If the Achilles Tendon Hurts When We Run – Is It Achilles Tendinitis?

Achilles tendinitis is one of the most common sports injuries. It’s no wonder that almost all of us have complained of pain in the heel area at some point. About every tenth person who runs into us knows the discomfort in the Achilles tendon all too well – as soon as we start running, the heel suddenly stings and twinges. For years we’ve had no problems on our weekly run. The problem is that Achilles tendinitis is treacherous. It is often easy for us to ignore the symptoms, especially when the discomfort first occurs. However, despite only slight pain in the beginning, constant training slowly and silently increases the inflammation of the Achilles tendon.

But what is the reason that all, of a sudden, we are no longer able to handle this discomfort? “The Achilles tendon is like a tightrope,” is how Prof. Dr. Gert-Peter Brüggemann, biomechanics expert and co-founder of True Motion, describes this phenomenon. “We can bend a wire rope like that once, we can bend it a hundred times. But if we do it too often and nonstop, eventually the wire will give up – and break.”

In order to avoid inflammation of our Achilles tendon, we need to know how to what extent we can strain it. Because this is often exactly where the causes lie – and the answers can be found in the biomechanics of our body.

The natural, limited ability of the Achilles tendon to heal itself is juxtaposed with the constant overuse injuries. Thus, over time, the tendon reaches its limits. Ultimately, this is precisely the reason why most runners only develop Achilles tendinitis after a long and pain-free period.

The typical symptom of Achilles tendon irritation is first and foremost the pain that occurs when we put weight on our feet and legs. If we suffer from acute inflammation of the Achilles tendon, we will feel burning pain in the area of our heel even during the first few meters of running. This can quickly cause us to lose the desire to run after just a few steps.

In principle, this is a protective function of our body. Because while the inflammation is still fresh, the pain often disappears after a short time – sometimes even during exercise. It is not uncommon for runners to think that they can outrun their pain. But this thought is fatal. If the inflammation has taken up residence in the tendon, the painful burning sensation disappears neither during running nor shortly afterwards. The tendon in the heel usually continues to hurt for many minutes even after we have stopped exercising.

Other symptoms of an inflamed Achilles tendon include redness and swelling in the affected area. When patients press on their tendon, they feel an unpleasant stabbing pain – but usually only on one side. It is particularly painful for those affected if not just one, but both Achilles tendons are inflamed. Sport then becomes torture. Heel spurs and plantar fasciitis are often the consequences of an inflamed Achilles tendon.

If we want to understand the clinical picture of Achillodynia, we have to look at its natural origin – human biomechanics. This is exactly the field of expertise of Gert-Peter Brüggemann. He knows the natural dangers that can ultimately lead to an inflammation of the Achilles tendon; the whip effect and tendon twisting.

• The whip effect: most runners put their foot down heel first. “In the process, the Achilles tendon stretches like a bow,” explains biomechanist Brüggemann. This is not a problem at first – but it can quickly become one.

   

  Whenever runners are about to roll over their foot and the toe of their foot tilts, there is a tiny moment when there is no tension on the Achilles tendon. That changes when the rolling starts. Abruptly, our Achilles tendon becomes tense – and an enormous pulling force is created. “Figuratively speaking, we can imagine it like the movement of a whip,” says Prof. Dr. Brüggemann. This whip effect ultimately causes extreme strain on our Achilles tendons – and can damage them in the long run.
  
  

• The tendon twist: our Achilles tendon consists of three strands. Like a rope, these are twisted into each other – because this is the only way the tendon can withstand the acting forces under stress. These three strands, in turn, are connected to different muscles. “This leads to them being subjected to different levels of stress,” explains biomechanics professor Brüggemann.
  
  It is precisely this natural interaction that is problematic when the foot strike is not centered. Then the muscles pull on the tendon cords with varying strength. Sometimes we can even hear what happens; the cords rub against each other and damage the Achilles tendon in the long run. An Achilles tendinitis can be the result.

• Age: With age, the speed of our body’s processes decreases. This is biological and quite normal. For us, however, this means that the already slow regeneration of the Achilles tendons slows down even more with age. Thus we can overstrain our tendon even faster.
  
  

• Weight: With every step, our Achilles tendon absorbs our entire body weight. This extreme force is increased many times over when we run. Thus, it seems only logical that our weight plays a decisive role in how much strain we put on our Achilles tendon during sports. Ultimately, each additional kilogram brings our tendon closer to its overload limit. Nevertheless, even people who are overweight can go running. However, they should take special care to regenerate sufficiently between their training sessions.
  
  

• Unsuitable running shoes: Especially our Achilles tendons suffer from worn down or low-quality running shoes. A good running shoe helps to optimally absorb the high force impulses during our running session. And that’s important, because when we run, up to six times our body weight acts on our tendons. If a running shoe does not fit us properly or is already worn out, it can no longer protect us from these forces. Our Achilles tendon surrenders.

  
  Runners with shortened calf muscles in particular struggle with this problem. Here, running shoes with a low offset can cause pain due to the strain on the Achilles tendon. If this is the case, it helps to stretch the Achilles tendon. Such a stretching exercise can look like this: We stand on a stair tread with the forefoot, lowering the heel as far as we can. We hold this position for about 30 seconds.

When the Achilles tendon is acutely painful, it calls for a break. And we should give it a break. After all, Achillodynia is a classic overuse condition. The best therapy in acute cases is therefore to give the Achilles tendon time to recover. Additionally, it helps to cool a swollen tendon with a cold pack after running. To avoid burning ourselves during treatment, we should wrap the cold pack in a towel before placing it on the affected tendon. This helps to alleviate the swelling.

If Achillodynia causes Achilles tendon pain after running, surgery is not necessary. Instead, patients can support their recovery with stretching and strength exercises. Sports and physical therapists show us helpful exercises.