One of Physiotherapy London’s Lower Limb Specialists, Jody Chappell, is currently undertaking a PhD in Achilles Tendinopathy at Queen Mary’s University. We therefore asked him to summarise the main issues and for some basic pointers with regards rehab:

‘The Achilles tendon is the strongest tendon in the body, but at the same time it has to deal with the most load. The demands of exercise put the tendon under massive amounts of stress. Running is in the region of 5-6 times bodyweight usually, jumping comes in at around 8 times body weight, and multi jump events such as triple jump can be as high as 18 times body weight. Anatomically there are two muscles that feed in to the Achilles tendon, the Gastrocnemius (sprinting muscle) and the Soleus (endurance muscle). Due to there being two muscles, there are two forms of each exercise to do to rehabilitate both parts of the married couple!

If you have had some pain and/or stiffness around the Achilles tendon for a few weeks, then it is likely to just be a ’reactive’ tendinopathy because of an increase in mileage, change of shoe, or something along those lines. In these cases its best to do an exercise called ‘isometrics’, with the goal of calming the tendon down. These are just heel raises with a sustained hold at the top, and these should be done with the knees straight and also with the knees bent. Start on both legs on 50% weight share between legs, then progress over onto the affected side until you are able to do it on one leg. Start on 4-6 repetitions of 15-30 seconds until symptoms begin to ease.

If the pain has been present a little longer, say 6 weeks or so, then you are likely to be looking at a more degenerative tendon. Because the target now is to strengthen that tendon, you should look to start an ‘eccentric program’ of heel drops on the edge of a stair. This dosage needs to be MUCH HIGHER. The normal recommended dose is 3 sets of 15 repetitions with both knee straight and knee bent, and this should be done twice daily. That’s right, 180 reps every day for a period of 12 weeks! This will greatly improve the strength within the tendon itself however and if you are a runner, it will directly translate into faster running, so it’s not all wasted.

Finally, to those who are active, it is important not to stop your activity. This can actually upset a tendon longer term. You will likely have to reduce, but try to maintain your fitness and health alongside tackling the problem. If running is too painful, then switch to non-impact based exercise such as swimming or cycling.

Top Tip: DO NOT OVER-REHABILITATE AN OVERUSE INJURY. A tendinopathy is an overuse injury, the last thing you want to do is do too much so it breaks down further and deteriorates even more. If you run twice a week, then that counts as rehabilitation. The same goes for any exercise that puts more strain on the calf and Achilles tendon.

If you ever do feel pain in the Achilles tendon however, get it checked by someone who knows what they are doing. There can be many causes of Achilles based pain, including tears within the tendon, fascia cruris tears, accessory Soleus, retro-calcaneal bursitis, Achilles insertional tendinopathy and Hagglund’s deformity to name a few. A thorough history, physical assessment and scan will provide the clinician with all the information they need to produce a specially tailored rehabilitation plan aimed at getting you back to 100% pain free.