Why Relative Rest is so important when treating Achilles pain

People often ask me on YouTube: “For how long should I rest my injury?” The answer to this is “Not long at all!” Injuries don’t heal well if you rest them completely – they do much better if you give them "relative rest". Let me explain how this applies to Achilles tendinopathy or tendonitis.

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

In this article:

1. A quick recap of what causes Achilles tendonitis

2. Why complete rest isn’t useful

3. How to achieve relative rest

4. How we can help

I've also explained it in this video:

A quick recap of what causes Achilles tendonitis

Achilles tendonitis/tendinopathy is an overuse injury. Or in other words, it develops when you work the tendon too hard. The injury causes your tendon to change its structure, making it soft and decreasing its capacity to cope with the loads/forces of running or other exercise.

The only way to get it back to normal is through:

1. Making sure that you stop over-loading it (load management) – this is where relative rest comes in.

2. And doing specific strengthening exercises. These have to be prescribed on an individual basis to ensure that the exercises themselves aren’t too hard, which can cause your injury to worsen, or too easy, in which case you won’t make much progress.

Why complete rest isn’t useful

If you rest a body part completely, it will start to lose some of its strength and fitness over time. This means that you can actually weaken your Achilles tendon further if you rest it tendon completely and try to avoid using it most of the time.

Short periods of complete rest may be appropriate for very painful Achilles tendons, but this should rarely last for more than a few days.

How to achieve relative rest

Relative rest means that you stay as active as possible while your Achilles tendon recovers. You only cut out or dial down the things that really aggravate your tendon and keep on doing your other usual activities. This not only helps to preserve your tendon’s current strength, but also helps it to recover more quickly.

The tricky part is to figure out what level of activity your tendon currently can cope with that does not cause your pain to increase. Make sure that you don’t just monitor your pain during the activity, but also check what happens in the next 24 hours. If you did something today that was OK at the time, but then you have a lot more pain the next morning, that level of activity was too much and should be reduced.

For example, if you can run slowly for 20 minutes without any discomfort during or after the run (or the next morning), that run is absolutely fine to continue with. If, however, you find that your Achilles pain increases every time you try even a short run, you would be better off replacing it with walking, swimming, or cycling until your tendon is stronger. Or you may find that you are absolutely fine if you walk for 30min on a flat surface, but that your tendon hurts when your walk on uneven terrain; so, stick to walking on the flat.

Sometimes it can feel as if your tendon pain has flared up for no reason. My patients will say things like “I didn’t do anything different” or “I didn’t run further than normal”. In these cases it can be useful to look at the other things you did during those days. Did you also walk around town for several hours or did you wear different shoes or did you do a lot the day before which caused cumulative fatigue in the Achilles?

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.

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.

About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter, and Instagram.

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. Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Medicine and Arthroscopy Review 2018;26(1):16-30.