One of the most common sport injuries for runner or jumpers is an Achilles tendinosis or to be more precise, tendinopathy, while it is the largest tendon. Nonetheless, it is poorly understood and one of the most difficult sport injuries to treat properly. Usually, it is due to a sudden increase of the load in intensity or length of time, without accurate training. It may take up to a whole year before recovering, and even more if a new injury occurs during the time of healing.
From my experience as a physiotherapist, then a chiropractor, I can tell that I have felt very uncomfortable to treat these kinds of injuries. Some professionals recommended stretching in the stairs for 3 minutes, others to wear walking boots to relieve the load on the tendon, and other modalities such as wearing orthotics, icing, massage or ultrasounds.
However, a breakthrough in the protocols to treat Achilles tendinitis has brought some solutions in exercising therapy.
Before entering into the details, we need to consider the two types of tendinopathy: midportion and insertional. For the later, the discomfort or pain is triggered at the insertion of the tendon onto the calcaneus or heel bone. If the symptoms are similar, the treatment is quite different and we will focus on the most common, the midportion tendinosis.
FIGURE 1. Localization of Achilles tendinopathy: (A) midportion and (B) insertional.
Treatment for Achilles Tendinopathy
The management is moderated according to the symptoms, age and sex, disability and the sport needs.
Eccentric exercise has been the reference in all the studies and should be done for 3 months before considering more invasive options. It is recommended 3 sets of 15 repetitions with the knee straight or mildly bent.
The Eccentric Exercise
Heel drop: knee straight (FIGURE 2)
Standing on the edge of a step on the involved side. Start with standing on the toes, then lower the heel as far down as possible. Rise back on the toes with the assistance of the other foot: 3 sets of 15 repetitions, 2 times per day, 7 days a week for 12 weeks. The exercise can be painful to a certain extent. When you feel no pain any more, you can hold some weight.
Repeat the exercise bending moderately the knee.
FIGURE 2. The heel drop: knee straight and heel drop: knee bent exercises.
Regarding the insertional tendinopathy, the deep fibres of the tendon are squeezed against the tubercle of the calcaneus, or sometimes the bursa. This is a compressive traumatism due to repetitive dorsiflexion, and so should be avoided exercising.
In this particular view, a heel lift is recommended first during the activities of the daily life. The calf raises should avoid the heel lower than the floor level. It is so better to avoid exercising in the stairs. The range of movement will increase with a reduction of the symptoms. Walking and running on a flat ground will be reintroduced progressively. Running in the hills is the last stage when the pain is very minimal.
A combination of the excentric exercise and manipulations of the joints of the foot such as subtalar articulation or midfoot mobilisation have shown better outcomes during the studies. At Orewa Chiropractic, we have a large experience in treating sport injuries.