Achilles Tendon strengthening techniques.

 
This month we’re addressing another common presentation amongst our running clientele (and something I have personally undergone rehab for): an Achilles Tendinopathy.

The term tendinopathy basically refers to degeneration of a tendon, and is usually precipitated by tendon overload/overuse. NB. Tendinopathy can be interchanged with the term Tendinosis.  Some of you may recall this condition was previously referred to as ‘tendinitis’, this is not the case as inflammatory cells are absent within the tendon itself.

Achilles TendinopathyThere are two types of Achilles Tendinopathy: a mid-portion Achilles Tendinopathy (more common) versus an insertional Achilles Tendinopathy. It is important to distinguish between the two as they differ in the prognosis and response to treatment.

Some common predisposing factors to a tendinopathy include:

1. years of running,
2. a recent increase in activity (distance, speed, hills),
3. decreased recovery times between training sessions,
4. a change in training surface or footwear,
5. biomechanical abnormalities (eg excessive pronation),
6. calf weakness/tightness, and
7. restricted ankle ROM.

Clinically athletes will describe a gradual development of symptoms (as opposed to a partial tear or rupture, which is more of a sudden/acute pain at the time of activity). Athletes will often describe they can ‘run through’ the pain, or will report the pain disappears when they warm up, only to return post-run once cooled down. More frequently clients will report pain and stiffness upon rising out of bed the following morning.

Treatment for an Achilles Tendinopathy will differ depending on whether the client presents with a mid-portion versus an insertional Tendinopathy. The clinician may also need to order imaging to determine the stage of the Tendinopathy, as this will also affect where we head with rehabilitation. The client’s training schedule and load, as well as any biomechanical errors also need to be taken into account.

In terms of exercises, a 12-week eccentric strengthening programme was developed by Alfredson and has been shown to have good results for patients presenting with mid-portion Achilles Tendinopathy. Attached are some pics to demonstrate Alfredson’s painful heel-drop protocol over the side of a step, and number of sets/reps. Again, it is important to determine the type of Tendinopathy before commencing this programme because doing it over the side of a step for an insertional tendinopathy could potentially make your symptoms worse.

Please see this video for an example of an eccentric strengthening program:

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