What is the best home treatment for Achilles tendinopathy?
Achilles tendonitis can be treated at home using relatively simple methods, and self-care is important to prevent recurring episodes.
Pain Relief & Modalities
- Rest: Avoid activities that hurt your tendon and allow recovery.
- Ice: Apply ice on your back of your heel to reduce pain and swelling.
- Pain Relief: Taking nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen for pain relief. Please speak to GP or pharmacy first if you have heart or gastric problems.
- Shoe wear: Make sure your shoes give you good support, with heel cushioning and firm arch support.
Activity Modification
- • Exercise: including isometric, eccentric training targeting your calf muscles.
- • Stretching: Stretch your calf and Achilles tendon every day, especially before and after exercise.
- • Low-Impact Activities: Swimming or cycling can reduce stress on your tendon whilst exercising.
- • Avoid High Impact Activities: Running uphill can put too much stress on the tendon.
- • Activity Level: Slowly build up your activity level to avoid overloading your tendon too much.
- • Cross-Train: If your pain allows, mix high-impact activities (like running) with low-impact activities (like swimming) to avoid stressing your tendon too much.
Physio Exercise Guide
Do consider alternative treatment as acupuncture or shockwave therapy with tendon-loading appear superior to a wait-and-see approach at 3 months.
What is the best way to cure my Achilles tendinopathy?
Achilles tendinopathy, commonly referred to as Achilles tendonitis, is best addressed through a combination of approaches aimed at reducing strain on the tendon, gradually increasing its capacity to withstand load, and promoting healing.
Understanding Achilles Tendinopathy
- Achilles tendinopathy is a degenerative condition caused by overuse and cumulative microtrauma. It is characterized by pain, swelling, and impaired function, especially during walking and exercise.
Initial Management and Activity Modification
- Early management may include relative rest, activity modification, and patient education. It is crucial to identify an optimal level of loading that keeps symptoms tolerable during, immediately after, and the day following activity.
- Avoid activities that place excessive stress on the Achilles tendon, such as hill running.
Exercise and Loading Protocols
Isometric
Holding a contraction with little to no movement (e.g., Heel hold).
Eccentric
Slowly lowering the heel below the edge of a step (Alfredson protocol).
Heavy Slow
Slow heel raises performed on a seated calf raise or leg press machine.
How did you recover from your Achilles tendon injury?
For Achilles tendinopathy, several exercise options can aid in healing and restoring function. These exercises should be performed within tolerable pain levels, and it's important to monitor symptoms during and after exercise. The goal is to progressively load the Achilles tendon to increase its capacity and function.
The "Heel Raise" Mechanism
Strengthening the calf muscle and tendon unit is vital. The animation shows the mechanical action of a heel raise, which loads the tendon to stimulate repair.
Visualisation of tendon loading during exercise
Stage 0: Isometric Exercises
Hold for 45 seconds at 4/10 effort with 2 minutes rest between sets, for 3-5 sets. Examples: Double leg heel raises; Single leg heel raises; Seated heel raises.
Stage 1: Heavy Slow Resistance
Aim for a minimum of 1-2 exercises, 2-3 days per week, with slow and controlled repetitions. Examples: Single or Double leg heel raises on flat ground.
Stage 2: Energy Storage
Incorporates jumping, landing, and plyometrics. Hopping Progression and Jumping Progression. Perform 2-3 times per week.
Stage 3: Return to Sport
Gradually returning to a preferred sport or activity.
Common Questions & Symptoms
Why, when after running, do my left ankle/Achilles feel stiff?
Following a run, stiffness can arise from several factors:
How can Achilles tendinopathy cause knee pain?
Achilles tendinopathy can lead to compensatory changes in biomechanics:
- Altered Gait: Changing walking pattern to minimize stress on the tendon places stress on the knee.
- Kinetic Chain Imbalance: Disruption in the lower limb affects alignment.
- Muscle Weakness: Weak calf muscles force muscles around the knee to work harder.
- Hyperpronation: Often associated with pes cavus or pes planus.
Does wearing heels shorten your Achilles tendon?
Regularly wearing high heels, which can shorten the calf muscle, might impact the Achilles tendon over time. Tight calf muscles are known to place more stress on the Achilles tendon. Heel lifts or more supportive shoes can be trailed with the intention of temporarily reducing Achilles tendon load early on when symptoms are high.
Why does my Achilles tendon sometimes 'click'?
Potential causes include Tendon abnormalities (disruption in structure), Inflammation or Bursitis (retrocalcaneal bursa), or Adhesions (scar tissue rubbing against surrounding tissues). Consult a GP or physiotherapist for evaluation.
Signs of an Achilles Rupture or Tear?
Seek immediate medical attention if you experience:
- • A popping sound: You might hear a pop from the back of your heel.
- • Sudden, sharp pain: In the back of your leg or heel.
- • Feeling of being kicked: As if kicked in the back of the leg.
- • Giving way sensation: A feeling of popping or giving way.
- • Swelling and bruising: Significant swelling.
- • Palpable gap: Usually 2 to 6 cm above the heel bone.
- • Impaired movement: Difficulty flexing the foot.
- • Positive Thompson Test: No foot movement when calf squeezed.
What causes tear to your Achilles tendon?
Here are some factors and activities that are commonly associated with Achilles tendon ruptures:
- Sudden forceful contraction: Sudden push-off while the ankle is dorsiflexed (e.g., jumping, cutting).
- Overuse and Strain: Repetitive or intense strain on the tendon.
- Loading imbalance: Sudden increase in intensity or duration of activity.
- Activities: "Weekend warriors" (middle-aged people playing sports without specific training).
- Tight calf muscles: Increases stress on the tendon.
- Exercising on an uneven surface: Unstable terrain increases risk.
- Starting a new sport: Body not accustomed to new movements.
- Medical conditions: Psoriasis, high blood pressure, diabetes.
- Certain medications: Fluoroquinolone antibiotics have been linked to increased risk.
References
- Johns Hopkins Medicine - Achilles Tendon Injuries
- Mayo Clinic - Achilles Tendinitis
- NHS - Cancer Symptoms
- von Rickenbach K. J., et al. Massachusetts General Brigham Sports Medicine Rehabilitation Protocol for Achilles Rupture Repair.
- Wang Y., et al. Prevalence of Achilles tendinopathy in physical exercise. Sports Medicine and Health Science, 2022.