Rehabilitation for Achilles Tendinopathy
LUCAS THEYS, PT, DPT | UP HEALTH SYSTEM REHAB SERVICES
Achilles tendinopathy is a common overuse injury to the foot and ankle in sports. Most individuals with this condition tend to complain of a gradual onset of pain overall with Achilles pain and stiffness after a period of resting or sleep. Patients typically feel better with some movement but then worsen with too much activity and have tenderness over the tendon. Tendinopathy typically occurs in those who are training for competition and is very common with recreational runners, runners who run with a heel-strike pattern, and those beginning a running program. Tendinitis leads to tendinopathy when changes in the tendon weaken and cause long-term pain.
Active individuals involved in recreational or competitive sports are at risk for developing Achilles tendinopathy. Even rock climbers have a risk of developing this issue as well. An individual’s risk of becoming symptomatic increases with age and males tend to get Achilles tendinopathy more than females. Outside factors such as decreased ankle range-of-motion, being overweight, high blood pressure, and diabetes are associated with increased risk of Achilles tendinopathy.
PHYSICAL THERAPY CAN HELP
Initially, complete rest is not advised. Patients with initial symptoms may benefit from anti-inflammatory treatments including ice and iontophoresis with a physical therapist. Your physical therapist may use rigid taping for pain control. Those with recurring Achilles pain may choose to swim, bike, run in deep water, or walk for maintaining fitness as long as they are tolerating the pain.
Your physical therapist should have you complete a functional questionnaire to monitor your pain and function throughout the rehab process and your return to activity. Initially, your ankle range-of-motion, flexibility, strength and joint mobility will be assessed and improved as needed with physical therapy and a home program. As you progress back to your normal activity, it may be necessary to further train the rest of your lower extremity, core, and balance system if other deficiencies are found.
As you progress, the hallmark treatment for mid-tendon Achilles tendinopathy is an extensive program of heavy-loading eccentric training (lowering your body weight while on your toes). Eccentric training involves raising up on both feet and then lowering on the affected side. This program needs to have structure and include more intense training and increased weight as you tolerate in order to change the structure of the tendon back to its normal state. There are some treatments, due to conflicting research, that is not currently recommended such as a low-level laser, heel lifts, orthotics and night splints.
The current literature reports an average recovery time of 2-3 months. However, remember you are still participating in normal activity as tolerated during your recovery. Younger athletes are able to get back to competition fairly quickly. If not treated correctly, older athletes and those with more significant injuries may have a decrease in sports performance and recurrence of pain. The key is to listen to your body, gradually resume recreational activities, and rehabilitate with sound evidence and guidance. Physical therapists with experience in treating with eccentric training and knowledge of running techniques can expedite your recovery and get you back to sport and life.
Martin, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthopedic Sports Physical Therapy 2018; 48(5): A1-A38 doi:10.2519/jospt.2018.0302