Achilles pain

Maybe you have already been to PT.  You do your calf raises, your eccentrics, and you did get better, but now things are just stalled.  This is one option they could be overlooking.

Sometimes the problem isn’t in the tendon at all. If the quadriceps — especially the outside part called the Vastus Lateralis (VL) — can’t lengthen and share load, the Achilles ends up carrying more stress than it was ever designed for.

Achilles pain can be notoriously tricky to resolve quickly. Something overlooked is the importance of restoring the lengthening capacity of the VL — think shock absorber of the lower limb. Ignore it, and the Achilles tendon keeps working overtime. Work with it, and the whole chain of muscles starts working in your favour.

Let me explain 

Your foot hits the ground, and the Force of the impact travels up through the shin bone ( tibia), going directly to the knee — the body’s most effective shock absorber.

 The quad muscles, particularly the Vastus Lateralis (VL), are central to this system, dissipating ground reaction forces with every step.

During running, proper shock absorption relies on the knee flexing and the quads lengthening rapidly under load. If this mechanism isn't working, energy that should be absorbed at the knee will be transmitted further down the chain into the Achilles.

Tendopathies 

This is often an issue with inefficiency in distributing force. When a muscle contracts, large amounts of force go to the tendon, and the remaining force goes to adjacent tissues. If muscles cannot perform their job adequately (potentially due to previous injuries), then excessive load will redirect through the tendon instead.

Let’s test

Do a single-leg calf raise right now. Do you end up on the outside edge of your foot? Do you find that you're pressing really heavily with your big toe, and your little toes have almost no weight in them? 

If you end up on the outside edge of your foot, likely your body is trying to distribute the force by relying on your perineal muscle on the outside edge of your calf.

If you find that you're loading in your big toe on your little toes are empty, then it is likely your tibialis posterior is not functioning correctly.

If all you are doing is treating the Achilles and the main calf muscle, the gastrocnemius, then you're missing the mark. 

We need to establish good load tolerance through all major muscle groups. You need a strong calf raise, then we need to focus on building speed and elasticity back through the tendon. 

Using tests like the ‘heel taps’ and ‘reverse leaps’ can now become a useful KPI’s (key performance indicators). The fastest way to heal is through graded exposure. 

What is graded exposure? 

This means we follow a natural progression of steps in treatment and rehab. 

• First, get unused or overused muscles working so that everything is doing its job, no more/no less.  This will help the body properly distribute force as you run, walk or climb stairs. 
• When everything is working as a team, we shift to more dynamic movements that will build force and resilience in the tendon.  

This approach will help you rebuild the strength and elasticity needed to get back to pain-free activity for good.  

Getting the right diagnosis is key to knowing what to do. Then, we focus on careful treatment and precise exercises to make sure you get lasting results and feel better fast. Just remember, tendons take a little patience to heal since they don't have a direct blood supply. 

I'm really looking forward to helping you and your friends feel good again. See you soon!