Follow this cycling PT’s approach to preventing and treating Achilles Tendinitis When Cycling.
What is Achilles Tendinitis?
The Achilles tendon is the body’s largest tendon and connects the calf muscles (gastrocnemius and soleus muscles) to the heel bone (calcaneus). When we contract our calf muscles, the force pulls on the Achilles, causing us to point our feet or raise on our toes. The Achilles is vulnerable to injury because it’s prone to overuse and has a poor blood supply—Achilles tendinitis when cycling is a common overuse injury.
Repetitive overuse and irritation from improper biomechanical motion cause inflammation where the Achilles attaches to the heel, and chronic inflammation builds up. Achilles tendinitis when cycling, can become a chronic condition that must be identified, treated, and prevented.
If left unaddressed, chronic tendinitis will progress to tendinosis, tendon thickening in the inflamed area from ongoing microtrauma, or worse. Severe cases of chronic tendinitis and repetitive overuse may result in a tendon rupture requiring immediate surgery.
Achilles Tendon Pain When Cycling
Achilles tendonitis when cycling occurs in about 9 percent of amateur and professional cyclists, but the condition also occurs in runners (10 percent), dancers, gymnasts, and tennis players [Althunyan et al. 2021]. Of the cyclists experiencing Achilles tendon pain, over 30 percent complained of more pain when riding. A staggering 25 percent of racers studied described symptoms of Achilles tendinitis when cycling.
The heel pain associated with Achilles tendinitis when cycling is rarely due to a traumatic injury, but it’s possible in severe crashes. In most cases, cyclists experience heel pain that begins as little more than an annoyance, and we try to forget about it.
However, if you don’t get to the root of the problem, it will progress and become a challenge to control. A sudden increase in training volume and intensity, especially climbing, may prompt the onset of Achilles tendinitis when cycling.
Incorrect biomechanics, poor pedal stroke dynamics, and an improper bike fit cause inflammation from a repetitive overuse injury. Excessive tightness or weakness of your calf muscles increases the likelihood of Achilles tendinitis when cycling. Overdoing it on a weak, fatigued, or tight calf muscle is also to blame.
Symptoms and Diagnosis of Achilles Tendon Pain When Cycling
A mild and dull ache above the heel, when you push down on the pedals or climb out of the saddle that worsens over time, is the start of Achilles tendinitis when cycling. There will be tenderness to the touch.
As the condition progresses, you will have pain when off the bike while walking on inclined terrain and climbing stairs. The tendon will be red and thicker, and you will have weakness when pushing off while walking and pedaling.
Ask yourself these questions.
- Does it hurt when I push down on the pedals or climb out of the saddle?
- Do I have pain in my heel when I walk uphill, climb stairs, or do toe raises?
- Does it hurt when I squeeze my Achilles 2 to 6 cm above where it attaches to my heel bone?
- Does my Achilles look thicker than it did before the pain started?
- Have I been riding harder or putting on more miles recently?
- Does my calf feel weak or tight?
- Does my heel hurt when I stretch my calf?
If you answered “Yes” to two or more of these questions, Achilles tendinitis could be the reason, and you need to do something about it before it worsens.
Accurate and proper diagnosis of Achilles tendinitis in cyclists requires a detailed history and physical examination. Changes in the intensity and volume of training, pedaling technique, bike fit, footwear, and previous injury are factors to consider. Pain or tenderness and thickening in the area 2 to 6 cm above where the Achilles tendon is attached to the heel is a typical symptom.
The degree of pain is directly related to exercise duration and intensity. Pressure to the area will cause significant pain. If the pain results from a traumatic injury, or if you experience sharp shooting pain accompanied by an audible “pop” and have difficulty moving your foot, seek medical attention immediately. Severe injuries, like tears and ruptures, require emergent care.
Causes of Achilles Tendon Pain When Cycling
Improper Bike Fit
An improper bike fit is a common cause of Achilles tendinitis when cycling. If your saddle is too high, it causes your toe to point down at the bottom of the pedal stroke. Your calf muscles constantly contract, overworking the muscle and straining the tendons.
The opposite is also true. If your saddle is too low, your toe will point up excessively during the bottom of the pedal stroke, and the stress will irritate the Achilles tendon. Position your cleats so the ball of your foot is forward on the pedal.
Seek the help of a certified Bike Fitting specialist to find the right saddle height and cleat positioning for you. The pedal stroke’s repetitive motion can add to pain-causing irritation and inflammation when your bike isn’t correctly adjusted.
Once you’ve made sure that your positioning is sound, take a break from climbing. I bet that the problem will resolve itself. If not, seek medical advice.
Inefficient Pedal Stroke Dynamics
Now that you’ve optimized your positioning on the bike, it’s time to take a look at your pedaling mechanics. Be careful to avoid pedaling at a low cadence with excessive downstroke force. If you’re doing a lot of climbing, over gearing and pushing too hard on short, steep hills will irritate the Achilles tendon.
Take frequent breaks when your feet start to hurt, and choose flatter routes if pedaling out of the saddle causes increased pain. Perform these pedaling drills to improve your technique and efficiency, but only if you’re pain-free when you do.
Improper Foot Positioning and Footwear
Many cyclists suffer from poor skeletal structure of their feet, commonly known as “fallen arches” or “flat feet.” When applying pressure on the pedal during the down stroke, the arches on the inside of the foot flatten.
Your foot will move when your cycling shoes don’t provide sufficient arch support. It will negatively affect the float of your pedals, which are the primary source of leg rotation when pedaling. The rotation decreases irritation of the Achilles tendon.
You can correct the situation by replacing the insoles of your cycling shoes with cycling-specific inserts. The “stock” insoles are usually just a flimsy cover for the shoe’s inside, providing little to no support. Cycling-specific inserts give your feet the help they need.
Strength and Flexibility Limitations
Achilles tendon pain and tendinitis when cycling are effectively treated and prevented by maximizing lower leg strength and flexibility. A cyclist will experience Achilles tendon pain due to repetitive and excessive load on the tendon. An underlying lack of flexibility in your calf muscles puts undue strain on the tendon, where it attaches to the heel bone. To reduce the loading force on the tendon, build up the calf muscles so they can take the brunt of it and make sure they are flexible.
A Five-Step Achilles Tendinitis When Cycling Treatment and Prevention Plan
Step One: PRICE
If the pain comes on suddenly (acutely within ~24 hours) or is the result of injury with swelling, use the “PRICE principle” (an acronym which stands for Protect, Rest, Ice, Compression, and Elevation) immediately for 2 to 3 days to control the symptoms.
You may institute some dynamic or active recovery movements, like swimming or easy pedaling, but only if it’s pain-free.
Step Two: Perform a Foam Roller and Self-Massage Routine
Self-massaging and rolling your leg muscles will help relax them, which makes stretching them easier, so they become more flexible. Here’s how:
Step Three: Perform a Stretching Program
Adding gastrocnemius, soleus, and hamstring stretching to your daily routine will improve posterior leg muscle flexibility, decreasing stress on the Achilles tendon. Only stretch if it doesn’t cause more pain to the area. Here’s how:
Step Four: Perform a Strengthening Routine
A program focused on improving and maintaining calf strength and addressing the resilience of the Achilles tendon will improve performance. Follow this link to the Training & Performance page of The Zommunique’ to learn how. Here are a few exercises you can try:
Eccentric training is a good way to increase tendon strength. Here’s how:
- Stand with both feet on the edge of a step so that your heels are off the edge of the step, as shown.
- Press down through your toes as you raise your heels upward.
- Next, lift the non-target foot off the step to stand on one leg.
- Then, lower the heel of the foot that is on the step back down.
- Place both feet on the edge of the step and repeat.
Step Five: Refine Your Pedal Stroke
Techniques to Improve the Pedal Stoke
In an easy gear, progressively increase your cadence to as fast as possible while retaining proper position, a fluid stroke, and without bouncing.
With only one foot clipped in, pedal in a light gear and focus on smooth transitions and eliminating dead zones in your stroke.
Concentrate on pulling your foot backward as the pedal approaches the bottom of the stroke, and as you improve, combine with a more forceful push-down.
Concentrate on pushing your foot forwards as the pedal approaches the top of the stroke, and as you improve, combine with a more forceful push-down.
Pedaling Drill Tips
Try to perform pedal stroke drills in your training 2 to 3 times per week. Doing the exercises during your warm-up saves time and activates your muscles to pedal efficiently. Once you have improved your technique at a regular cadence, vary your rpm and the power you apply to the pedals. Research thoroughly and invest in one of the many pedal stroke efficiency measuring devices available, allowing you to analyze your real-time changes and document your progress.
Achilles tendon pain when cycling, from tendinitis, is a common overuse injury affecting many cyclists’ performance and enjoyment. It doesn’t have to be your Achilles heel. Ensure your legs are strong and flexible, your bike fits right, you pedal efficiently, and you avoid riding too hard or too much.
Following these tips and this Five-Step Achilles Tendinitis When Cycling Treatment and Prevention Plan will eliminate your pain and keep it away for good.
If all else fails, seek guidance from a healthcare professional. But don’t give up. Achilles tendinitis when cycling doesn’t have to be your Achilles heel!
Has Achilles Tendinitis when cycling ever been your heel?
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!