Physiotherapy for Achilles Tendonosis
What is the Achilles Tendon?
A tendon is the part of the muscle that connects it to the bone. It is denser with connective tissue and is no longer contractile tissue. The Achilles tendon is the largest tendon in the body and it connects the calf muscles to the heel bone. Your calf muscles and Achilles tendon are highly involved in helping you stand upright, walk, jump and run.
What are the Symptoms of Achilles Tendonosis?
Common symptoms of Achilles tendonitis include pain and stiffness along the Achilles tendon. The symptoms may be most noticeable after prolonged positions and/or first thing in the morning when you take your first few steps. You may also notice that the symptoms decrease as you move around. If you are exercising vigorously then you may experience more pain and you will especially notice increased discomfort the morning after. You may also notice swelling and thickening around the Achilles tendon.
What causes Achilles Tendonosis or Achilles Tendonitis?
If there is excessive strain, repetitive stress or failed load transfer through the lower leg, then the Achilles tendon can become inflamed- termed tendinitis (active inflammation). The fibres that make up the Achilles tendon start to break down and degenerate which can lead to an inflammatory process that causes swelling and pain. As your body responds to the trauma to the tendon, scar tissue is produced which leads to thickening of the tendon. The tendonitis most commonly occurs through the middle of the tendon (non-insertional tendonitis) or where it attaches on to the bone (insertional tendonitis). Often, this issue is precipitated when you progress the amount or intensity of an activity too quickly without giving your body (muscles and tendons) a chance to adjust and adapt. Tissue injury follows.
How can a Physiotherapist or Chiropractor help with Achilles Tendonosis?
Physiotherapy and chiropractic treatments are very successful for the resolution of Achilles tendonopathy. Your physiotherapist or chiropractor will conduct a thorough assessment of your lower extremity and back to determine what the underlying causes are.
Typically, patients that present with Achilles tendonosis have tight calves and joint restrictions in the ankle and foot bones. Your physiotherapist or chiropractor will release your tight muscles and mobilize your stiff joints here and even maybe up the chain into your back. Your therapist might also use acupuncture to reduce your pain and promote healing of the tendon or dry needling to release tight muscles. Extracorpeal shockwave therapy is another adjunct treatment that your physiotherapist or chiropractor can incorporate into your treatment plan. Shockwave therapy research has shown superior results in breaking down scar tissue and accelerate healing of the Achilles tendon.
In addition to the above, your physiotherapist or chiropractor will also guide you through exercises that will strengthen your tendon and correct any muscle imbalances that exist. They may not just have you perform exercises for your ankle but also your knee, hip and core weakness which may have contributed to the development of Achilles Tendinitis.
If you are not progressing as expected your physiotherapist or chiropractor may refer to for massage therapy or a consultation with a sports medicine physician. These other options will help aid in your recovery and ensure that all appropriate measures are being taken.
What are the best exercises to help with Achilles Tendonosis?
Eccentric calf strengthening exercises have been supported by research to improve the strength and integrity of your Achilles tendon. Eccentric loading, simply means the phase of an exercises where the muscle is working as it is lengthening, such as the lowering phase in a calf raise.
Eccentric Gastroc loading
Standing on both feet. Keep your knees straight and raise your heels off the floor until you are up on the balls of the foot. Then remove your non-injured foot from the ground so that you are standing on just your injured leg. Slowly lower the heel with control back to the ground.
3x 15reps 2xday
Eccentric Soleous loading
Repeat the same movement as above but this time keeping your knee bent at about a 20-degree angle.
3x 15reps 2xday
Isometric Calf Strengthening (For Pain Relief)
Standing on both feet to start, lift both your heels up until you are on the balls of your foot. Remove the non-injured foot from the ground and hold that high heel position of the injured leg for 45 seconds. Repeat this 5 x. Take a 2 minute break between each repetition.
What should I avoid doing if I have Achilles Tendonosis?
- Power movements- jumping, hopping, sprinting, running
- Pushing through pain, continuing with aggravating activities
- Deep static stretching before activity
What can I do to prevent Achilles Tendonosis?
- Doing an active dynamic warm up before an activity
- Stretching of lower extremities in the hours following an activity
- Strength training the calves 2-3x/week
- Wearing supportive shoes or prescribed orthotics
- Always start new activities slowly and gradually, allowing your muscles, joints and tendons to adapt to the new load.
How long does it take to recover from Achilles Tendonosis?
If you are able to manage your symptoms early with activity modification and rehab exercises you are likely to recover in a 6-8 week timeline. If your Achilles has been painful for longer than 6 weeks, your tendon has thickened, it will take longer, even up to a few months.
Our physiotherapists and chiropractors have a lot of experience treating this Achilles tendonitis (tendonosis) successfully. Contact us for more information or to book an appointment with one of our highly trained physiotherapists or chiropractors today.
- Alferdson H and Pietila T. Heavy load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26: 360-6
- Roos EM, Engstrom M, Langerquist A, Soderberg B. Clinical improvement at 6 weeks of eccentric exercises in patients with mid-portion Achilles tendinopathy- a randomized trial with 1 year follow up. Scand J Med Sci Sports 2004;14(5)286-95
Alishah Merchant, FCAMPT Physiotherapist
Alishah Merchant is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.