Achilles Tendinopathy – Self Help Exercises
Here is a testimonial from one our patients:
“I came to Physio-logical in December with an injured Achilles one week after accepting a charity place for the Brighton marathon, and one week before I was due to start training, certainly bad timing! Your ongoing professional, articulate and tailored advice that allowed me to continue running, as part of an active recovery strategy, was absolutely key to not only getting me to the startline, but getting fit at the perfect time. This in turn allowed me to complete the marathon, but also smash my PB”. Mr C
What is Tendinopathy?
If the load we put on a tendon is too much and we continue to do this frequently then the amount of tissue breakdown starts to exceed the growth of new tissue. The structure of the tendon then starts to change and becomes less efficient at dealing with load. It is now believed this is the cause of pain rather than inflammation hence why now it is called tendinopathy not tendonitis.
There are two main stages:
Reactive Stage – the tendon will be painful and may swell in response to a sudden increase in load/change in footwear.
Degenerate (Chronic) Stage – the tendon may be thickened and you may feel nodules within the tendon. The tendon can progressively deteriorate until it can’t handle any load, this puts it at higher risk of rupturing.
The achilles tendon is the thick band of tissue that connects the calf muscle to the heel bone. The achilles tendon lifts the heel off the ground during walking and running. It is one of the strongest tendons in the body.
- Pain is normally worse first thing in the morning and after sitting for long periods of time.
- It usually effect’s those who take part in sporting activities such as running.
- The tendon is normally painful if you squeeze it.
The best treatment for achilles tendinopathy is load management, activity modification, hands on physiotherapy including massage, frictions, ultrasound, kinesiology taping, acupuncture, stretches and eccentric calf raise exercises (see below).
Please be aware of your body and take advice from your GP before exercising if you have any aches or pains or send us an email (firstname.lastname@example.org) for advice and guidance.
Treatment for a reactive achilles tendinopathy:
- Load management
– only continue to run if it is pain free to run and pain free the next day (tendons make take 24 hours to respond to load). If it is painful to run then it is best to rest for a few days until you can run pain free.
– avoid tight shoes that cause direct tendon compression
– wearing shoes with a heel may help to reduce load on the tendon
– using a heel raise within your shoe may also help reduce achilles load as a short term measure
- NSAIDS / Anti-inflammatory medications such as ibuprofen – please speak to your doctor or pharmacist first prior to taking any medication – this can help to reduce swelling
- Ice – to reduce pain – 15 minutes x 2-3 per day, protect your skin from ice burns by wrapping the ice in a towel
- Kinesiology taping to offload the tendon
- Massage the calf muscle to reduce tightness
- Isometric calf exercises (heel raises) – tendon pain is likely to effect muscle function, using isometric exercises to reduce pain and maintain strength can be very beneficial
Treatment for a degenerative achilles tendinopathy:
If you have had a niggling tendon for some time with periods of painful flare ups it is likely you have a more degenerate tendinopathy. Your achilles may be thickened.
You still may get flare ups similar to reactive stage above, during flare up please settle symptoms first (see above).
- Load management – only continue to run if it is pain free to run and pain free the next day (tendons make take 24 hours to respond to load). If it is painful to run then it is best to rest for a few days until you can run pain free.
- Eccentric calf exercises (mid tendinopathy only – effects the mid portion of the achilles typically 2-7cm above the calcaneus – heel bone, not insertional tendinopathy) will improve your tendon’s ability to handle load.
Once the pain has settled it is time to improve the load capacity of the muscle and tendon by improving calf strength.
Normally you should be able to manage 10-15 single leg calf raises with minimal increase in your pain before you progress to this level.
The calf complex is composed of 2 main muscles – gastrocnemius and soleus – both need to be strengthened.
The most simple way of achieving this is by doing calf raises on the edge of a step.
Eccentric Calf Raises
Heavy Slow Resistance
Single Leg Balance
Energy storage exercises
- Start these exercises when you have minimal or markedly reduced morning stiffness in the achilles tendon on waking.
- Very mild tenderness on palpation of the achilles tendon.
- Have been tolerating some running without a flare in tendon irritability and symptoms.
Double Leg (DL)
Single Leg (SL)