By Nick Mazzone PT, DPT, CSCS
What is Achilles tendinitis?
The Achilles tendon is the thick band that connects the rear calf muscles to the heel. Achilles tendinitis is considered an overuse injury and may be caused by a sudden increase in physical activity and is commonly seen in the running population. Some risk factors for the development of this condition may be improperly fitting footwear, a stiff ankle and foot, weakness of the muscles that act on this region, and over-pronation of the foot during walking or running. If left untreated, this condition can lead to degenerative changes in the makeup of the tendon itself, which will further exacerbate the symptoms. At this point, the condition would be considered a tendinosis.
What should be done in the early stages of this condition?
In the early stages of the condition it may be wise to combine active rest with techniques that help decrease swelling. This would mean refraining from running, long distance walking, or any other higher intensity activity that may have led to this issue in the first place. The active part of this equation would include gentle strengthening and range of motion exercises for the region to help improve blood flow for healing and address some of the issues that may have contributed to the condition in the first place. It is important to elevate the leg above chest level so that gravity can assist in decreasing swelling. If desired, ice can be used in combination with these methods as well.
What can PT do for me in later stages of this condition?
Once the acute stages of the condition have passed, it is important to restore normal function of the muscles in this region. Your physical therapist will prescribe a specific program based on your flexibility and strength assessments. Foot posture and stability will also be addressed after screening is completed. Stretching of the Achilles tendon is important; however, it is more important that we gradually reintroduce normal activities to the foot and ankle. Progressive loading of the Achilles tendon combined with eccentric exercise is the gold standard method for healing this condition.
What does progressive loading and eccentric exercise mean?
Progressive loading of the Achilles tendon simply means that we will be using specific exercises to gradually increase the amount of pressure that the Achilles tendon is under. For example, early exercises may include an activity performed with a resistance band while the foot is off the ground and later stage exercises may include activities on one leg.
Eccentric exercise simply means that we are strengthening the muscle’s ability to contract while it moves from a shortened position to a lengthened position. Most functional activities require eccentric strength. An example of an eccentric-focused exercise would be standing on your toes and then slowly lowering the heel to the ground. The eccentric portion of the exercise is the part where you focus on slowly lowering the heel to the ground (muscle is lengthening).
Check out this video that shows an example of a program that utilizes eccentric activity with progressive loading of the Achilles tendon:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Main photo (green background) retrieved from http://www.achillestendonitis.co.uk/
Photo of anatomy of Achilles region retrieved from https://www.researchgate.net/figure/The-anatomy-of-the-Achilles-tendon-and-the-suralis-muscle_fig1_262230849
Photo of “RICE” retrieved from https://www.quora.com/How-do-I-heal-my-Achilles-tendon
Photo of foot posture retrieved from http://okanaganpeakperformance.com/knee-solution-seminar-recap
Photo of heel raise retrieved from https://fitness.stackexchange.com/questions/14976/is-this-a-good-at-home-exercise-routine-for-a-beginner