How to Use Clinical Somatics Exercises to Heal Achilles Tendinitis
What is Achilles tendinitis?
The Achilles (calcaneal) tendon is located at the back of the ankle, where it attaches the calf muscles to the heel bone. Overuse injuries to the Achilles tendon—whether they be inflammatory tendinitis or degenerative tendinosis—can be very painful and limit physical activity. People with Achilles tendinitis or tendinosis also have an increased risk of rupturing (tearing) their Achilles tendon, a very painful injury which requires surgical repair.
Throughout this article I will use the term tendinitis, but be aware that sometimes tendon pain can be caused by degeneration of the tendon (tendinosis) rather than inflammation.
Achilles tendinitis is classified into two types: insertional and non-insertional. If inflammation or pain is occurring where the tendon attaches to the heel bone, it is called insertional. If the inflammation or pain is occurring in the middle of the tendon, it is non-insertional. If you feel pain in either of these areas, it is likely due to overuse of your Achilles tendon.
What are the risk factors for Achilles tendinitis?
- Activities including tennis, basketball, and dancing that involve running, jumping, or pushing up on the toes.
- Running or playing sports only on the weekends; this results in sudden strain put on the tendon, which is not conditioned throughout the week.
- Running: Suddenly increasing the intensity or duration of your runs.
Running on hilly terrain.
Running in worn-out running shoes that are not supportive.
- Older age: The Achilles tendon weakens with age.
- Gender: Achilles tendinitis occurs more often in men.
- Obesity: Excess weight puts strain on the Achilles tendon.
- Flat feet: Having low arches can put strain on the Achilles tendon.
- Tight calf muscles increase the strain on the Achilles tendon, making it more likely to develop micro-tears or a full rupture.
The overall pattern of muscle tension that leads to Achilles tendinitis
While tight calf muscles exert the most direct strain on the Achilles tendon, people with Achilles tendinitis often have a pattern of muscle tension in their lower body that operates like a pulley system, involving the lower back, hip flexors, gluteal muscles, and hamstrings.
Tight lower back muscles—the quadratus lumborum and erector spinae group—pull the top of the pelvis and lumbar vertebrae closer together. This typically brings the pelvis into an anterior (forward) tilt.
Tight hip flexors (including the rectus femoris, iliopsoas, tensor fascia latae, sartorius, and hip adductors) also tilt the pelvis forward, and can play a role in Achilles tendinitis.
When the pelvis is tipped forward, the hamstrings get pulled tight. The hamstrings originate at the bottom of the pelvic bone, run down the back of the thighs, and insert at the tops of the tibia and fibula, the bones of the lower leg.
The resulting tension in the hamstrings pulls on the bones of the lower leg, trying to flex (bend) the knees. This attempt to flex the knees recruits the muscles of the calf that flex the knees as well—the gastrocnemius and the plantaris.
The gastrocnemius, soleus, and plantaris muscles attach to the Achilles tendon, which attaches to the heel bone. So when these muscles are tight, they not only flex the knee, but also plantar flex the ankle and pull the Achilles tendon taut.
If all of this tension occurred while we were lying down, we probably wouldn’t feel any negative effects. But if this pulley system is chronically tight, and you do repetitive movements that put strain on the Achilles tendon—running, jumping, or rising up on your toes—pain and injury to the Achilles tendon is almost inevitable. That’s why it’s extremely important to keep not just your calf muscles but all of the muscles from your lower back down to your feet as loose and flexible as possible.
Treatment for Achilles tendinitis
The R.I.C.E. method is often recommend for Achilles tendinitis; this stands for rest, ice, compression, and elevation. This approach can be helpful for allowing the tendon to heal, but it doesn’t prevent the injury from reccuring in the future.
Stretching and strengthening may also be prescribed. However, static stretching activates the stretch reflex, often making muscles tighter. And strengthening the leg muscles may result in making the calf muscles even tighter, exacerbating Achilles pain.
A specific type of strengthening called “eccentric strengthening” has proven to be effective for Achilles tendinitis. Eccentric strengthening is essentially a faster, more intense version of pandiculation, the movement technique used in Clinical Somatics. A 2011 study found that Alfredson’s heel drop exercise leads to long-term pain relief from Achilles tendinitis.
Pandiculation, the movement technique used in Clinical Somatics exercises, is an ideal way to recover from Achilles tendinitis. Pandiculation releases chronically tight muscles throughout the body, reducing the strain put on the Achilles tendon. Clinical Somatics exercises should be practiced before beginning Alfredson’s heel drop exercise in order to reduce strain on the tendon.
How to heal from Achilles tendinitis
1. Take some time off from the activity that caused the tendinitis so that your tendon can heal. This can be tough, but you have to do it!
2. Practice Clinical Somatics exercises to release chronic muscle tension in your calf muscles, hamstrings, glutes, lower back, and hip flexors.
3. Practice Alfredson’s heel drop exercise to strengthen your Achilles tendon. When you begin this exercise, start with just a few gentle repetitions per day, and gradually increase.
4. When you resume the activity that caused your tendinitis, take the time to warm up slowly and cool down properly. Your warm-up should include slow, gentle versions of the movements you’ll be doing in your workout. Clinical Somatics exercises are an ideal cool-down.
5. Cross-train: Vary your athletic activities throughout the week to avoid overuse of your Achilles tendon, and avoid developing dysfunctional muscular patterns that overuse certain muscles in your body.
6. If you’re a runner, wear running shoes that provide adequate support.
7. When you increase the intensity or length of your workouts, do it gradually.
Clinical Somatics exercises for Achilles tendinitis
If you have Achilles tendinitis, practice these exercises from the Level One & Two Courses regularly to release the chronic muscle tension in your lower back, hip flexors, gluteal muscles, hamstrings, and calf muscles:
Arch & Flatten
Lower Back Release
Proprioceptive Exercise 1
Iliotibial Band Release
Standing Hamstring Release
Seated Hamstring Release
Head & Knee Lifts
If you want to try Clinical Somatics exercises, try this sample exercise video.
The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain by Sarah Warren, CSE
Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health by Thomas Hanna