How to Manage Achilles Tendinopathy
What is Achilles Tendinopathy?
Achilles Tendinopathy is a common and painful overuse injury for runners. You may have achilles tendinopathy if you have severe pain and stiffness limiting physical activity in the achilles tendon. It is thought to be a result of tiny repeated small injuries, or microtraumas.
Causes of achilles tendinopathy for runners can include:
Overuse of the Achilles tendon.
Training or exercising wearing inappropriate footwear.
Having poor training or exercising techniques, such as a poor running technique.
Making a change to your training program, such as rapidly increasing the intensity of your training and how often you train.
Training or exercising on hard or sloped surfaces.
Achilles tendinopathy foccurs equally in men and women, and can happen to athletes and non-athletes. It is more common among athletes over the age of 30, but it occurs in all ages. Achilles tendinopathy is particularly common for runners.
What is the Difference Between Achilles Tendinopathy and Achilles Tendinitis?
The two injuries are often used interchangeably, but they describe different diagnoses.
Tendinopathy is a degeneration of the collagen protein that forms the tendon. Tendonitis, on the other hand, is just inflammation of the tendon.
How to Recover from Achilles Tendinopathy.
Recovery from Achilles Tendinopathy goes through four stages:
Symptom management
Recovery
Rebuilding
Return to Sport
Runners should follow the recommended exercises as they move through these stages. These exercises for achilles tendinopathy are meant to promote tendon healing, reduce symptoms, and improve muscle strength & endurance. Runners who want to recover from achilles tendinopathy need to take their time, and should consider working with a physical therapist or running specialist for further support.
Symptom Management
Symptom management is the first stage of recovery for achilles tendinopathy, done to help alleviate pain. During this stage, the runner has pain and difficulty with any movement of the ankle. The main exercise to test the severity of the injury is attempting 10 single leg heel raises.
Each day for the first 1-2 weeks of achilles tendinopathy, runners should complete 3 reps of 10 of the following:
Circulation exercise (moving foot up and down)
2-legged heel raises standing on the floor
1-legged heel raises standing on the floor
Eccentric heel raises (while standing, raise up on your toes as you lift your heels off the ground. Next, bend the non-target leg. Then, lower your heel back down.)
Seated heel raises
During the standing exercises, it is recommended to hold on to a chair or the wall for balance.
Continue these pain management exercises until the heel raises can be done without difficulty (they likely will still be painful). If pain is at a 5 out of 10, stop exercising and contact your doctor of physical therapist.
Recovery
You will reach the second phase of achilles tendinopathy recovery when there is pain with exercise and morning stiffness, as well as pain when performing heel raises. However, it should be easier to perform these exercises and the pain should be lower than before. This is around 2-5 weeks into recovery.
Every day, runners should practice 3 sets of 15 reps of the following to increase speed of movement and external resistance:
2-legged heel raises standing on the edge of a step
1-legged heel raises standing on the edge of a step
Eccentric heel raises on the edge of a step
Seated heel raises
Quick-rebounding heel raises
Rebuilding
The next phase (typically around 3-12 weeks post injury, is focused on continuing to progress external resistance and initiate plyometrics. There should be decreased pain at the achilles tendon. Recovery is near for runners with achilles tendinopathy.
Complete 3 sets of 15 reps of the following 2-3 times per week:
1-legged heel raises standing on the edge of a step with added weight
Eccentric heel raises on the edge of a step with added weight
Seated heel raises
Quick-rebounding heel raises
Your physical therapist may also work with you to incorporate plyometric exercises specific to your sport, particulary for runners recovering from achilles tendinopathy f.
Return to Sport
After 12 weeks, or up to 6 months, an achilles tendinopathy patient will be ready to return to running. At this point, you should have minimal symptoms and morning stiffness.
However, 2-3 times per week you should still practice the weighted heel raises from the rebuilding phase. You can also begin to slowly return to running and other sport-related activities.
Overall Recovery for Runners
When returning to running after achilles tendinopathy, runners should focus on slowly controlling intensity, duration, and frequency of Achilles tendon loading. The rehabilitation exercises should be done for at least a year after you return to running. Achilles tendinopathy recovery can take a long time. By following these directions, you can reduce your risk of future injury.
If you are looking for assistance in recovering from achilles tendinopathy or other running injuries, contact Oregon Running Clinic today for a consultation.