UNDERSTANDING ACHILLES TENDINOPATHY
by Alison Brunson, PT, DPT, CSCS, PCES
Achilles tendinopathy can occur due to repetitive microtrauma and excessive stress to the tendon.
To put it simply - this is an overuse injury.
What are the symptoms?
Morning pain, immediately when standing out of bed
Subtle thickening of the achilles tendon
Deep, sharp pain pin-point at the tendon
Swelling behind the ankle
Pain during walking or other activities that cause a quick load of the tendon
What can I do to fix it?
Treatment:
Isometrics have been shown to decrease pain. The contraction is held for 45 seconds and repeated 5 times with a 1-2 minute rest between each set. It should be heavy weight!!
Eccentric and isotonic exercises are introduced once pain is reduced & then plyometric exercises are added to regain full function
Activity modification: reduce or stop performing activities that make your pain worse
But immediately after the injury, continue to move your ankle to stay mobile
Complete rest may make your tendon worse… *speak with your PT to figure out a program specific to you
Manual therapy: shown to reduce pain with massage
As you would expect, the main management of achilles tendinopathy should include a progressive strength program!!
Why progressive strengthening? Loading the tendon will force the body to adapt to new stimuli from the rehab exercise. By overloading the tendon (with what it can handle), we can jump start the body to “healing itself”.
Progressive Strengthening:
ISOMETRICS: manage pain + load the tendon!
Remember: hold heavy weight for 45 seconds and repeat 5x with a 1-2 minute rest between each
1) Plantarflexion with band - isometric hold
2) Single leg heel raise, knee bent - isometric hold
3) Single leg heel raise, knee straight - isometric hold
Once you have some pain relief and only minimal symptoms during the day - continue with eccentrics ->
ECCENTRICS: stretch while strengthening
SLOWLY move through your range of motion
Please note: if you have insertional achilles pain (pain at the bottom of your heel) stop at the middle of your range of motion, do not continue to full end range
3 sets of 15 repetitions, daily
1) Eccentric heel rasie, off a step “up on two, slowly down with one”
As you progress through your rehab - continue with isotonics ->
ISOTONICS:
Strengthen the muscle + work on adding compressive loads for return to previous activities
3 sets of 15 repetitions, daily
1) Heel raise, off a step - go through your full range of motion
2) Loaded double leg heel raises, knee bent
3) Loaded double leg heel raises, knee straight
Finally, power and elastic training will be introduced - plyometrics ->
PLYOMETRICS:
Returning back to sport, loading tissue at a velocity based movement
1) Double leg hopping in place (gentle) “pogos”
2) Double leg hopping over a line
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