a cause for injury! 

As a Physiotherapist I would always say that an ounce of prevention is worth a pound of cure. The last thing I want is for anybody to find themselves in pain when they could have simply avoided it.  


Avoiding Common Sports Injuries 

Different sports make different demands on the body so there is no one size fits all when it comes to prevention. A key factor to consider is the part of the body which is being used and what role proper preparation for exercise can have on your ability to do it for longer periods without experiencing discomfort.   

Warming up muscles before exercise can seem time consuming but the role of proper warm ups cannot be overstated, especially in cold weather or if you have had previous muscle injuries. It serves many benefits including increasing circulation around the body and ensuring that the muscles themselves are not under as much strain when you do start exercising.   

If you are looking to discuss what specific exercises and warm-ups would be good to do in order to avoid injuries in different sports, you can always email me at and I will be happy to help.  

Running is usually a popular choice in January – there is nothing better than putting on a pair of trainers and hitting the road on a crisp winter’s morning. It is also a leading cause of small-scale aches and pains for this very reason.  


What is Plantar Fasciitis?  

(Planta – Fash-ee-ahy-tis) usually presents as heel pain sometimes radiating to the arch of the foot. Studies have found that reduced calf flexibility as well as foot muscle weakness correlates with plantar fasciitis.  

To avoid this all too common pain – first, make sure you have the correct footwear when you go exercising. This doesn’t mean going to buy the most expensive trainers on the market, but make sure they are light, comfortable, the right size and done up correctly to support your feet (not too tight though!).  

Physiotherapy Chhosing the right foootwear

You should also be aware that flat feet/ high arched feet are more predisposed to Plantar Fasciitis.


Exercises You Can Do At Home 

There are some simple and fun exercises you can do to strengthen the small muscles of the foot. This should help you prevent common injuries such as Plantar Fasciitis and make sure you can go for longer without sustaining any uneccessary aches and pains. 


1. Begin by sitting and scrunch a towel with both feet.  

Progress to standing scrunches with both feet, then to scrunches standing on one foot.  

Sets of 10 reps. 

Towel Scrunching Exercise


2.  Pick up a small object – for example a cotton ball – with one foot and place it into a small cup on the floor.  

Begin in sitting and progress to standing – sets of 10 reps. 

Aim to do these exercises x 3 times per week, this will mean you stand a much better chance of avoiding Plantar Fasciitis. 


Runner’s World shops also do a slow motion video assessment of your feet whilst running, assess abnormalities and suggest footwear.   

Find out more about this here:   

Alternatively it may be a good idea to see a musculoskeletal podiatrist and have your feet assessed for insoles. This is a great way to make sure that you can keep up a sustainable exercise regime which will provide the long term benefits you are looking for. 


The Coronavirus epidemic is closing in. We are all practising social distancing, hand washing, wearing masks and gloves. What else can we do to prepare ourselves?

We can improve our health before an anticipated massive stress to the body so that it can deal with it better.

This is not a new concept, it was used by the British Army during WWII in order to be able to enlist as many soldiers as possible.

How do we prepare ourselves, just in case? 

Physical conditioning and exercise build muscle mass and improve heart and lung function.

Eating a protein rich diet, breathing exercises and psychological strengthening improve nutrition and mental health. We keep hearing about underlying health issues causing complications. These can be diabetes (so keeping a tight control on it becomes important)  and giving up or at least reducing smoking does too.


Not becoming a couch potato is important. We can watch all the box sets and netflix series we like but we must keep moving. Jogging on the spot, dancing to music, short bursts of high intensity exercise are all good. Use cans of food instead of weights and do a few arm raises. Use a sock filled with gravel and tie it around your legs as a weight… there are lots of imaginative ways to make weights and of course, you can always use Amazon.

Breathing Exercises

These involve taking a deep breath and holding it for a few seconds before breathing out. In order to expand the upper lobes of your lungs, place your hands on either side of your chest, in the front just beneath your collar bones, for the middle lobes place them at the level of your arm pits and for the lower lobes place them at the level of your diaphragm.

Mental well-being

I’m not qualified to talk about psychological wellbeing but I’ve compiled a small list of free apps for mental well being like Elefriends, Silvercloud, Catch it, Stay Alive, SAM from MIND charity. Take a look at them and see what you like.

Free Video Consultation from First4Therapy

With a view to helping people stay fit in my area, I am offering to do telephone and video consultations for free for those that are not insured. The major insurance companies are paying for video consultations. I will assess you and provide a plan of self- management including simple ways to relieve pain and exercises to deal with the problem.

Please ring 01277 841118 or e-mail for more details.


You are not alone! Almost 80% of adults have suffered it at some point. Most of the time it is short term and lasts for a few days to a few weeks.

So what should you do if you have an acute episode ? Treatments have changed drastically over the past 30 years that I have been practising as a physiotherapist- Bed rest and traction was the norm for treating low back pain in the past.

But now, keeping active is the new mantra! Treat your back like you would an acutely sprained ankle- keep moving but gingerly avoid too much of any movement that hurts.
Take painkillers like Paracetamol- they don’t speed up your recovery but combined with activity will help a return to normal movement. Over the counter Ibuprofen, an anti-inflammatory also helps but you must check with your pharmacist to rule out any contra-indications to taking it. 

Hot or Cold – what is best ?

Some people prefer cold packs in the acute stage- never applied directly but with a wet flannel between the ice and the body – this helps in the first 2- 3 days to reduce inflammation. You can apply it for 20 minutes at a time 2 to 3 times a day. Cold packs work better if you have nerve pain or sciatica. 

If you have a lot of muscle spasm then you will find that heat helps to relax your muscles and if there is underlying wear and tear of the spinal joints, heat will improve local circulation and be more effective. Moist heat works better than dry heat but heat patches can be kept on for long periods and have been found to be effective.

I’m going to do a series of posts on low back pain. Feel free to ask questions and I will try and answer them to the best of my ability





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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.

Copyright by Kevin James Ltd 2018. All rights reserved.