Achilles Tendinopathy

Jul 12, 2021

With the official start of summer and the re-opening of events such as Taste of Edmonton and the Calgary Stampede, Albertans are going to be doing a lot more walking than normal this summer! An increase of load, which could mean an increase in walking, running, hiking, or exercising at the gym, can cause achilles tendinopathy.

Achilles tendinopathy is a diagnosis characterized by pain, swelling, and stiffness of the achilles tendon; the tendon that joins your calf muscle to your heel. The pain can be close to the heel itself or higher up into the calf. The pain is typically a sharp pain that occurs with walking or running, and sometimes an achy pain when you are at rest/sitting. Achilles tendinopathy can sometimes present similarly to plantar fasciitis, another common overuse injury that can cause heel pain. Besides an increase in load, achilles tendinopathy can occur due to improper footwear (flip flops!), poor running technique, and walking on incline surfaces.

 Other risk factors for developing achilles tendinopathy include:

  • Obesity
  • High blood pressure
  • Type II Diabetes
  • Prolonged steroid use
  • Family history of tendinopathy

So, if this condition is caused by overuse or overloading the tendon, treatment should just be rest and ice? Right?

Wrong!

This condition will respond best to properly exercising the tendon. Overuse injuries are commonly misunderstood. When we talk about an “overuse” injury in physical therapy we are most likely referring to the fact that the tendon or muscle was being loaded too much/too fast + with improper form. We can always train the tendon properly and get it stronger, so for the next time it is then loaded in a new activity, chances are it will not get injured!

New research supports 3 phases of achilles tendon training:

  1. Isometric Loading
  2. Isotonic Loading
  3. Energy Storage Loading

Isometric loading is essentially going up into a calf raise and holding this position. You can hold in the middle of the range or the end of the range. This exercise should be performed with both your knees straight and your knees bent. Changing the position of the knees will help work the gastrocnemius and the soleus, these are the two muscles that form the achilles tendon. Repetitions and the time spent in this isometric contraction is best determined with your physical therapist based on your symptoms and presentation.

Isotonic loading can begin once the irritability of the tendon has significantly reduced. Isotonic loading is basically the classic calf raise. You can perform both seated and standing calf raises to target the soleus and gastrocnemius respectively.

The last phase of training is “energy storage loading”, this means that you are able to start plyometric training. These exercises are based on jumping and hopping. This is the last step in returning to normal exercise.

To properly rehabilitate achilles tendinopathy it can take up to 6 months of selective and proper loading. This is a condition that will commonly recur if not rehabed properly the first time. The exercises in stage 1 and 2 can seem boring and redundant but they are essential. It is important to stick with the loading program your physical therapist creates and to not give up if you want long lasting results.

If you have been experiencing pain in the heel or achilles tendon call 780-458-8505 to book in for an assessment today!


 

Cook JL, Purdam CR. The challenge of managing tendinopathy in competing athletes. British journal of sports medicine. 2014 Apr 1;48(7):506-9



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