Achilles tendon pain, previously called achilles tendinitis and now called achilles tendinopathy, is a common condition in both sedentary, active, and athletic populations. Researchers estimate this condition will affect between up to 1 in 5 runners in their lifespan with the highest prevalence among all athletes found in ages younger than 45. In our practice we most commonly see this injury among patients with a training error (too much too soon or too little for too long) on parameters of activity frequency, duration, and intensity. In addition, abnormal mechanics secondary to imbalances of strength, mobility, and balance can also play a role.
As our understanding of tendon injuries has improved we have moved away from strict rest for a tendinopathy and instead focused on load management. An often challenging task of balancing activity, exercise for the injured body part, and recovery time periods. As the tendon is loaded through exercise it undergoes an important part of the healing process called remodeling. Allowing the tendon to improve its’ stiffness, strength, and most importantly, its’ tolerance for a patient’s preferred activities.
A recent clinical practice guideline was updated in the Journal of Orthopedics and Sports Physical Therapy highlighting the most important treatment strategies for mid portion achilles tendinopathy (Chimenti et al. JOSPT. 2024). Authors recommended against the utilization of ultrasound or low level laser in this population. Importantly, authors continue to recommend against strict or complete rest of the injured tendon. Instead, patients are educated to continue with their activities as tolerated.
Exercise remains the most supported intervention for patients with achilles tendinopathy. These tendon loading exercises are critical for healing and should be used as a first line treatment. Working with a Physical Therapist can correct your mechanics, contributing factors, as well as, determine the most appropriate load management strategies for the tendon.
Click here to schedule your next appointment with the experts at MEND