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Our bubble diagram from the Running Repairs Course has been really popular so I wanted to share it with you as a visual way to discuss the key treatments for Achilles Tendinopathy:
For a step by step approach to assessment and treatment that includes all of these options in detail see our Achilles Tendinopathy Masterclass.
CLICK HERE for free access
Let’s focus first on the big bubbles, those treatments with an important role:
Activity load management and progression – it’s vital for people with tendon pain that we guide them back to valued activities. This starts by finding a manageable level that doesn’t cause a lasting flare. From there we can gradually build towards their goal which could be running and sport or simply walking and daily activities.
Progressive rehab programme – most successful rehab approaches to Achilles Tendinopathy have one thing in common – they’re progressive. I favour a heavy, slow resistance training approach as it’s follows S&C principles and seems most effective in addressing rehab needs. This usually starts with 3 exercises, each 3 sets of 15 reps (15 Rep Max) and builds with increasing loads to 12RM, 8RM and eventually 6RM over a period of around 12 weeks. I don’t think we always need to be this prescriptive. You’re likely to see good results if you select exercises based on your assessment findings, start at a manageable level and gradually increase the load over time. When strength is restored and symptoms are non-irritable it can help to work on restoring power which is frequently reduced following tendon pain.
Patient empowerment and education – the key steps that get a patient better are actually the ones that they take themselves! We can’t make them stronger or run the miles for them. So we need to help them understand the condition, address their fears and concerns and empower them to take control.
What about the rest?!… There is some evidence to support using an in-shoe heel raise for Achilles Tendinopathy so we can consider this. In addition shoe selection may help reduce tendon load if the patient opts for footwear with a high heel to toe drop (E.g. >8mm, rather than flat/ minimalist). For some patients general health and weight management may be key, especially if they are overweight or have conditions that influence tendon health such as diabetes. A subgroup of patients with Achilles pain show high levels of psychological distress and may benefit from help to improve mental wellbeing and quality of life.
Most patients see significant improvement in Achilles symptoms by around 12 weeks of treatment. In those that don’t a course of shockwave can be considered and is supported by recent evidence. Other ‘adjuncts’ such as massage, taping or acupuncture may help but the results tend to be short term and are unlikely to address the rehab needs of the patient in isolation.
Our free Achilles Tendinopathy series takes you through all these treatment options in detail including a great selection of exercises and options for progression. Access it now at clinicaledge.co/freeachilles