My Achilles tendon started hurting one Sunday. And for good reason.
Achilles tendon pain is a classic overuse injury. It afflicts middle-aged and older adults.
And also Jacob Forsythe, age 31. This injury had me feeling old.
Here’s what happened.
I wish I had a cool injury story – like I sprinted across the street to save a puppy from an oncoming bus.
Nope.
I mowed my lawn.
Push mower + big yard + weed-whacking a steep hill = Achilles tendon pain.
Like most tendon pain, this episode started after excessive repetitive loading which the tendon was (apparently) unprepared to handle.
The Don’t List
Once the pain started, I avoided these things that I don’t recommend for acute tendon pain.
1) Panic
Overuse tendon pain heals on its own, with the right management. So it’s not a scary injury like a tendon rupture.
Tendon ruptures result from large forces and are accompanied by a “pop” and immediate weakness.
2) Ice
This might come as a surprise – current research cautions against using ice for soft tissue injuries like muscle strains and tendon pain.
Ice is a good pain reliever. But it also causes vasoconstriction, reducing blood flow to the injured area and delaying the body’s natural inflammatory cascade.
Inflammation is beneficial for acute injury. It signals that the body recognizes an injury and has started sending blood and nutrients to the injured tissue.
Bottom line: Ice delays healing.
3) Stretching
Much like ice, stretching is not the panacea scientists once thought.
Stretching is almost useless for tendon pain management, except for gentle stretching to maintain range of motion. In fact, aggressive static stretching exacerbates tendon pain.
4) Rest
Rest implies staying on the couch or in bed all day. As the father of a tireless toddler, I don’t have that option.
Fortunately for me rest isn’t required to heal Achilles tendon pain. Sure, avoiding activity temporarily reduces symptoms.
But upon reloading, the tendon starts hurting again. Instead of rest, “protection” is a better strategy.
The Popular Spots
These are the most common types of tendon pain:
Tennis elbow – outside of the elbow
Golfer’s elbow – inside of the elbow
Quadriceps tendon – just above the kneecap
Patellar tendon – just below the kneecap
Achilles tendon – back of the ankle
Rotator cuff tendons – front, side, back of the shoulder. Particularly the supraspinatus tendon (shown below)
The Quick Fix?
Two treatments offer short-term pain relief for tendon pain.
First, counter-force braces or straps apply pressure to the irritated tendon and alter the force distribution through the tendon during exercise.
These braces offer the best symptom relief for tennis elbow, golfer’s elbow, and patellar tendon pain. But it’s not an effective strategy for Achilles tendon pain.
Second, isometric exercises reduce tendon pain for >45 minutes when performing before exercise.
Check out our short ~10 second videos for elbow pain relief, knee pain relief, and Achilles tendon pain relief to see the most effective isometric exercises for each.
The Real Solution
Tendon pain requires progressive loading of the painful area. This strengthening approach remodels the tendon tissue and enhances activity tolerance.
For Achilles pain, calf raises work best. So I’ve been doing lots of calf raises in the past week. The right way, as explained in our YouTube video on better calf raises.
During tendon strengthening exercises, aim for pain 0-4/10. Some experts argue that pain-free tendon exercise is too easy and ineffective.
While I wouldn’t go that far, most clinicians agree that strengthening tendons through minimal to mild discomfort promotes recovery.
Rehab nerds like me debate whether eccentric strengthening exercises (emphasizing the lowering/lengthening phase of the movement) or heavy, slow resistance exercises work better for tendon pain.
Overall, research shows they are similarly effective for overcoming tendon pain.
Nowhere Fast
A few days after my Achilles tendon flare-up, I implemented heavy, slow resistance exercises via calf raises to strengthen my Achilles tendon. This helped to resolve the pain episode quickly, within 2-3 weeks.
Tendon pain normally heals within a few weeks to a few months (with proper treatment).
Check out these tendon pain articles for region-specific insights:
Quad and Patellar Tendon Pain
Golfer’s Elbow Relief
Rotator Cuff 101
And for science-supported health tips you won’t find anywhere else, join the free Facts & Physio Newsletter. Plus, get The Recovery Checklist when you sign up.
