4 Simple at Home Exercises for Achilles Tendinopathy in Runners

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Written by: David Burnett, BScH, MScPT, Registered Physiotherapist

 

What is Achilles Tendinopathy?

  • Characterized by pain, stiffness, maybe some swelling or thickening of the Achilles tendon
  • Common running injury – prevalence varies but may make up 6-8% of all running injuries
  • 58% male to 42% female
  • Important to note the following differences but generally treatment remains the same:
    • Insertional tendinopathy vs mid tendon tendinopathy – best determined by a physiotherapist
    • Different stages of tendinopathy exist – best determined by a physiotherapist
  • Tendinopathy is tendon tissue disorganization – not tissue damage

Unmodifable Intrinsic Risk Factors:

  • Previous lower limb injury
  • Previous lower limb tendinopathy
  • Age
  • Gender

Modifiable Intrinsic Risk Factors

(*Best evaluated by a Physiotherapist*)

  • Reduced muscle power/strength
  • Reduced ankle dorsiflexion
  • Weight (Increased BMI)
  • Biomechanical abnormalities – foot alignment/pronation
  • Muscle imbalance and inflexibility

Extrinsic Risk Factors

(*Best evaluated by a Physiotherapist*)

  • Change in loading – return to running/activity after a break
  • Training errors
    • Increased volume/intensity too quickly
    • Change in pace
    • Change in training type (i.e. increased hills)
    • Change in training duration
    • Increased training frequency
    • Change in weekly distance
  • Footwear – Achilles load is higher in minimalist shoes/barefoot compared to standard shoe regardless of where the foot strikes
  • Running style – A forefoot strike increases Achilles load by 15%
  • Training surface – Running on a treadmill has been shown to mildly increase Achilles load
Physiotherapist treating ankle

Treatment Principles

  • Despite different areas of Achilles tendinopathy and stages of tendinopathy the general treatment principles remain the same
  • Identify and address potential causes (i.e. intrinsic and extrinsic factors)
  • Reduce Pain
  • Improve load capacity of muscle-tendon unit
  • Improve load capacity of kinetic chain as a whole
  • Gradual return to training
  • Advise on long term management

Pain Reducing Tips for Runners

  • Initial relative rest and ice
  • NSAIDs (anti-inflammatories) – discuss with family doctor
  • May need to avoid ankle dorsiflexion initially which can contribute to tendon compression
  • Change type of training – bike, swim, walk
  • You may still be able to run!! BUT avoid training/activity that pushes pain past a 2-3/10 and does not settle within 24 hours
  • Potential running modifications to decrease pain during rehab
    • Run every other day
    • Increase cadence by 5% and build up to 10%
    • Cut down on hills and speed work
    • Perform strength training and running on separate days
    • Gradually increase training as pain allows
    • Monitor response of tendon after activity – keep pain below 2-3/10 – find the sweet spot between no activity and too much
  • Wear good standard running shoes
  • Long hold isometrics – 5 x 30-45 second holds mid-range 70% max voluntary contraction

Exercise Progression – Improving Load Capacity 

***Note: These are not recipe exercises but rather examples – see your Physiotherapist for an individually tailored, appropriately graded exercise program!

Above table taken from Tom Groom Running Repairs course

Sample Isometric Exercises 

Focus will be on tendon loading in a position that limits tendon compression (plantar flexion). These exercises should have an analgesic effect but make sure pain is never above 2-3/10 and settles within 24 hours. Start with 5 sets of 30-45 sec at 70% max voluntary contraction. Repeat as needed throughout the day.

Standing Isometric Calf Raise

With straight knees, push up onto your toes around mid-range focusing weight through your big toe. Use support if needed initially. Hold for 30-45 sec. Can progress to one leg only.

Physio demonstrating achilles exercise
Physio demonstrating achilles exercise

Knee to wall press

Place knee against wall with a towel in between. With a bent knee push up onto your toes around mid-range focusing weight through your big toe. Use support if needed initially. Hold for 30-45 sec. Can progress by putting more weight through affected leg.

Physio demonstrating achilles exercise

Sample Isotonic Exercises

Focus will be on the eccentric movement and heavy slow load (HSR) meaning exercise will be performed at a slow fatiguing pace – pain never above 2-3/10 and should settle in 24 hrs. Start with 3 sets of 15 max reps (MR). Increase load gradually until 3 sets of 8 max reps (MR) is achieved. Repeat Daily.

Eccentric Calf Raises – Straight Knee

Place both feet on the front of a step.  With straight knees, push up onto your toes focusing weight through your big toe. Use support if needed initially. Hold for 2-3 sec at the top. Take ‘good’ foot off the step. Slowly lower affected foot to a count of 5 sec.

Physio demonstrating achilles exercise

Eccentric Calf Raises – Bent Knee

Similar to a straight leg calf raise but bend your knee to around 30 degrees. Hold for 2-3 sec at the top. Take ‘good’ foot off the step. Slowly lower ‘bad’ foot to a count of 5 sec.

Plyometrics

  • Depending on individual goals, further rehab may be required. Be sure to see your physiotherapist for a specific and personalized plyometric program.

Long Term Management

  • Takes time to resolve – slow to settle and quick to aggravate
  • Continued improvements up to 12 months into rehab
  • Rehab relies on consistent, continued self-management from the patient

David Burnett, BScH, MScPT
Registered Physiotherapist

David joined GRSM in July 2016.  David graduated with his MScPT from Leeds Beckett University and B.Sc. Biomedical Sciences from the University of Waterloo, while playing for the Warriors Men’s basketball team.  

He has been working in hospital and multi-disciplinary clinic environments in the UK since graduating.  

Dave previously worked as a Sport and Fitness Director in Sydney, Australia. In his free time, Dave enjoys keeping active through the gym, playing any and all sports and enjoying the outdoors.

Virtual Appointments at GRSM

As social distancing continues in response to COVID-19, we feel it is important to provide ways to continue care for our existing patients and to provide opportunities to start treatment for new patients.

Although we cannot open our physical doors, continued treatment and new assessments are available through virtual rehabilitation. This form of treatment may be very new to some, but others in our field have been practicing virtual rehabilitation for years in remote areas, in pelvic health and with clients who have trouble travelling to a clinic. Virtual assessment and treatment is completed in the comfort of your own home with flexibility in timing, either face to face on a secure platform or over the phone.

Due to the importance of providing continued care during these unprecedented times, most insurance companies now provide coverage for virtual rehabilitation. We do however encourage everyone to confirm this with their insurance provider.

If you are still not sure if virtual rehab is right for you, email us at virtual@grsm.ca.  One of our registered physiotherapists will connect with you to discuss your personal rehab needs.

Resources

Almonroeder, T., Willson, J. D., & Kernozek, T. W. (2013). The effect of foot strike pattern on Achilles tendon load during running. Annals of Biomedical Engineering41(8), 1758-1766.

Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine43(7), 1704-1711.

Esculier, J. F., Dubois, B., Bouyer, L. J., McFadyen, B. J., & Roy, J. S. (2017). Footwear characteristics are related to running mechanics in runners with patellofemoral pain. Gait & posture54, 144-147.

Lyght, M., Nockerts, M., Kernozek, T. W., & Ragan, R. (2016). Effects of foot strike and step frequency on Achilles tendon stress during running. Journal of applied biomechanics32(4), 365-372.

Rice, H., & Patel, M. (2017). Manipulation of foot strike and footwear increases Achilles tendon loading during running. The American journal of sports medicine45(10), 2411-2417.

Tam, N., Wilson, J. L. A., Noakes, T. D., & Tucker, R. (2014). Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med48(5), 349-355.

 

Taunton, J. E., Ryan, M. B., Clement, D. B., McKenzie, D. C., Lloyd-Smith, D. R., & Zumbo, B. D. (2002). A retrospective case-control analysis of 2002 running injuries. British journal of sports medicine36(2), 95-101.

 

Willy, R. W., Halsey, L., Hayek, A., Johnson, H., & Willson, J. D. (2016). Patellofemoral joint and Achilles tendon loads during overground and treadmill running. Journal of orthopaedic & sports physical therapy46(8), 664-672.

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