That pain in the back of your heel may be Achilles tendonitis. It may have come on gradually or suddenly after a quick movement or jump.

The Achilles tendon has an important job. It attaches the two large calf muscles to the back of your heel. Pain can be from inflammation resulting from running and jumping. Overuse also can cause a slight tear in the tendon.

Rupture of the tendon is when there is a complete tear of the tendon. This is rare, and a consultation with an orthopedic surgeon is recommended to determine if surgery is required to repair the damaged tissue.

Symptoms of Achilles tendonitis are pain and stiffness, especially in the morning. You may even notice a bump on the back of your heel. I have had patients say they can hear a crackling noise in their heel. This is from fluid buildup or the formation of scar tissue on the tendon.

Causes of the pain include running too far, too fast, too soon or wearing the wrong or worn-out shoes. Weak or tight calf muscles are also a major contributing factor. Flat feet or foot pronation and inflexible ankles will put stress on the tendon as you exercise.

Activities such as running, jumping and climbing stairs will aggravate your pain.

One of my patients in her late 30s decided to sign up for a women’s triathlon. She thought it would be a fun way to improve her fitness and lose weight. She hired a coach to help her, especially with the swimming portion of the triathlon.

This young woman began to feel pain, and stiffness started in the back of her heel during her training. She had a case of Achilles tendonitis.

I worked with her coach to modify her training to include more cycling and swimming and less running, which would maintain her cardio endurance.

My staff and I taught her how to stretch the Achilles with a straight and bent leg. We had her doing toes raises on stairs to increase her calf and tendon strength. She used ice therapy at home for the first two weeks.

Manipulation of her ankle was used to increase her flexibility, along with ultrasound and deep friction massage to increase circulation and reduce scar tissue. Her shoes were fine.

She responded beautifully and her family and friends were at the triathlon when she crossed the finish line.

A man in his late 70s visiting from Annapolis, Md., was limping off the golf course. His brother and playing partner introduced me to him.

We chatted on the veranda of the golf club and I asked why he was limping. He said two weeks ago while playing squash he felt a pain in his ankle. He was told he had a sprained ankle.

He proceeded to take his shoe and sock off. He wanted my opinion. I examined his ankle and asked him to remove his other shoe and sock. My suspicion was confirmed. He had ruptured his Achilles tendon while playing squash.

He returned home from his vacation the next day and I instructed him to contact his physician for a referral to an orthopedic surgeon. His brother reported to me his surgery was a success and that he was expected to make a full recovery.

To prevent Achilles tendonitis, start your workouts slowly and gradually increase the intensity. Always stretch after a workout. Using a roller can work as a massage to your calf muscles.

Cross training is also helpful in preventing injuries. And remember to replace your training shoes every six months.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday.