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So I’ve started doing some Achilles exercises, how long does recovery take?

Well done for making a start and heading in the right direction! Unfortunately there are no quick fixes for Achilles tendinopathy and things take time. How long this is relies on many variables. In this blog post we explore what you need to consider and how long things might take to improve. If you tick off the considerations in this blog, it will help you discover what is the right pathway for you.



In this blog we will explore:

  • How does my diagnosis affect the timescale of getting better?

  • Have I got my treatment right and why this matters?

  • Have I given myself enough time in the first place?

  • Have I looked at the bigger picture?

  • I’ve done all the above and its still not improving, what next?


How does my diagnosis affect the timescale of getting better?


Have you had your Achilles assessed my a medical professional? There are common signs of a tendinopathy that you can find in this link that can help you diagnose your condition.


Occasionally there can be another reason (other than a pure tendinopathy) for your Achilles pain. Medical professional such as a Physiotherapist can identify this by listening to how your symptoms feel/act as well as how it all started in the first place.


Sometimes there may be previous medications you have taken or indeed other medical issues / conditions for example the menopause that can affect the rehab timescale and you may need to progress slower. Therefore your professional needs knowledge of your medical history too.


These different diagnoses may change how long it will take to get better and what rehabilitation you need. So before you embark on exercises, please see a professional to make sure you are doing the right ones for you.


Have I got my treatment right and why this matters?


If you do an internet search for Achilles tendinopathy treatment, many options of treatments can pop up on your search list. Some of these may have an up-to-date researched evidence base, some of which may have been shown by research to not be effective, and others may not have been studied much at all.


The best treatment for Achilles tendinopathy that has been proven time and time again is exercises that make your calf and tendon more robust, alongside looking at your activity (load) and monitoring what you do and how that makes your tendon feel. These exercises must be tailor made to you and your abilities, activity, and current condition as well as progressed over time.


Passive treatments like acupuncture, cross friction massage techniques and some electrotherapy modalities (such as ultrasound) have been shown to not be effective treatments for Achilles Tendinopathy and therefore we do not advocate them at Treat My Achilles.



Have I given myself enough time in the first place?


A common reason why people don’t find strength exercises useful is that they haven’t persevered for long enough.


Strength takes time!


If you imagine going to the gym and lifting some weights - you won’t suddenly be stronger after just one session or if you only went for a few weeks. Your body needs time to adapt to this strength stimulus and so does your Achilles tendon.


The research shows us that most people should start to notice a good change by 6 weeks and be significantly better by 3 months of regular, progressive (gradually made more difficult) strength exercises in addition to looking at their activity levels.


It can be demoralising to start a strength regime and not see major results sooner rather than later, but the big tip here is to keep going.


Have I looked at the bigger picture?


By this I mean what you do such as your job, looking after children, walking dogs or going on school runs and doing other sports. All this equates to the total load your Achilles tendon has to absorb in a day.


If you have diligently been doing your exercises but not addressing this load or any training errors in your programme, this may be a reason why you are not progressing and why things are taking too long.


At treatmyachilles.com we look at your overall load and help design your training programme with you whilst considering the bigger picture. If this load is a contributing factor to your symptoms or hampering your strengthening exercises, then we may ask you to apply relative rest. This means cutting out only the really aggravating activities or adjusting your training programme so that you can continue to train without making your injury worse.


Rest alone is not useful for getting tendons to recover. It may make the pain feel better for a while but it will not fix the injury or prevent it from coming back. In most cases you don’t need total rest to allow healing to take place.


I’ve done all the above and its still not improving what next?


If the above have all been considered and at 3 months there has been no improvement, it is worth revisiting your rehabilitation programme and possibly adjusting it accordingly. The main bulk of evidence shows that up to 12 months of rehabilitation may even be necessary before we can say this isn’t working for you. However, during this time the programme needs to be adjusted and progressed as you need it to for your individual goals and symptoms. It’s no use doing the same exercises at the same level for 12 months.


There are other treatment options that can be explored after 3 months with no improvement, such as Shockwave therapy, and it may be worth seeking a Consultant’s opinion alongside this.


It is only after 12 months of all of these factors being considered and after good compliance with a progressive rehabilitation programme that surgical options would be considered and this is on a patient by patient basis.


Need more help with your Achilles injury? You can consult us online via video call for an assessment of your injury and a bespoke treatment plan. Let me know if you have any questions!

Best wishes

Alison


About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.




References

  1. Challoumas D, Clifford C, Kirwan P, et al. How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials. BMJ Open Sport & Exercise Medicine 2019;5:e000528. doi:10.1136/bmjsem-2019-000528

  2. Korakakis, V., Whiteley, R., Tzavara, A. and Malliaropoulos, N., 2018. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med, 52(6), pp.387-407.

  3. Scott, A., et al. (2013). "Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012." British Journal of Sports Medicine 47(9): 536-544.

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