Stiff and Sore Achilles Tendon in the Morning?

James Naughton of The Fit Physios talks about Stiff and Sore Achilles Tendon for Physio Corner

Does your Achilles tendon feel stiff and/or sore when you take your first few steps in the morning?  This may be a sign that you have Achilles tendinopathy. This blog will help you understand why it feels like that and what you can do to help the healing process. 

So, what is Achilles tendinopathy you may ask? 

Achilles tendinopathy (A.K.A tendinitis) is a term which describes pain and dysfunction within the Achilles tendon predominately caused due to overuse injuries in recreational and professional athletes. Studies have shown that Achilles tendinopathy can affect up to 29% of middle and long-distance runners (1). The Achilles tendon connects the muscles in the back of your calf to your heel bone.

There are two types of Achilles tendinopathy:

1. Mid-portion tendinopathy affects the middle section of the tendon.
2. Insertional tendinopathy which affects the bottom of the tendon where it attaches to your heel.

What causes Achilles tendinopathy?

Achilles tendinopathy occurs when the demand placed on the tendon exceeds its ability to cope with the current workload. Sharp increases in running distance, running hills when you are used of flat surfaces, or going for a run after a long period of inactivity are common causes of excessive overload which may lead to Achilles tendinopathy. Often, once the tendon becomes irritated then any action using the tendon can provoke pain. Symptoms are usually amplified upon weight bearing after long periods of rest and can prove difficult to manage if not addressed.

What can you do to help the healing process? 

Firstly, you need to calm down the tendon, which means initially reducing activities that provoke pain - not stopping totally but just reducing the total workload. In the meantime, starting some gradual exercises will enable the tendon to strengthen and increase its capacity to handle workload and will also help reduce pain. It is important that the rehab exercises are set at the correct intensity for your Achilles tendon. A typical rehabilitation program should start with low load exercises that will gradually increase in complexity as your tendon recovers and gets stronger.

If you wake up in the morning and your Achilles tendon is significantly stiffer and/or sorer than it usually feels, it can be a sign that the exercise program/activities you did the previous day were too much for the tendon. Monitoring 24hr pain/stiffness response can be helpful to ensure your rehab exercises are pitched at the correct intensity for you.

Rehab programs must be tailored so that the exercises are pitched at the correct intensity for your current symptoms. Exercise therapy is the most evidence-based treatment for Achilles tendinopathy (2). With the help of your physiotherapist, a rehab program can be designed to help kickstart the rehab process.

In conclusion, there are 3 key takeaways: 

1. Achilles tendinopathy is an overuse injury where sharp increases in training load exceed the tendons capacity to cope with the workload.
2. Activity modification and getting an individualised rehab program are two important first steps kickstarting the healing process. Rehab exercises will promote better regeneration of the tendon tissue than complete rest.
3. If your tendon is stiffer and/or sorer in the morning than normal, this may be a sign that the previous day’s activities were too much for the tendon. Monitoring this 24hr pain/stiffness response provides valuable information to ensure your rehab plan is pitched at the correct intensity.

If you're training for a marathon, and currently have an injury or are worried about an injury, why not book a consultation with THE FIT PHYSIOS.

References 

1. Janssen I, van der Worp H, Hensing S, Zwerver J. Investigating Achilles and patellar tendinopathy prevalence in elite athletics. Research in Sports Medicine. 2018;26(1):1-12.
2. Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. Journal of Foot and Ankle Research. 2012;5(1):15.