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achilles pain

Achilles pain: Sweden has the answer

Achilles pain is difficult to live with for professionals and amateurs alike. So, some simple exercises to help prevent injury in the Achilles area and reduce the pain once an athlete contracts it would be just the ticket. Fortunately, research carried out at the Sports Medicine Unit of the University Hospital of Northern Sweden in Umea, Sweden can provide such data to help eradicate Achilles pain quickly.

There, investigators divided 30 athletes with chronic Achilles tendonitis into two groups. One group of 15 received only traditional Achilles-tendonitis therapy (non-steroidal anti-inflammatory medications, rest, orthotics, shoe changes, cortisone injections, and physical therapy), while 15 others engaged in 'heavy-load eccentric calf-muscle training' (to be explained in a moment). All 30 subjects experienced morning stiffness in one of their Achilles tendons (athletes with problems in both tendons were excluded from the study) and suffered from pain while running

The heavy-load eccentric calf-muscle training proceeded as follows: athletes stood on a step, with the front edge of the step touching the soles of the athletes' shoes about one-third of the way from the toes to the heel (so that the heels were basically hovering in mid-air). Body position was upright, legs were straight, and all body weight was supported by the forefeet. The athletes then used their good calf muscle (the one not associated with a hurting Achilles) to lift the body upward and plantar flex the ankles, bringing the heels upward while the forefeet remained in contact with the step

Then, the healthy leg and foot were removed from contact with the step, and as the unhealthy leg remained straight the patient slowly lowered the heel of the unsound leg to below the level of the step, eccentrically loading the calf muscle attached to the throbbing Achilles tendon. That constituted one rep!

Speed of movement (the velocity with which the heel moved downward) was kept slow throughout the overall training period. Three sets of 15 straight-leg reps were conducted per workout, and there were also three sets of 15 reps performed with the unhealthy leg bent at the knee, to activate a deep-calf muscle called the soleus (when the leg is straight, the well-known gastrocnemius is forced to bear most of the load). These straight-leg and bent-leg series of sets, which really didn't take long to carry out, were performed twice a day, seven days a week, for a total of 12 weeks

The patients experienced calf-muscle soreness during the first few weeks of their exertions, but they stayed with the programme (they did stop any workout in which they felt disabling pain). Initially, the exercises were performed without added weight, but as the athletes grew stronger, they conducted the exercises while wearing backpacks with added weight, starting with just a few pounds and building up to a greater load as strength increased. Once the athletes became really strong, weight machines were used to provide additional resistance

No concentric activity

An extremely interesting aspect of this research was that no concentric work was carried out by the calf muscles attached to the afflicted Achilles. Concentric contractions are those in which muscles actually shorten while they are contracting, and of course concentric contractions of the calves would be needed to bring the heels back up above the level of the step and plantar flex the ankles prior to another repetition of the eccentric activity (as you know, eccentric contractions are ones in which muscles elongate while they are contracting, which is exactly what was happening to the athletes' 'unhealthy' calf muscles (ie, the calf muscles attached to the ailing Achilles) as their heels dropped below the level of the step

If there was no concentric action by the unhealthy calves, how did the athletes get back into position (with heels above the step) for another eccentric load? Elementary - once the unhealthy calf was eccentrically strained (with heel lowered below the level of the step), the healthy leg was positioned back on the step, and the calf muscles of the healthy leg were used to push the body upward and bring the ankles into plantar flexion again

So what happened to the hurting Achilles tendons? Prior to the eccentric training, the runners' 'unhealthy' calf muscles were consid-erably weaker than their healthy ones - both eccentrically and concentrically. However, after 12 weeks of eccentric training, there was no difference in strength, either eccentrically or concentrically, even though no concentric training had been carried out with the 'bad' calves

Illustrating the importance of good calf-muscle strength for allaying Achilles problems, the eccentrically trained athletes reduced pain while running (which initially had averaged 81 on a scale of 1 to 100, with 100 being the most-intense-possible pain) to near zero after 12 weeks of training. The best news, however, was that all 15 individuals were back to their normal work schedules, training successfully without further Achilles problems. As long as they faithfully performed the eccentric-loading exercises a couple of times per week, they were able to keep their Achilles free from serious trouble

The news wasn't nearly so good for the 'control' group of 15 athletes who abstained completely from eccentric training. All 15 had to undergo surgery, and post-surgical recovery was not so pleasant. In contrast to the eccentrically trained athletes, the 15 surgical patients were unable to re-build calf-muscle strength in the afflicted leg - even 24 weeks after surgery (they used traditional physical therapy rather than the eccentric programme). Thus, calf strength in the problem leg remained below calf strength in the normal leg, making future Achilles problems on that side of the body more likely

Of course, never attempt these exercises unless you have warmed up properly. If you've been prone to Achilles-tendon problems, here's a good routine to get into: at the very beginning of your workout, warm up by jogging easily for 10 minutes. Then, carry out the Swedish exercises before continuing on with the rest of your session

The Swede’s have certainly shown that Achilles pain can be easily treated without paying a penny for help. You can follow these exercises consistently whenever you experience Achilles pain – and you may be surpised by just how effective they are.

Owen Anderson

achilles pain