How to massage Achilles Tendonitis for pain relief

I once used to tell patients that massage for Achilles Tendonitis was a waste of time – but I was wrong.

The reason was simple, I was so focused on exercise that I didn’t think of massage as a means for short term pain relief.

Will massaging the Achilles tendon fix your pain?

Probably not.

But it can help with symptom relief whilst exercises are being performed.

This article will cover exactly how to perform an Achilles massage and the reasons it can be beneficial for pain relief.

Let’s have a recap on what Achilles Tendonitis is before tackling how massage may help.

What is Achilles Tendonitis?

Achilles Tendonitis is a process of degeneration that happens when your tendon is placed under too much strain.

This process could begin because you ran more than normal, or you went on a long hike when you were usually not very active.

The body’s response to this increased load is to try and heal the area. Blood vessels begin to grow in the tendon fibres which usually run parallel.

The tendon fibres begin to cross into each other, much like a tangled vine, instead of standing tall like bamboo shoots.

All these changes result in a stiff tendon with a lump. The tendon will often be painful as well, and usually worse in the morning.

You can have Achilles Tendonitis in the middle of your Achilles (mid-substance), or right near the base of the heel (insertional).

The more correct term for Achilles Tendonitis is actually Achilles Tendinopathy – the latter is just a new term for the same condition.

Does massage help Achilles Tendonitis?

Achilles tendon massage

Massage was first recommended years ago as a treatment technique, but the understanding of how it worked was not there.

Physiotherapists have been massaging Achilles Tendons for decades with results, but there was not any research to back this up.

Our understanding of Achilles Tendinopathy has changed greatly in the last 10 years and treatment has shifted to active movements like calf raises.

With this change, massage was put on the back burner as it was only considered short term relief. This was a similar story for other temporary treatment techniques like taping.

The question that many of you may now be asking is, ‘should you massage Achilles Tendonitis?’.

Lately there has been a few studies investigating whether massage combined with calf raises will have a better long-term result. One study although it was extremely small found some positive results.

Even if massage doesn’t have a better combined effect on Achilles pain, sometimes short-term relief is better than no relief at all!

Our patients constantly want some reprieve from the heel pain, even if it is short-lived – then they can get into the treatments that will really work. This is why patients love looking for the best shoes for Achilles pain, and trialling other treatment options like heel lifts.

We do know that certain massage techniques for the Achilles tendon can provide temporary pain relief, even if it isn’t better than the gold-standard exercise therapy in the long-term.

Achilles Tendonitis massage techniques

Certain muscle groups can become tense with Achilles Tendinopathy.

The main reason for this is protection. When you sustain an injury, your body wants to protect the injured section. The way your body achieves this goal, is to stiffen up and prevent as much movement.

This stiffening is often detrimental as you need movement to recover well. Movement helps to move fluid around joints, it increases blood flow and prevents stiffening of the joint capsule.

Early on you may well need to let the tendon rest and not move as much, but as you improve its important that your limb begins to move through more normal ranges.

There are a few ways to massage for Achilles tendonitis. It will depend on whether you have insertional or mid-substance Achilles tendonitis.

Insertional tendonitis will respond better to massage away from the tendon – like massaging the tight calf muscle. Whereas if you had mid-portion Achilles Tendonitis you could massage right over the tendon itself. 

Massage for Insertional Achilles Tendonitis

Pain at the back of the heel is usually due to Insertional Achilles Tendonitis.

This is by far the more difficult location to treat, as it can flare up easily and it does not respond as well to direct massage. But you can get around this by massaging the muscles that connect to your tendon.

The muscle group that stiffens after an Achilles injury is your calf muscles. These muscles can get tense because they are connected to your Achilles tendon.

Muscles of the calf

How to release your calf muscle

To release these muscles all you need is a deodorant can wrapped in a towel. If you have a foam roller, you can definitely use this as well.

Put the rolled deodorant can or foam roller on the ground, and then sit and lie your leg over the top of it so that your calf rests on it. The good leg is bent and your hands a behind your, ready to take the bodies weight when you lift your bottom off the ground.

You can then lift your bottom taking some weight with your hands and the leg on the ground. Move your straight leg up and down so the roller applies pressure as it moves up and down your calf muscle.

Make sure you stay away from the Achilles tendon itself.

The best thing to do is to put enough weight so that its slightly uncomfortable but not painful. People’s definition of pain will be different, but as long as you don’t push so that you’re in agony, you should be ok.

If there is any bruising or soreness in the calf muscle the next day, you have pushed too hard the day before. There should be no side-effects after performing this technique, except maybe feeling looser through the ankle with walking.

This self-release technique can be performed for about 10 minutes, slowly going up and down the calf muscle. Once a day is more than enough for this technique, but if you find it really helps, there is no harm in performing this twice or even three times in a day.

Here is a video demonstrating the above technique:

If this technique does not work, feel free to try the below technique on the heel itself.

Massage for Mid-substance Achilles Tendonitis

This cross-friction technique first suggested by Cyriax is great for pain located in the middle of the Achilles tendon. It is very simple and should offer some short-term pain relief.

Sit in a comfortable position where you can reach the back of your tendon. This may be on the floor, or in a chair with your leg pulled up in front of you.

Pinch either side of your Achilles tendon and move up and down until you come to the painful spot. Slowly rub your fingers over this spot, making sure you pinch across the tendon, not up and down the tendon.

Start reasonably firm pressure, and after a minute or so, move to maximum pressure over the tendon. You should aim to keep this up for at least 4-5 minutes if possible.

Some simple principles to follow with this cross-friction technique are:

  • Make sure your fingers move the skin over the sore area of the tendon, instead of letting your fingers glide over the skin. This will help to prevent blisters.

  • The rubbing must be in the opposite direction of the tendon fibres. You need to rub across, rather than up and down the tendon.

  • Pressure needs to be as firm as you can handle.

  • If you have pain 2 hours after the massage, you need to be gentler next session.

You can do this every other day to give the Achilles tendon a break on the days between.

Conclusion

Massage for Achilles Tendonitis can be very effective for short term pain relief. For longer term relief it is essential that you include calf raises and other lower limb strengthening exercises. Most Achilles Tendonitis cases will respond effectively to conservative management.

 

Does massage help Achilles Tendonitis?

Yes! Massage can have great short term results for Achilles Tendonitis. It is best supplemented with exercise for the best results.

Can massage fix Achilles Tendonitis?

Massage is great for short term benefits, but needs to be supplemented with exercise for the best results.

Is it ok to massage a sore Achilles Tendon?

You can definitely try an Achilles massage and see how it makes the tendon feel after. If better, then keep going. If it flares up the pain, stop and try again a few days later.

 

References

Altinpulluk, Emrah, Smith, Gordon, Price, Jonathan and Liu, Liang Q. (2020) Does Transverse Friction Massage add benefit to loading exercises for achilles tendinopathy? A pilot and feasibility study. Physiotherapy UK, 13-14 Nov 2020, Virtual

Paula Chaves, Daniela Simões, Maria Paço, Francisco Pinho, José Alberto Duarte, Fernando Ribeiro. (2017)
Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists,
Musculoskeletal Science and Practice, 32, PP 92-97, https://doi.org/10.1016/j.msksp.2017.09.005.

Stefansson, S. H., Brandsson, S., Langberg, H., & Arnason, A. (2019). Using Pressure Massage for Achilles Tendinopathy: A Single-Blind, Randomized Controlled Trial Comparing a Novel Treatment Versus an Eccentric Exercise Protocol. Orthopaedic journal of sports medicine7(3), 2325967119834284. https://doi.org/10.1177/2325967119834284