Achilles Tendinopathy

Learn how the Exakt Health App can optimize your recovery.

Achilles tendonitis or tendinopathy treatment plan

We know that recovering from Achilles tendinopathy can be really frustrating. Especially if you can’t access quality treatment advice immediately. Yes, you can find exercises on Google but how many repetitions should you do and are they even the right ones for you? When can you play sport again?

The Exakt Health app provides answers to all of these questions.

The Exakt Health App:

  • Guides you safely from initial injury to full return to sport.
  • Prescribes evidence based exercise programs with clear guidance on reps, sets and frequency.
  • Adapts the program according to your feedback and specific needs.
  • Implements a walk/run program for a safe return to running.
  • Provides you with a maintenance program to prevent re-injury.
Achilles Tendinopathy Activities Dashboard
The injury overview screen teaches your about plantar fasciitis - what causes it, when to see a doctor and what treatments work best.

The App teaches you about your injury

Understanding what caused your Achilles tendinopathy, how it heals and when to see a doctor helps you better plan your recovery and prevent re-injury. The App has a different treatment plan for Mid-Portion vs. Insertional Achilles tendinopathy.

Your Achilles tendon is the thick tendon in the back of your heel that connects your calf muscles to your heel bone. Achilles tendinopathy or tendonitis is an overuse injury which develops when you increase the volume of your activities too quickly beyond the tendon’s capacity. It can also occur when you don’t allow the tendon to fully recover between hard training sessions.

When you have Mid-Portion Achilles Tendinopathy, you will feel the pain in the tendon about 5cm above the heel bone and the tendon is usually tender when pinched. You may even see or feel a thickened bump where you feel the pain.
 
The first time runners usually notice Achilles pain is towards the end of a training session or a few hours after a run. In most cases the Achilles is stiff in the morning but then warms up as the day goes on. In severe cases your tendon may remain painful and make you hobble throughout the day. Other symptoms include:
  • Stiffness and discomfort at the beginning of a run that disappears as the tendon warms up. Discomfort and pain may return worse than before a few hours later.
  • In more advanced states, a more constant pain stops you from running and even walking might hurt.
  • Calf stretches can feel good at first, but typically worsen the symptoms later in the day.
Note that not everyone will have the typical symptoms. Some only report a lump in the tendon without any symptoms. This is known as a silent tendinopathy. If you have a silent tendinopathy, you can still benefit from our rehabilitation program. Please consult with a medical professional first to confirm your diagnosis.
Achilles tendinopathy can be treated effectively at home using a conservative exercise-based treatment plan as outlined in the app.
 
You should consider seeing a medical practitioner if you have any concerns about your injury, particularly if:
  • You heard or felt a pop, or it felt as if someone kicked you in the back of the heel, or you felt a sudden sharp pain in your Achilles tendon when you injured your leg or while doing your exercises. This can indicate a serious tear that involves the Achilles tendon and you need to have it investigated immediately. Delaying treatment or following the wrong treatment advice when you have an Achilles tendon tear can mean that your tendon won’t heal properly. The program in the app is not appropriate for treating a tear.
  • You notice bruising – an Achilles tendinopathy does not cause bruising.
  • Any part of your leg (thigh, calf or foot) is very swollen, red, hot to touch, or throbs with pain. This can indicate that you have a blood clot and it should be investigated as soon as possible.
  • You have pain at night that keeps you awake or interrupts your sleep.
  • You feel pins and needles or tingling in your leg. This can indicate that you’ve also injured a nerve and our treatment plan may not be right for you.
  • Your symptoms are getting worse.
  • Your injury is not healing as expected.
 
Some of the most common causes for developing mid-portion Achilles tendinopathy include:
  • Increasing your running intensity or training volume too quickly – e.g. fast or hill running.
  • Not allowing enough recovery time for your tendon to repair between intense training sessions.
  • Changing from running in a shoe with a higher heel-toe drop to a flatter shoe – this increases the load on the Achilles tendon
  • Fluoroquinolone antibiotics can cause tendon injuries, including tendinopathy and tears.
  • Inflammatory conditions like gout, rheumatoid arthritis and psoriasis can cause tendon pain that is easily mistaken for a simple tendinopathy. Speak to your doctor if you also have an inflammatory condition.

It’s a common misperception that tight calf muscles cause Achilles tendinopathy. It is rather over-stretching that can cause your tendon to be injured.

Treatment

There’s no one-size-fits-all treatment for Achilles tendinopathy. The right combination of rest and exercise is usually the most important intervention, but it has to be tailored to the individual. The most useful treatment for Achilles tendinopathy include:
  • Relative rest: cut out really aggravating activities and reduce your training program to avoid any increase in symptoms.
  • Strengthening exercises for the calf and Achilles tendon to restore its strength and endurance.
  • Improving strength and control in your core and other leg muscles to reduce the load on your Achilles while running.
Other treatments that you may encounter:
  • Doing calf or Achilles stretches is NOT a priority and they can actually make your pain worse.
  • Complete rest can be useful to help your pain calm down at first. However, it’s not advisable to rest for a prolonged period, because it will weaken your tendon even further.
  • Massage can help to make your pain feel better but it does not actually strengthen your tendon.
  • Electrotherapy is currently not recommended by the research.
  • Shockwave may be useful in cases not responding to exercise therapy.
The following recovery times can give you an idea of how long your tendon’s rehabilitation will take:
  • with the right treatment starting shortly after your first symptoms, it can take between 12 and 16 weeks to recover;
  • if you’ve neglected your tendon pain and kept on training, it can take 6 months to a year to fully recover.

Prevention

  • Avoid sudden increases in running intensity or volume.
  • Allow enough recovery time after intense training sessions.
  • Vary your training – don’t go to the limit in every session.
  • Do regular strength training for your calves, core and legs in general.
  • When changing from a high heel-toe drop to a more minimalist flat shoe, transition slowly to allow your Achilles and calves to adapt.
 

The Mid-portion Achilles Tendinopathy treatment plan consists of 7 stage

In order to regain full strength the workout intensities have to increase as your injury heals. The app ensures that you progress at the correct time by setting you clear targets for each stage. The App contains treatment plans for both Mid-Portion and Insertional Achilles tendinopathy.

In this stage you’ll carefully test what exercises your Achilles tendon can currently support and use that as a base to build from. Don’t progress the exercises too quickly. Only increase intensities if pain or stiffness doesn’t increase in the 24 hours following a workout. It’s best to avoid calf and Achilles stretches as well all jumping, hopping, and running activities during this stage.

You are slowly preparing your Achilles tendon and calf muscles for heavy strength training. You should still avoid all calf and Achilles stretches as well as jumping or running activities. You can proceed to the next stage if you can walk short distances and complete the assigned strength training without an increase in pain.

Start doing heavy strength training for the Achilles and calf muscles until they are strong enough to start plyometric exercises. You’ll also further improve your strength and control in your core and legs. You should still avoid all calf and Achilles stretches, running and jumping activities. Continue to the next stage when you can walk 30 minutes and do the hop tests without an increase in pain.

You’re now preparing your Achilles and calves for a safe return to running. Start plyometric exercises while the calf strength program increases in difficulty. Avoid strong calf and Achilles stretches and running activities. Proceed to the next stage when you can walk at a brisk pace for 30 minutes and can do the assigned Achilles strength and hopping exercises without pain.

You’re now ready to start a return to running program. The focus in your strength sessions will shift to maintaining your strength and their frequency will reduce as your running volume increases. You should not yet do any high intensity sessions e.g. tempo runs, interval, or hill sessions. Progress to the next stage when you can jog 20 minutes at an easy pace without aggravating your symptoms.

The focus is now on regaining your previous running endurance in your Achilles and leg muscles. The strength workouts will maintain the strength that you’ve built in the previous stages. Avoid high intensity running e.g. tempo, sprint or hill sessions. You can progress to the next stage when you’re able to run your normal weekly running volume at your regular easy running pace pain free.

You can now start to train with increasing speed and intensity. You should continue with your weekly strength routine to support your running activities and reduce re-injury risk.

The exercises in the Achilles treatment plan increase in intensity as you recover.
The Exakt Health app is a sports injury app that provides exercise based treatment plans for the most common running injuries.

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