Achilles tendonopathy has long been the Achilles heel (see what I did there!?) of foot and ankle injuries. Let’s take a dive into the three phases of tendonopathy rehabilitation and how to get that pain free bounce back in your step.

Firstly, a correct diagnosis is always paramount. Also, understanding how the tendon became inflamed is important to ensure a resolution that is long-lasting, not just temporary symptom management. Being assessed by a Physical Therapist will allow you to look at how you are moving both locally at the foot and ankle, and globally into the knee, hip, lower back, and core. 

There are two types of Achilles Tendonopathy:

Typical Presentation:

Risk Factors:

The purpose of this phase is to stop the inflammatory process and begin to heal and strengthen the tendon. When deciding how to load and progress a tendonopathy, it’s best to look at the severity and current load tolerance. We use a stoplight system and look for the following things:

We know that calf and soleus raises are vital in the recovery of Achilles tendonopathy. Other considerations include the volume of movements. While adding a few cleans to a workout may be OK, doing too many reps causing you to come onto your toes may increase the Achilles’ pain. 

You can and certainly should continue to exercise during this rehabilitation period! Your activities may need to be modified, and a return to full activity status will be part of your plan! We meet you where you are and move forward from there.

It may be helpful to think of load management as a series of levels.

Level One: Isometrics, double leg heel raises , soleus raises  

Level Two: Eccentrics, increased range of motion to deficit heel raises, walking, single-leg heel raises

Level Three: Introduction of rebounding and pogo hopping

Level Four: Plyometrics, speed, and agility, single leg hopping, running

As you are feeling better and becoming more confident, you will be able to return to running and explosive jumping. For running- it’s best to start on a level surface as hills promote more force through the calf. It may also be suggested that you raise your step cadence by 5% to increase your step frequency and decrease your ground reaction force. For jumping, start with standing pogo jumps and progress to single-leg hops and explosive jumps as you are able. 

Progress is different for everyone, and it’s important to understand the underlying cause of the tendonopathy to keep it from coming back again! If you have been struggling with Achilles tendonopathy, email me to set up a consultation and get that bounce back in your step! 

*As always, this article is meant to be educational content and not medical advice. Please consult your licensed medical professional before starting an exercise program or for individualized guidance.

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