Achilles Tendon Injuries: Risk Factors and Treatment for Rock Climbers and Runners

The achilles tendon, which lives at the back of your heel, is the thickest and strongest tendon in the human body. The achilles tendon attaches the two main calf muscles, your gastrocnemius and soleus, to the heel or calcaneus. These muscles and tendon cause plantar flexion, or toe pointing / heel raising, which propels the body forward during walking and running. The achilles tendon undergoes huge forces, up to 10x body weight during running. These high forces and frequent usage are why this tendon is susceptible to injury, especially in runners. 

Symptoms of achilles tendinopathy are typically pain and tenderness through the tendon, near the back of the heal. Pain is typically worse when engaging that muscle - raising onto toes, running, walking up stairs, etc. Commonly, pain is worse in the morning or after times of prolonged sitting/rest, and pain tends to ease as you get the tendon warmed up.

There are a few different varieties of achilles tendon irritation, outlined below:

• The most common is mid-portion achilles tendinopathy, Symptoms occur about 2-3 inches above the heel.

• Insertional tendinopathy is less common, and symptoms are present on the back of the heel where the tendon connects. 

  
  

Treatment for these two types are fairly similar, however there are key differences in the way we load the tendon. For mid-portion irritation, calf raises can be performed in full range, using heavy and slow loads. For insertional tendon pain, we want to avoid excessive range of motion into dorsiflexion (like dropping your heel off the back of a stair), and focus more on the top range platarflexion (heel raised high off the ground).

Runners are at a much higher risk than the general population to develop achilles tendon irritation due to the repetitive nature of running and the high loads associated. Running fast and running uphill both place more stress on the tendon, so increasing general volume of running, or volume of speed work or hill work too quickly can cause overload in the tendon. 

Running uphill places an increased stress on the achilles tendon

For climbers, injury is possible when increasing demand of the calf muscles, such as projecting something very steep/overhung. We also see acute injuries from falls which place a large stress on the tendon, or from pressure and subsequent inflammation from climbing shoes digging into the heel or friction from a heel hook.

Some general risk factors for developing achilles tendinopathy are:

• Being between the ages of 40-60

• Male sex

• Obesity

• Frequent alcohol consumption

• Decreased strength of the calf

• Poor balance

• Increased lower extremity stiffness/decreased flexibility

• Poor movement mechanics

Obviously, a few of those risk factors we cannot change. However, things like calf strength, balance, movement mechanics, and decreased flexibility are all things that can be address in physical therapy and improved upon.

Treating this condition involves introducing therapeutic load to the calf and achilles tendon, and progressing through a protocol primarily focused on slow and heavy loading. In addition to this, addressing the above factors including flexibility, balance, and movement mechanics is essential for long term recovery. Finally, manual therapy including massage, dry needling, and joint mobilizations of the ankle are all helpful in getting symptoms to calm down.

Example loading of the calf muscles with weight in the backpack. This would be suitable for mid-portion achilles injuries, but not insertional due to the increased range of motion into dorsiflexion.

There may need to be an offload of the tendon initially, depending on the severity of symptoms. This may include heel lifts in the shoe, orthotics, and/or modification of training. For runners with severe pain, a brief total shut down of running may be indicated, however in most cases does not need to be longer than 1-2 weeks. Following this, there may be some modification in training such as holding off on speed work or avoiding hills until symptoms become more manageable.

As for climbing, there may need to be a modification in footwear to put less pressure on the heel. In addition, be mindful not to do too many climbs where the heel drops below the forefoot, common in slab, which will put stress and strain on the tendon. 

Ultimately, achilles tendon injuries are very treatable, especially if addressed early on! If you are concerned you may have an achilles tendon injury, contact us at The Climb Clinic and let us help you set up a personalized rehab plan to get you back to running and climbing without pain!

References: 

Wong, M., Jardaly, A. H., & Kiel, J. (2023, August 8). Anatomy, Bony Pelvis and Lower Limb: Achilles Tendon. In StatPearls [Internet]. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499917/

Carroll, L. A., Paulseth, S., Fraser, J. J., & Martin, R. L. (n.d.). The Foot and Ankle: Evidence-Informed Physical Therapy Patient Management (Independent Study Course 31.2.12). Duquesne University; Paulseth & Associates Physical Therapy, Inc.; US Naval Health Research Center.