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Why Relative Rest is so important when treating Achilles pain

Updated: Feb 17

I often see people in the Sports Injury Group ask “For how long should I rest my injury”. The answer to this is really “Not long at all!”. Injuries actually don’t heal well if you completely rest them – they do much better if you give them relative rest. Let me explain how this applies to Achilles tendinopathy or tendonitis.



In this article:

  • Quick recap of what causes Achilles tendonitis

  • Why complete rest isn’t useful

  • How to achieve relative rest


I've also explained it in this video:



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.


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 tendon further if you rest your Achilles 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 the things that really aggravate your tendon and keep everything else. 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 the pain that you feel while doing 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 ground – then 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?


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

Best wishes

Maryke


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 or 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.

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