Achilles Tendinopathy

Achilles tendinopathy (opathy=pain) causes pain with the first steps in the morning, with prolonged or dynamic activities, with contraction of the calf muscles for plantarflexion (gas pedal motion) and with stretching into dorsiflexion (toes toward your nose). It is typically an overuse injury or related to a drastic increase in activity or training volume.

Diagnosis can be determined with a clinical exam and confirmed with ultrasound imaging or MRI.

The most important treatment for Achilles tendinopathy is progressive loading through the use of heel raises. Progressions are made by transitioning from double limb to eccentric (up with 2, down with 1) to single limb, from flat on the floor to off the edge of the step, from slow to fast, from low rep ranges to high and eventually to weighted and dynamic movements.

Stretching may provide relief though it also may be irritating if it is an insertional tendinopathy (at the attachment to the heel) rather than a midportion (halfway up the tendon). Heel raises should be completed flat on the floor with insertional. There is some evidence for the use of heel lifts, orthotics, taping, night splints, manual therapy, and laser treatment - the need for these should be evaluated on a case by case basis depending on symptom response. There is emerging evidence for the use of shockwave therapy in chronic, persistent tendinopathy.

For specific details on a clinical progression of exercises to incrementally load the Achilles tendon, go to our channel on YouTube This progression is based on data captured with a team from UPenn and University of Delaware.

Check out the progression on YouTube.