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Can tight calves cause Achilles tendonitis?

We are often asked whether tight calf muscles can cause Achilles pain. The short answer is no. The slightly longer answer is that it actually works the other way round – Achilles tendonitis often causes a stiff feeling in the calf muscles. This article explains how this works as well as the dos and don’ts of getting rid of stiff calf muscles. And remember, if you need more help with an Achilles injury, you're welcome to consult one of our team of sports physios online via video call.


Can tight calves cause Achilles tendonitis and pain?

In this article:

We've also discussed it in this video.



Stiff or tight calf muscles don’t cause Achilles tendonitis


One end of the Achilles tendon is attached to the bottom parts of the calf muscles, and the other end is attached to the back of the heel bone. So, some people say that when the calf muscles are too tight, they pull on the Achilles tendon and cause a strain in the tendon, which then leads to Achilles tendonitis or tendinopathy.


However, this is not supported by the research into the causes of Achilles tendinopathy. The main evidence points to people overusing their Achilles by doing too much exercise too often. This means that the Achilles tendon doesn't get time to recover from all the exercise, and then it causes injury.


How Achilles tendonitis/tendinopathy can causes tight calves


When you have Achilles tendinopathy, it means that there's an injury to your tendon. That tendon, as we have seen, attaches to the calf muscles. And whenever there's an injury somewhere in the vicinity of a muscle, that muscle gets irritated and tightens up and we talk about it having ‘increased tone’.


This is not the same as a cramp, which is seriously painful. It just feels tighter and more contracted than what it should be. It is quite normal for any injury to cause that sensation.

In my experience, that tightness disappears as the tendon heals, because then that injured part is not irritating the muscle anymore.


How to relieve tight calf muscles without aggravating Achilles tendonitis


Be careful with stretches for tight calves

Stretches may feel good while you're doing them and you may feel that it relieves the tightness for an hour or so, but then you'll find it's tight again and you've got to stretch again.

For some injuries that's absolutely fine to do, because it doesn't make it worse.


But when it comes to Achilles tendon injuries, stretching the calf muscles, and therefore also the tendon, can actually make it more irritated, because irritable tendons do not take kindly to being stretched.


We get two types of Achilles tendinopathy: the insertional type, where the tendon inserts into your heel bone, and mid-portion, which is higher up, between the insertion and the calf muscles.



Mid-portion Achilles tendinopathy is not always as sensitive to stretching, but often stretching – even when it feels good while you’re doing it – can make it ache more later on.

However, insertional tendinopathy is super sensitive to being stretched, because it was originally caused by the tendon being compressed against the heel bone. If you now do a typical runner’s calf stretch, leaning against something with your heel flat on the floor, you compress that tendon even harder against the heel bone, which causes more pain.



Get the rehab for tight calf muscles right

The main thing to do for the medium term is to get your rehab exercises for the Achilles tendonitis right. (You may find our YouTube video playlist on Achilles Tendinopathy Treatment useful if you want more information on rehab.) As the injury heals, your calves will naturally start to not feel as tight. However, this can take a few weeks. So, what can you do in the meantime?


Foam rolling for tight calves

Foam rolling can be a good option, unless you go and really roll the parts that are painful. So, when you do foam rolling, it has to be ‘comfortably uncomfortable’, and it shouldn't be on that part of the tendon that's really sensitive, because that will just make it even more painful.


Massage for tight calf muscles

Another option that works really well is a massage gun. And again, you don't want to go hammer that painful part that's actively injured; you want to work around it. So, rather concentrate on the calf muscle belly – the nice fleshy bits.


You could also go for a massage, but again, don't let them dig into the painful tendon. Rather let them release the parts around it – the muscles that can pull on it – and it should give you some relief.


Relieving tight calves with dry needling

Something else that can be useful for reducing muscle tension is dry needling. I find with my patients that the effect of dry needling lasts a little bit longer than just massage on its own. But again, it's not something that's going to make your tendon heal more quickly; it will just make your muscles feel more comfortable.


How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.




References:

  1. Cook, J. L., et al. (2018). Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone–updated evidence of non-surgical management, Taylor & Francis.

  2. Steinmann, S., et al. (2020). "Spectrum of Tendon Pathologies: Triggers, Trails and End-State." International journal of molecular sciences 21(3): 844.

  3. van der Vlist, A. C., et al. (2019). "Clinical risk factors for Achilles tendinopathy: a systematic review." British Journal of Sports Medicine: bjsports-2018-099991.