Acupuncture for Achilles Tendinitis

How Chinese medicine understands Achilles tendinitis

In Chinese medicine, tendons belong to the sinews, and the sinews rely on the Liver’s Blood to keep them supple. The back of the heel sits on the Bladder and Kidney channels, which run up through the calf. Achilles pain is usually seen as a blockage of Qi and Blood in those channels, on top of sinews that are not being nourished well enough to recover from the load you put on them.

The common patterns are:

• Qi and Blood stagnation. Sharp, fixed pain after a jump in training, a new hill route or new shoes. The tendon is tender to squeeze. Treatment moves circulation through the calf and heel.
• Cold and Damp. A stiff, aching tendon that is worst in the morning and in cold weather, loosens up with movement and warmth, and may feel thick or puffy. Treatment warms the area.
• Liver Blood deficiency. The tendon is slow to heal and tightens easily, and you may have cramping calves, dry skin or poor sleep. Treatment aims to nourish the sinews as well as move them.
• Kidney deficiency. A dull, long-standing ache in an older runner or walker, often with a tired low back or knees. In Chinese medicine this is seen as a lack of support from within, so treatment also builds you up.

If your pain is under the heel and along the arch instead, see the page on plantar fasciitis.

What treatment involves

Your first visit at the clinic in Keswick starts with a lot of questions: when the pain began, what you were doing in training or at work, your shoes, your sleep and your general health. I also look at your tongue and take your pulse. An assessment usually includes finding exactly where the tendon is sore and how tight the calf is.

Acupuncture is usually the main treatment. Points are commonly chosen around the ankle and through the calf, and on other parts of the body for your pattern. I treat the whole body at every treatment, not only the area that hurts. A sore heel changes how you walk and run, and the knees, hips and low back often take up the slack.

Moxibustion can warm a stiff, cold tendon. Cupping and tuina massage can loosen tight calves. When the pattern is one of deficiency, Chinese herbal medicine can be added: a formula written for you and dispensed at the clinic.

Tendons change slowly. Treatment works best alongside a gradual strengthening program from a physiotherapist. Plan on 5–10 treatments to judge progress.

Between visits

• Keep loading it, gently. Calf raises done slowly, as your physiotherapist shows you, are the usual starting point. Mild discomfort is fine. Pain that is worse the next morning means back off.
• Cut back, don’t stop. Reduce running distance, hills and speed work for a while. Cycling and swimming keep your fitness up with less strain.
• Check your shoes. Worn-out shoes, or a sudden switch to much flatter ones, can load the tendon more.
• Warm up before activity. A few minutes of walking and gentle calf movement before you run.
• Tell your doctor about new pain on antibiotics. If the tendon started hurting while taking a fluoroquinolone, let your doctor know promptly.

When to see your doctor first

See a doctor, or go to emergency, if:

• You felt a sudden snap or a kick at the back of the ankle, or heard a pop.
• You cannot push up onto your toes, or walk with a flat-footed limp.
• There is a gap you can feel in the tendon.
• The calf is swollen, hot, red or tender. This needs checking for a blood clot.
• The area is red and hot and you have a fever.
• Tendon pain started while taking a fluoroquinolone antibiotic.
• Both heels hurt along with other joints, or with back pain and morning stiffness that lasts over an hour.