Is Your Achilles Injury Not Getting Better?
Achilles tendon injuries seem to have a habit of hanging around which makes it absolutely essential that you receive treatment from a professional. Unfortunately some elements of the long-standing rehab guidelines are now known to potentially perpetuate the injury plus it is not simply a case of rest to recover.
The Achilles tendon is located in the back of your lower leg and attaches your calf muscles to your heel bone.
The majority of injuries to the Achilles tendon are classified as tendinopathy (used to be called tendonitis) and are characterised by a breakdown of the normal structure and arrangement of connective tissue in your Achilles tendon.
Tendinopathy is commonly an overuse injury and is especially likely to develop if you have had a rapid increase in activities such as running, jumping, walking and cycling. It may also occur from an acute strain of your tendon during sport or even something as simple as misjudging the depth of a step.
Signs & Symptoms
The main symptom of Achilles tendinopathy is pain along the tendon or at its attachment to your heel bone during movement. There may also be visible swelling of a portion of your tendon and any direct pressure on this region can cause severe pain.
Pain during movement is often most intense when you first move after a period of rest, such as after getting out of bed or after sitting. In many cases your pain will reduce or stop once the area has ‘warmed up’ but the pain will return after activity.
The intensity and duration of pain you experience after getting out of bed each morning is a useful indicator of your recovery and the likely tolerance of an increased level of activity.
Achilles Tendon Rehabilitation Program
Apply Ice – Daily application of an ice pack or cold pack is recommended to reduce any swelling and to provide pain relief. A period of 10-15 minutes is usually adequate to assist your recovery whilst minimising the risk of an ice burn or frostbite.
Isometric Strengthening – Sustained heel raises provide sufficient ‘time under tension’ for the Achilles tendon to be stimulated to synthesise more collagen and thereby strengthen the tendon. This exercise should be done daily and progressed according to your rate of improvement.
Avoid Stretching – Whilst the normal structure of the Achilles tendon is compromised it is important to avoid stretching your Achilles tendon and calf muscles as this can disrupt the repair process.
Tendon rehabilitation used to recommend eccentric heel drop exercises during which the heels were lowered off the edge of a step. Due to the intense stretch created this is now widely considered to only be suitable in the very last stages of rehabilitation.
Return to Repetitive Activity – The strength and integrity of your Achilles tendon, like other connective tissues, is optimised by a level of activity or load that enables your body to repair at a faster rate than it is damaged.
As outlined in the diagram below if loading is applied during the period when the degradation of collagen fibres within a tendon exceeds the synthesis or repair there is the potential to impair healing or further damage the structure of your tendon.
The frequency and intensity of repetitive loads such as running or cycling need to be carefully managed so that your Achilles tendon will be more tolerant of load than it was before the previous episode of loading.
As the normal structure and arrangement of the connective tissues in your tendon is restored then the loading can be gradually increased.
Magnusson SP, Langberg H,Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6(5):262-8