Tommy’s Insertional Achilles Tendinopathy

In my previous article, “What Caused Tommy’s Heel Pain With Running?”, I ended with revealing Tommy’s diagnosis — Insertional Achilles Tendinopathy. Tendinopathy is a term used to describe an overused tendon. Tendinopathies typically occur at the bony attachment site of tendons, however, in achilles tendon injuries, it seems that the middle aspect of the tendon is more commonly injured. In this case, Tommy is dealing with a tendinopathy where his achilles tendon attaches to his calcaneus (heel bone). Although less common, this type of injury can still occur. There are two main things that stick out with the development of Tommy’s particular injury, up-hill running and poor training habits.

Up-Hill Running

The bony attachment site of tendons are susceptible to compression and tendons do not like being compressed. What causes achilles tendon compression where it attaches on the calcaneus is ankle dorsiflexion, which is a movement involving the foot bending backwards. Running up-hill really increases this movement, often forcing the ankle to its limits, especially if someone is dealing with decreased ankle dorsiflexion range of motion.

Poor Training Habits

In Tommy’s case he performed up-hill running at a high intensity, which is not bad, however, he also performed this type of training repetitively over a period of time without proper progression, rest, or incorporating other modes of training. Tommy’s achilles tendon was loaded or stressed beyond its capabilities, resulting in his injury. Training methods are completely modifiable and this is something Tommy will end up learning how to manage appropriately with physical therapy.

What will rehabilitation look like for an insertional Achilles Tendinopathy? In Tommy’s case physical therapy will address reducing his pain and improving his strength in order to help him return to running.

Reducing Pain

This will likely involve having Tommy having to stop running up-hill to avoid further compression to a tendon that is already acutely inflamed. Sometimes runners may be able to keep running with modifications depending on how severe and irritable their tendinopathy is, however, there are definitely times were it is recommended to take a break during the rehab process.

Isometric exercise of the calf muscles, where they are activated without being lengthened or shortened, are often implemented and can be very effective in reducing pain and preventing muscle atrophy.

Sometimes heel lifts are utilized to limit the amount of ankle dorsiflexion performed which can be a simple way to reduce compression on the Achilles tendon as well.

Improving Strength

Strengthening of the calf muscles to improve tolerance to loading through the Achilles tendon and to improve muscle performance is often implemented in order to improve a runners ability to handle the demands of running. Performing calf raises is quite common to achieve this.

Return To Running

As stated before, uphill running will likely be avoided initially. Tommy’s physical therapist will guide him on the volume, frequency, and intensity of his running in order to promote a gradual return to running. With tendinopathies it is often okay to run with pain. A common guideline used is to avoid running with a greater than 2–3/10 pain. Any increases in pain beyond this during or after running would result a modification in the return to run program.

Getting back to running without pain especially when it involves a tendon injury can definitely take time, however, if you are someone experiencing pain with running don’t lose hope! There are many great physical therapists out there who specialize in treating the injured runner and who help runners get back to healthy and consistent training!

Medical Disclaimer:

The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by this article is solely at your own risk.



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Orthodox Christian. Physical Therapist. Just your average Joey.