What is Achilles Tendinopathy?
I have had Achilles tendinopathy twice in my life and let me tell you, it is not fun! Sure, no injury is fun, but when walking itself is extremely painful (and impacts the ability to walk my dogs), I am not my happiest.
First, let’s talk about what tendinopathy is.
Tendinopathies are structural changes in the collagen that makes up your tendons, which are the strong connective tissue that attaches your muscle to your bone. Essentially, the makeup of your tendons changes in a way that leads to cell death and a weaker and less robust tendon overall.
For the achilles specifically, the biggest risk factors are relatively “weak” calves and training error. So, like many other “pains” and “injuries,” an achilles tendinopathy can begin when a person attempts some exercise at an intensity, volume, or frequency that their tissue was not prepared for. This is what happened to me.
So, what do we do about it?
First, we need to unload.
BUT WAIT! Do not unload completely. Total rest is not recommended! Tendons were made for loading, so we want to continue to supply movement and blood flow, it just needs to be in a way that respects their irritability. Modalities, such as dry needling, cupping, etc can be helpful in decreasing the level of pain but passive modalities like these should not be the only intervention. At MOTION RX, we use dry needling to decrease baseline discomfort so that we can load tissues more!
Second, do NOT stretch!
I have firsthand experience that having achilles tendinopathy can make your ankle feel super tight. Believe me, mine got to the point where even an air squat was difficult due to the sensation of tightness in the back of my ankle. Did I stretch a single time? Nope! Stretching an already irritated tendon can make it more irritated! Hold the stretching please.
Third, let’s load!
This is where a physical therapist is essential because everyone needs a different dosage and intensity of exercise as they recover from achilles tendinopathy. Isometric exercises (exerting force without moving through a range of motion) can be helpful initially and can provide some pain relief. We want to progress to eccentric exercises as these can also be helpful for pain relief as well as “normalizing” tendon structure. Eventually, exercises also need to be progressed to plyometric type movements (ex. jumping) as that is a huge part of what the achilles tendon does.
In these exercises, a large focus should be put on soleus strengthening (one of your calf muscles). A study found that achilles tendinopathy is associated with plantarflexion torque and endurance deficits due to greater loss of soleus strength versus the gastrocnemius.
A noteworthy point – even though your pain may go away, structurally, achilles tendinopathy takes one year, on average, to resolve completely. That means continuing to strengthen and work through plyometric exercises. Once they’ve progressed accordingly, you can push your tissues to adapt further.
Yes, achilles tendinopathy can be very painful, and it can take time and persistence to completely resolve. But it can get better and you can get back to the activities you love. Reach out to us and we’ll get you moving in the right direction!
O’Neill S, Barry S, Watson P. Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: The role of soleus. Phys Ther Sport. 2019 May;37:69-76.