You’ve probably heard the phrase “Achilles’ heel” used to describe a vulnerability that has the power to bring a person down despite his/her overall strong character. That’s ironic because when it comes to actual Achilles heel pain, neither the Achilles tendon nor the heel bears any responsibility at all. In most cases, heel pain is caused by weakness in the muscles that support the hips or in the leg muscles.
Painful chain of events: One gluteus medius muscle sits on each side of the pelvis and is responsible for keeping the pelvis level when you are standing on one leg, as you do every time you take a step. When the gluteus medius on one side is weak, the lower back muscles on the other side try to compensate to keep the pelvis level. That shortens the back muscles and elevates the hip on the side opposite the weak gluteus medius. This means that the distance the foot must travel to the floor is increased causing a greater load to develop as the foot reaches the floor. This excess load, in turn, makes it more difficult to push off that leg when walking. And then that leg ends up hurting because of the undue strain on the calf, the primary muscle responsible for propelling you forward. Because the Achilles tendon connects the calf to the heel, strain in the calf often leads to pain in and above the heel.
If you have Achilles heel pain on both sides, there’s likely a strength imbalance between the hip flexor/quad muscles and the gluteus maximus/hamstrings. Such an imbalance can develop from running, stair-climbing and exercises that tend to overdevelop muscles in the front of the legs while neglecting those in the back. This imbalance causes a forward center of mass that must be picked up by a muscle in the back of the body or you would fall forward. In this case, the excess load ends up being supported by the calves, resulting in pain in both Achilles tendons.
The exercises on the next page will strengthen your gluteus medius muscles, gluteus maximus muscles and hamstrings— all the muscles involved in creating optimal posture. The descriptions below are for single-sided weakness, but if your pain is bilateral, perform the exercises on both sides.
Complete three sets of 10 repetitions for each exercise (resting 45 to 60 seconds between sets). Repeat the workout three times a week with one day between workouts. The level of resistance should feel like you are working reasonably hard to complete the set. Stay with this resistance level until it feels fairly easy to complete the set, then increase the resistance. This process can continue until you are strong enough to perform your daily activities without pain.
Important: For single-sided pain, work the leg that is opposite the side where the heel pain occurs. If you work the same side, you’ll inadvertently increase the imbalance between the two sides and the pain will continue.
For pain on only one side, the most important exercise is the hip abduction exercise. For pain in both Achilles tendons, perform the three exercises with both legs.
Knot both ends of a resistance band together, and put the knot behind a closed door at ankle height. Standing perpendicular to the door, place the loop of the band around the ankle farthest from the door (the working gluteus medius). Start with your feet together. Turn the toes of the working leg in so that the foot is pointing about 10 degrees in front. Keeping your nose aligned over the standing leg, lift the moving leg slightly and move it until the outside of the ankle is aligned with the outside of the hip. Put the foot down. Now shift your weight until your nose is over the moved foot. Immediately move the foot and your body to the start position with your nose over the standing leg again.
Close the knot of the resistance band in the door at about knee height. In a standing position facing the door, place the loop of the resistance band behind your knee. Start with the hip flexed to about 60 degrees. Bring the knee about 10 degrees behind the hip. Then return to the start position. Make sure your back is rounded and the knee of the leg you are standing on is not locked.
Close the knot of the resistance band in the door at about knee height. In a seated position facing the door, place the resistance band around the back of the ankle. Begin with the exercising leg pointing straight out with the knee unlocked. Begin to bend the knee until it reaches 90 degrees, then return to the start position. To isolate the hamstrings better, the toes of the exercising leg should point upward toward the face as the exercise is being performed.
