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Achilles tendonitis rehab - What if you can’t rest your tendon?

Updated: 7 days ago

A common question people ask us on social media is, “In my job, I can’t rest my injured Achilles tendon. How can I still do the rehab strength training on top of that?” Here are some tips that may help you to get your Achilles tendon rehab done in spite of having a physically demanding job. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.


It can be difficult to treat Achilles tendonitis if you can't rest your tendon because your job requires you to be on your feet.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.


In this article:

  1. Adapt your footwear

  2. Heel lift shoe inserts

  3. Relative rest

  4. Adapted strength training

  5. How we can help

Adapt your footwear


Shoes can make a big difference to how hard your injured Achilles tendon has to work when you walk.


Flat shoes place your Achilles tendon in a more stretched position. Injured tendons don’t like being stretched. Shoes that have a slightly raised heel reduce the strain on the Achilles tendon and may allow you to walk with less pain.


Injured tendons also don’t like being compressed. It has the same effect as prodding a bruise; the more you do it, the more it hurts.


Test several pairs of shoes. Can you find a pair where the heel is somewhat higher than the toes and doesn’t press directly on the injured part of the tendon? Running shoes are often a good solution.


I realise that not everyone can choose what shoes they work in. For instance, if you work in construction, you may be required to wear steel-toe boots. If this is the case, heel lift inserts may help.



Heel lift shoe inserts


Heel-raising shoe inserts are simply foam discs that you place inside your shoes to lift your heels. These may help if you’re forced to wear flat shoes for your job.


Quite a few of our patients with acutely flared up insertional Achilles tendonitis find that they have to combine heel inserts with higher-heeled shoes to get effective relief.


If you want to try these out, test flatter heel inserts first, and don’t wear them for too long when you start out. They change the way your foot carries your weight and can cause other injuries if they’re too high or you don’t ease into wearing them.


Put them in both shoes to keep things even.


If they feel uncomfortable, take them out.


Heel raising inserts can reduce the strain on your Achilles tendon.
Heel raising inserts can reduce the strain on your Achilles tendon.

Relative rest


You may not be able to completely cut out all aggravating activities, but you may be able to adapt what you have to do so that it doesn’t aggravate your tendon so much. For example:

  • Figure out whether it’s possible to cut down on the number of times you have to climb stairs in a day. Can you box clever with when and where you do what?

  • What “extra” walking or standing are you doing in a day (both in work and general life) that can temporarily be done by someone else? Or can you drive instead?

Any reduction in activities that load your Achilles tendon may help it to calm down.



Adapted strength training


If your Achilles tendon is already being pushed to its limit during the day due to your work or other tasks, it will likely not tolerate any of the traditional strength training programmes prescribed for Achilles rehab. However, it may be able to tolerate an adjusted programme.


Some of the things that we’ve found to work for our patients who find themselves in this position are:

  • Starting with a very low dose of low-load exercises (often isometrics, but for some isotonics have worked better).

  • Doing the exercises only two or three days a week.

  • Not sticking to a rigid plan (e.g. doing exercises on Mondays, Wednesdays, and Fridays) but rather being flexible and doing the exercises on days where the tendon has not had a very large load. What counts as a large load is different for everyone and also changes over time as the tendon recovers. So, we teach our patients how to assess this. Rest and recovery is sometimes more important that strength training.

  • Accepting that their progress will be slow and keeping a pain diary to heighten their awareness of the small improvements they experience month-by-month.


How we can help


Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

Meet the TMA physios

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.



References:

  1. Cook J, Docking S. “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians. British Journal of Sports Medicine 2015;49(23):1484-85. doi: 10.1136/bjsports-2015-094849

  2. Rabusin CL, Menz HB, McClelland JA, et al. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. British Journal of Sports Medicine 2021;55:486-492.