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Tendons need a strong and stable base. If you don’t have control of your body – the base of the foot is not properly stabilized – then the attachment points shift and the tendon operates in a longer position. This causes increased tension; the definition of deflection is the length under load. And too much tension is what creates a beakdown in your body and tendon damage.
The answer to tendon problems is often to strengthen it – and you definitely should. The reason the Achilles was damaged was that it wasn’t strong enough to begin with. Doing isometrics and eccentrics will create a healing response to improve tendon health, but it won’t repair the foundation. You need to fix both. It’s great to improve the density and strength of the tendon, but that tendon still needs to rest on a solid foundation, and that’s what gets overlooked.
But we cannot neglect it. You must learn to control the twisting motion through your foot. The forefoot and rearfoot should twist over each other. This torsion is mainly controlled by the first ray (big toe). When you do a good job of using your first ray, the pressure goes through the foot appropriately: your rearfoot twists down to the floor, your forefoot twists down to the floor, the metatarsal heads are flat on the ground, you roll through the metatarsal heads, push off appropriately – and Achilles is in a tight window. It’s happy.
Compare that to someone with too stiff a foot; he or she tends to walk on the outside of the foot and the Achilles is in a longer position with each stride. Or compare to runners with soft foot control: their foot is in a late pronation position and the tendon is in a longer position when pushing off. Both scenarios take the Achilles out of its preferred length/tension relationships. This increases the length of the fabric, which causes shearing and damage.
The following exercises aim to anchor the big toe to support the foot and improve control and coordination of your arch, while integrating that control along the chain and throughout your body. You should do control exercises for 5-10 minutes, 2-3 times a week.
RELATED: A Guide to Injuries for Triathletes
Achilles Injury Prevention and Rehabilitation Exercises: Single Leg Shoulder Press
- Stand on one leg, with a relatively light weight (8 to 10 pounds) in the opposite hand.
- Dial in your posture, lowering your big toe to set up your forefoot tripod from the inside to the outside of the ball of your foot, and extending to the end of the big toe.
- Press the weight overhead and bring it back down. The extra weight creates more instability that you can control with the forefoot.
- As your arm passes over your head, keep your weight centered on your midfoot to avoid leaning back onto your heel.
- Do 15 repetitions on each side.
TIPS: Use a water bottle or milk jug if you don’t have access to weights. If you arch your lower back when lying overhead, try dropping the ribs in front to keep a neutral spine.
Achilles Injury Rehabilitation and Prevention Exercises: foot screw
- Stand on both feet, maintaining equal pressure on the tripod of each forefoot.
- Turn your rearfoot slightly while keeping your big toe on the ground, then lift your heels about an inch.
- Staying on your tiptoes, allow the rearfoot to twist inward.
- Press the big toe into the ground to push your arch up and screw the heel into the outside position.
- Lower your foot to the floor and relax. This is a full representative. Keep the movement specific and controlled.
- Perform 20 repetitions.
RELATED: Treatment and prevention of Achilles injuries
Achilles Injury Rehabilitation and Prevention Exercises: foot rocks
The next two exercises use a MOBO board, designed with a hollow box under your little toes to prevent you from using a gripping strategy and thereby training your big toe to support and stabilize your arch.
This exercise trains you to use your foot correctly, controlling twisting through pronation and supination. In the secondary tilt axis, it gets the peroneals to the sides of your calf, also helping to anchor the first ray to create stability.
While standing with good posture, touch the toe side of the board to the ground, then the heel side. Make sure the sway is controlled, as if there are eggshells underneath and you are touching the board to them, not crushing them. This is a representative.
Repeat for 30 reps, swinging from the outside of the heel to the big toe side of the forefoot. Then do 30 reps, swinging from the arch side of the heel to the little toe side of the forefoot. (Note: when done on a MOBO board, the flip fins guide you in the desired directions of spin).
Repeat this entire sequence for the left foot.
RELATED: A simple mobility routine for happy joints
Achilles Injury Rehabilitation and Prevention Exercises: Tippy Bird
The deadlift is a key exercise for improving the posterior chain when you hinge from the hips. However, most people tend to reach forward, which increases the load on the spine, instead of pushing their hips back.
Doing a deadlift on a MOBO has two main benefits. First, if you reach forward, the board tips down. This will inspire you to pull your hips back properly and improve the load on the hips. Second, it forces you to screw in your big toe when you screw in your hip, to maintain stability. Combined, you get a ton of benefit on your foot and do a great job of loading your hip to work on propulsion.
For this exercise, 100% of the movement is a hinge of your hips while the spine remains 100% stable.
Step onto the board with your right foot, your left leg floating above the ground. Push your hips back so that your trunk becomes almost horizontal and the left leg moves behind you. Use your hands as a guide to make sure your hips stay level.
Come back up to a standing position to complete one rep. The knee remains slightly bent. You should always look in the same direction as your chest. This is a hinge, not a squat, so the knee remains only slightly bent during the movement.
Aim for 3 sets of 10 reps then switch legs.
For an added challenge, grab a hand weight on the side of your non-weight-bearing leg (a kettle ball or just a gallon of milk).
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Check out Dicharry’s full course on maximizing your stability and durability for more efficient and less stressful miles:
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Jay Dicharry, MPT, SCS is a physical therapist and researcher in Bend, OR. He is the author of Running Rewired and Anatomy for Runners.
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