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Achilles Tendonitis can be difficult to treat with no single approach being effective on its own. We outline a step by step approach to curing achilles tendonitis.
We recommend seeking professional advice before attempting any self help treatment. The aim of an achilles tendonitis rehab program is to decrease the initial pain and inflammation, improve calf muscle flexibility and strength, re-establish joint co-ordination and gradually return to full fitness.
Rest is very important. Achilles tendonitis is one injury that you should listen to your body with and if it hurts rest it. If acute achilles tendonitis is allowed to become chronic it can be very very difficult to cure.
This is the first stage of treatment, which can last for anywhere from 3 days to several weeks, depending on the severity of your condition. Cold therapy can be applied for 15 minutes at least three times a day. Every two hours if possible for the first day.
Place a heel lift of about 1cm into both your shoes to help take the stress off the tendon. Do not leave it there forever! If the calf muscles adaptively shorten, an increased strain will be placed on the achilles tendon in the future.
Identify the cause of the injury. Training too much too soon, training on hard surfaces, wearing the wrong shoes or shoes that are too old and not warming up are possible reasons for the injury occurring. Also, if you overpronate, the Achilles is twisted putting more strain on it.
Anti-inflammatory medication can be taken under a Doctors advice. This may help in the short term to reduce inflammation and pain of acute achilles tendonitis although there is no proof long term the medication can help and may even inhibit healing.
Maintain fitness by non weight bearing exercise such as cycling if pain allows. Rest is always the priority in the early stages.
Once you can perform daily activities pain-free, move on to this stage. Concentrate on improving the flexibility of the calf muscles. This will help to reduce the strain on the achilles tendon. Two stretching exercises in particular are important, one with a straight leg for the gastrocnemius muscle and one with the leg bent to target the soleus muscle.
Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
Use sports massage techniques. This will help prevent adhesions forming within the tendon. These adhesions stop the tendon sliding smoothly in its sheath. Sports massage should also be used on the calf muscles themselves to aid in improving the flexibility and general condition of these muscles.
Eccentric exercises have been proven to be very effective in the treatment of achilles tendonitis, particularly chronic achilles injuries. If the injury is a recent acute injury then rest is the priority until there is no pain.
If however the injury has become chronic and been around for weeks or months then beginning the Hakan Alfredson's eccentric heel drop exercise program is advised. Eccentric exercises are those where the calf muscles get longer as they contract and involved dropping the heel down from a tip toe position on a step. See achilles tendon heel drop exercises for more information.
Proprioception is the neural control or co-ordination of a joint. It is possible that the neural control or co-ordination of the ankle has been affected, especially if the injury has been severe and required a sustained period of rest. Wobble balance board exercises or balancing on one leg is a good way of developing proprioception. This will help prevent spraining the ankle in future and is a good all round strengthening exercise for the ankle. Aim for 2 minutes without wobbling. To challenge the ankle even further, a wobble board can be used.
When the patient has gone at least a week without pain and the range of motion at the ankle has improved then you can begin to return to training. If pain is felt when returning to training either during, after or the next day then stop.
Begin each training session with a walk to warm up followed by stretching. After training apply ice or cold therapy to the tendon for 10 minutes to help prevent inflammation from returning. Below is an example of a gradual build up running program.
Day 1: walk 4 minutes jog 1 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 2 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 3 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 4 minutes repeat 4 times
Continue this gradual progression until you can confidently run and resume normal training. Gradually increase the duration of your runs. No more than 10% increase per week is the usual recommendation. If your sport demands sprinting then gradually increase the speed. Continue with the stretching and strengthening programs. It is important to do these even if you do not feel pain at this stage. Continue for at least three months. Continue to ice the tendon after training.