Achilles Tendonopathy: How to bounce back!

Mike Collette • September 1, 2020

How to bounce back from Achilles Tendonopathy

By: Martha Theirl, PT, DPT, Cert- CMFA

A close up of a person 's ankle with a red muscle visible.

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.

 

Phase One: Diagnosis

 

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:

  1. Mid-Portion: along the Achilles tendon 2-6cm above the heel bone (calcaneus) insertion and is the most common
  2. Insertional: lower toward the insertion of the Achilles and may cause pain down into the heel on the bottom of the foot. 

 

Typical Presentation:

  • Tenderness to palpation on Achilles tendon (mid-portion) or heel (insertional)
  • Worse with increasing tendon load (hopping, running)
  • “Warms up” with activity
  • Pain with initial steps in the morning- can last anywhere from 5-30 minutes
  • Decreased function- having to decrease or stop running, decrease range of motion or regress to step-ups vs. box jumps
  • Minimal pain at rest

 

Risk Factors:

  • Decreased strength of calf muscles
  • Deficits in hip neuromuscular control
  • Decreased ankle mobility, specifically dorsiflexion (toes toward head)
  • Increased foot pronation
  • Increased body weight
  • Sudden changes in training type or volume

 

Phase Two: Load Management

 

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:

A picture of a traffic light with a blue sky in the background
  1. Symptoms not above a 5/10 during exercise/activity 2. Returns to baseline within 24hrs, and 3. No sharp or shooting pain. Having pain during exercise does not mean that you are doing more damage, and can be effective in the recovery process when properly controlled. 

 

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

 

Phase Three: Reintroduction and Plyometrics

 

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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