Updated: Sep 20, 2022
There is currently no standardised treatment protocol for Achilles tendinopathy. Every person’s case appears to be unique and whilst a combination of strength training and load management appears to be the most successful treatment approach, what exercises are used can vary dramatically depending on the patient. Recently researchers have also started looking at neuromuscular or motor control as a factor that may play a role in both the cause as well as the successful treatment of Achilles tendinopathy.
I've also discussed it in this video:
A very simplified definition of motor control is that it refers to how well your brain and nerves control your muscle contraction. Evidence is accumulating that a person who has a tendinopathy shows altered or decreased motor control in the affected limb (and sometimes even in the unaffected limb) compared to healthy controls and that this can persist even once they return to sport. What we don’t know is if the decreased motor control is part of the cause or if it developed as a result of the injury.
Motor control deficits are not always visible to the naked eye, but for Achilles tendon patients one can often observe it when they struggle to slowly lower themselves down from a heel raise. Instead of a nice smooth movement, it often turns into a shake-shake-shake all the way to the floor. You don’t see it when they quickly drop to the floor at speed, because then gravity pulls them down and the muscle doesn’t have to control anything.
So how does one retrain motor control in the calf muscle complex?
The research shows that self-paced training, where you just lift and lower at whatever pace you like, doesn’t really work for that. The best method is to try and match the speed of the contraction to an outside stimulus e.g. a metronome or a visual cue. Or in other words, it works best if you use a method that forces you to think about how you’re controlling the movement.
This is one of the reasons why we always get our patients to really slow their exercises down during the initial stages of rehab and focus on taking 3 seconds to lower all the way down from the heel lift – it forces the brain to really focus on the control. Another method, advocated by Dr Seth O’Neill, is to purposefully stop the heel drop at specific points during the heel raise exercise and then change direction as this also forces the brain to really think about how to best control the muscle contraction and movement.