Achilles Tendinopathy Treatment | Steps to a successful recovery

Achilles Tendinopathy treatment should follow specific steps depending on which phase of the healing continuum the tendon is in. This follows a gold standard, evidence based approach. Stretching alone will not cure Achilles tendinopathy. Due to it’s chronic nature, symptoms can usually last for months and lead to a ‘dysrepair’ of the natural healing process if not treated well in the initial phase, as discussed in our first instalment Achilles Tendinopathy | What is it?

In order to avoid and/or reverse these changes, answer the questions below and follow the correct steps to a successful recovery:



Reactive Phase | Time to Offload!

If you have had your pain for less than 12 weeks and the pain is constant, it is likely you have an acute, first time episode of Achilles Tendinopathy.

Alternatively if you have been experiencing pain for longer than 3 months, but the pain has recently become worse, it is likely you are experiencing an acute on chronic episode of Achilles Tendinopathy.

Both mean you are in the REACTIVE PHASE of the tendon continuum.


As we explained in our previous blog Achilles Tendinopathy | What is it? tendons are in a constant continuum of healing. The reactive phase occurs when the tendon becomes painful in the first 3-6 weeks, be it a first time episode or a flare up of a persistent problem. In this phase symptoms are typically more acute and irritable for example when walking with every step or going up and down stairs.

At a cellular level the tendon is inflamed. It is red, hot, sore, and can be swollen. Therefore it is crucial you offload it in order to allow the inflammation to calm down, and provide the tendon with the correct environment to begin healing. Methods to help this include:

  • DO NOT STRETCH THE CALF MUSCLE!!!
  • Wear good supportive shoes ideally with a bit of a heel raise during the day i.e good pair of running trainers
  • Insert a heel wedge into your footwear for additional support
  • Try to avoid barefoot walking where possible
  • Try to avoid footwear that may compress your heel too much and be uncomfortable
  • Icing
  • Taping
  • You can still stay relatively active in this phase without running as long as it does not aggravate your pain e.g. cycling/swimming/light gym sessions
  • You can STEADILY return to running once you have completed a week of the level 4 strengthening exercises in the pathway
  • If you’re still struggling with pain consult a Physiotherapist

**BEGIN AT LEVEL 1 ACHILLES TENDINOPATHY | TOP 5 EXERCISES following the specific instructions**


Dysrepair Phase | Time to Strengthen Up!

If you have had you pain for less than 12 weeks and your symptoms seem to be aggravated occasionally by certain things it is likely you have a sub-acute, first time episode of Achilles Tendinopathy.

Alternatively if you have been experiencing pain for longer than 3 months without targeting any specific treatment it is likely you have a chronic episode of Achilles Tendinopathy.

Both mean you are in the DYSREPAIR PHASE of the tendon continuum as shown in the diagram below:

As we explained in our previous blog Achilles Tendinopathy | What is it? tendons are in a constant continuum of healing. The dysrepair phase occurs beyond 3-6 weeks when the healing process of the tendon has been disrupted and needs some help to get things moving in the right direction. Whether you are starting off at this point following months of Achilles pain stopping you running, or just coming out of the reactive phase now that you can walk around more comfortably, it is time to begin the most important part of the treatment…strengthening!! In this phase symptoms aren’t as irritable as the reactive phase but can still stop you running, and feel sore the following morning. Typically DYSREPAIR PHASE can be characterised for runners as feeling sore at the start of a run, easing for a period but then returning when running too far, too fast or doing hills!

At a cellular level the tendon is starting to develop immature scar tissue that doesn’t quite do the job it should do. Tendons are your bodies springs. Without them you would not be able to walk or run in the first place. They absorb huge amounts of force on a daily basis. Did you know that when running, the deep calf muscles can take up to 8 times your body weight in force every step. As we highlighted in our blog 7 Series | Running Strength this is why strengthening is so important to keeping you running injury free.

As a result it is crucial you begin a progressive, calf strengthening programme to encourage to the new scar tissue to be laid down in the ideal way and correct the disarray. Methods to help this include:

  • DO NOT JUST REST FOR LONG PERIODS AND RE-RUN!!!
  • Wear good supportive footwear when running (freshen up that old pair if needed)
  • Insert a heel wedge into your trainers for the first month or so as you return to running
  • Try to avoid footwear that may compress your heel too much and be uncomfortable
  • Icing after runs as a precaution
  • Taping for the first few runs when you return
  • Continue to keep up other cardiovascular activities (e.g. cycling/swimming/walking etc) alongside any other moderate intensity exercise (e.g. gym/climbing/Yoga/Pilates etc)
  • You can STEADILY return to running once you have completed a week of the level 4 strengthening exercises in the pathway
  • If you’re still struggling with pain consult a Physiotherapist

**BEGIN AT LEVEL 2 ACHILLES TENDINOPATHY | TOP 5 EXERCISES following the specific instructions**


Degenerative Phase | Time to Reset!

If you have been experiencing pain for longer than 3 months despite following a specific treatment regime it is likely you have a chronic episode of Achilles Tendinopathy

in the DEGENERATIVE PHASE.

 

As we explained in our previous blog Achilles Tendinopathy | What is it? tendons are in a constant continuum of healing. The degenerative phase can typically occur following a period of 6-12 months+ of symptoms when treatment attempts of offloading and strengthening haven’t quite worked. In this phase symptoms are similar to the dysrepair phase. Not too irritable but can still stop you running, and feel sore the following morning. Typically feeling sore at the start of a run, easing for a period but then returning when running too far, too fast or doing hills!

At a cellular level mature scar tissue has developed within the tendon, maybe causing thickening in areas, and significantly reducing it’s ability to absorb force. At this stage the tendon needs some external help to reset the healing process and start a fresh. As a result, Shockwave therapy would be recommended.

Extracorporeal Shockwave Therapy is a relatively new treatment with scientifically proven, excellent results for chronic tendon and fascia conditions, such as, plantar fasciitis, tennis elbow, Achilles tendinopathy and frozen shoulder. Shockwave Therapy owes its heritage to lithotripsy where focused shockwaves were used to break apart gall stones so they could be passed. A number of years later, a bit of lateral thinking and a strong evidence base now presents SWT as the ‘gold standard’ treatment for chronic tendon problems.

Shockwave Therapy

Shockwave Therapy in action

As discussed in our previous blog, the term ‘Tendinopathy’ is characterised by a stalled healing process and dysrepair (more commonly called scar tissue). The more this scar tissue builds up, and the longer it lasts, the more the tendon begins to thicken and the chances of recovery reduced. SWT aims to agitate or shock the injury back to its acute phase of healing using acoustic energy – almost like pressing the reset button. Not only does SWT ‘reset’ the stalled healing process and expedite a return to activity, there is also a noticeable reduction in pain. It is then vital to introduce the calf strengthening pathway to the tissues to ensure an optimum recovery as and when your Physiotherapist advises. You may also do the following to help manage symptoms:

  • DO NOT JUST REST FOR LONG PERIODS AND RE-RUN!!!
  • Wear good supportive footwear when running (freshen up that old pair if needed)
  • Trial a heel wedge in your trainers when running
  • Try to avoid footwear that may compress your heel too much and be uncomfortable
  • Icing after runs as a precaution
  • Taping during running
  • Continue to keep up other cardiovascular activities (e.g. cycling/swimming/walking etc) alongside any other moderate intensity exercise (e.g. gym/climbing/Yoga/Pilates etc)

**Once you have begun Shockwave Therapy your Physiotherapist will guide you on where to begin in the calf strengthening pathway, as now you will have a new starting point to strengthen up more effectively. As well as telling you when its time to start running again.**


Our next series of blogs looks at the TOP 5 EXERCISES FOR EACH STAGE OF ACHILLES TENDINOPATHY


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