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The Best Treatment for Achilles Tendinopathy (PS it’s you)

Updated: May 29, 2019

In this blog I look at the current evidence around the best treatment for Achilles tendinopathy / tendinitis / tendonitis and why this is important.



In this article:

  • What’s the best treatment?

  • Why does it work?

  • What can I do?


What’s the best treatment for ongoing Achilles pain?


Quick answer: Making the Achilles and the surrounding muscles stronger


Achilles tendinopathy is a painful condition that, when it’s really sore, can reduce the amount of sport and activity we do. If a tendon has been sore for a few weeks, months or years, there can be a change in what the tendon looks like if you were to look at it structurally.


Please see our blog on “Why do I have a lump in my Achilles tendon?” for details on what happens to your Achilles when you get a tendinopathy. For a more scientific explanation please see this article by Cook et al 2016.


This change in the structure of the tendon causes it to lose some of its strength and capacity to cope with exercise. The aim of treatment is to improve the capacity of the tendon and associated calf muscles (with specific exercises) so that it can cope with the amount of activity (load) you want to do.


As your muscles and tendon get stronger, you’ll notice a reduction in your pain and symptoms. It’s important that you continually monitor your pain and response to the exercises as you can aggravate your tendon pain if you don’t do the exercises at the right level.


As to what exercises to do, these will vary greatly for each individual. Everyone has different starting points, health, size, strength, medications, previous injuries, lifestyles (including stress) and therefore it’s important to be prescribed these by a professional who can take all of these factors into consideration.



Why does it work?


Strengthening the calf muscles will also strengthen the tendon tissue by increasing its ability to carry load. A tendon is made of collagen. To keep collagen healthy it’s in a permanent cycle of laying down new healthy collagen fibres and removing the waste products and parts of the old fibres that the body no longer needs. Strength training increases the production of new collagen, therefore making the tendon more robust and less at risk of injury.


In some cases this can reverse the change in the tendon’s structure that occur as a result of a tendinopathy. In other cases, exercise will change and strengthen the fibres around those that are injured and act like a support by increasing the robustness of the tendon as a whole unit.



What can I do?


As I mentioned before, everyone’s starting point and indeed end point is different. What are your goals for example: couch to 5k, half marathons or ultra marathons?


You first need to establish what exercise you can already do without flaring your pain up. This is your starting point from where you can slowly build your strength. You then have to look at what you have to be able to do in order to achieve your goal.


The exercises that you do for your Achilles and calf (as well as the rest of your body) should be planned and adjusted so that they start at your current level and eventually take you all the way to your end goal.


It will be money well spent to see a professional or be referred to someone who can test you and find out where you should start your exercises and training. But, importantly, also work out how you should progress your exercises over the weeks it will take for your symptoms to disappear and for you to reach your goal fitness. Unfortunately there’s no quick fix for Achilles tendinopathy – it will take between 3 to 6 months for your muscles and tendons to adapt to the exercises and become more robust.


Need more help with your injury? You can consult us online via video call for a full assessment of your Achilles as well as the rest of your body. Have a look at how it works and let us 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. Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine 2016;50:1187-1191.

  2. Silbernagel, K. G., Brorsson, A., & Lundberg, M. (2011). The Majority of Patients With Achilles Tendinopathy Recover Fully When Treated With Exercise Alone: A 5-Year Follow-Up. The American Journal of Sports Medicine, 39(3), 607–613.

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