Achilles Tendinopathy (Achilles Tendonitis) Treatment

The Achilles tendon – named after the famous Greek mythic hero of the same name – is the largest and strongest tendon in the body. It attaches the gastrocnemius/soleus complex (calf muscle) to the calcaneus (heel bone). When the calf muscle contracts it pulls on the Achilles tendon which pulls on the heel bone. This causes the toes to move downward, allowing you to push-off the ground, common in activities such as walking or running, jumping, and climbing stairs.

Achilles Tendinopathy vs. Tendonitis

The most appropriate term to describe Achilles tendon pain and loss of function is actually Achilles tendinopathy. Achilles tendonitis is a term used to describe an acute inflammatory process of the Achilles tendon, which is a normal response and part of the adaptation process.

Achilles tendinosis is a term used to describe degeneration/tendon disorganization, which is actually common in both symptomatic and asymptomatic individuals. Thus, Achilles tendinopathy is the preferred term. Achilles tendinopathy is very common in individuals that run. 

Types of Achilles Tendinopathy

There are two main types of Achilles tendinopathy, and your symptoms and treatment options will vary depending on which applies to you.

Non-Insertional Achilles Tendinopathy

Approximately 80% of people with Achilles tendinopathy suffer from Non-insertional Achilles tendinopathy, the most common form of Achilles tendinopathy. The pain and swelling is located in a zone approximately 2-6 cm above the heel bone. Pain is increased with loading of the tendon such as running, going up or down the stairs, and jumping. 

Insertional Achilles Tendinopathy

Approximately 20% of people suffering from Achilles tendinopathy will have insertional Achilles tendinopathy. This form is characterized by pain that is located in a zone within 2 cm of the heel bone. The pain associated with this particular injury is increased with loading of the tendon and maximal stretch of the tendon. 

Symptoms of Achilles Tendinopathy

Common symptoms of Achilles tendinopathy include…

  • Pain or achiness of the Achilles tendon, especially first thing in the morning, when running, and with loading of the Achilles tendon 
  • Swelling
  • Decreased propulsion or ability to push off the ground in activities such as running, jumping, or climbing stairs 

Achilles tendinopathy is typically painful when loading is first initiated, but may have a “warm-up” effect and feel less painful as you go. Most patients will find that the greater the load placed on the Achilles tendon, the greater the pain experienced.

Causes of Achilles Tendinopathy

The most common cause of Achilles tendinopathy is over-exceeding the capacity of the tendon to adapt and recover; in other words, doing too much too soon.

This usually happens when starting a new activity or at the beginning of a sports season, particularly in sports that require a lot of running. 

Sports Where Achilles Tendinopathy Commonly Occurs

Achilles tendinopathy is common among athletes who participate in sports with high volume running, including:

  • Track & Field
  • Cross Country
  • Soccer
  • Lacrosse
  • Basketball
  • Etc. 

 

Given that the vast majority of sports require a high volume of running, Achilles tendinopathy is one of the most common injuries experienced by athletes.

Achilles Tendinopathy Treatment

At Herlong Sports Physical Therapy, we often see athletes who are suffering from Achilles tendinopathy. Our treatment for Achilles tendinopathy begins initially with load management by having the athlete take a break from the aggravating activity. 

Once the Achilles tendon is ready, we shift into gradual loading of the Achilles tendon to allow the tendon to adapt to the stress without it flaring up. The goal of this stage is to gradually load the tendon more and more over time to the point where activities that previously bothered you no longer cause pain. 

Towards the later stage of rehab more energy storage and release activities or higher speed activities will be introduced in a graded manner that stresses the Achilles tendon enough to elicit positive adaptation without causing it to flare up. Physical rehabilitation and strengthening exercise therapy is the first line treatment for Achilles tendinopathy. 

How Long Does Achilles Tendinopathy Take to Heal?

The timeline for total recovery from Achilles tendinopathy is approximately 6-12 months, but varies significantly from person to person. 

While that may sound like a long time, that does not mean that you will be in pain for the entire duration of your recovery or be sidelined from your sport or activity during this time. The goal of our rehabilitation process is to lessen day-to-day symptoms and to allow you to do more activity before the onset of symptoms. 

However, there may be a period of time where you may need to decrease the amount or intensity of activity you are doing. The goal is to gradually load more weight and power onto the Achilles until the pain lessens or vanishes.

What Patients Are Saying

Achilles Tendinoptahy Exercises

While you await your first appointment with our licensed physical therapists at Herlong Sports Physical Therapy, here are some exercises you can try at home to provide some relief from Achilles pain.

Single Leg Heel Raise 

This simple but effective exercise is incredibly helpful in aiding your recovery from Achilles tendinopathy.

  1. Start standing, facing the wall, on the leg that has the Achilles irritation. You can place your hands on the wall for balance. 
  2. Raise up onto your toes, hold it for a second, then slowly lower your heel back down to the ground. 
  3. Repeat 10 times for a set. Complete 3 sets daily. 

To increase the stress on the Achilles tendon, do this exercise with your toes on a step and heel off. As you lower your heel down, allow it to descend lower than the level of the toes to where you feel a stretch in the calf/Achilles, then repeat that exercise 10 times for a set. 

 

If you want to decrease the stress on the Achilles tendon, perform this exercise on two feet rather than one or complete fewer repetitions. 

Become a Patient

If you are seeking Achilles tendinopathy (Achilles tendonitis) treatment, fill out patient paperwork to get the process started with Herlong Sports Physical Therapy. We are in network with all major insurance plans. Contact us if you have any questions about insurance or our services.

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