Achilles Tendonitis Rehabilitation

Decreasing Pain and Swelling

• 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 - apply for 15 minutes at least three times a day. Every two hours if possible for the first day.
• 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.
• Rest - use crutches if needed.
• 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.
• Anti-inflammatory medication can be taken (under Doctors advice of course).
• Maintain fitness by non weight bearing exercise such as cycling if pain allows.

Improving Flexibility

• Once you can perform daily activities pain-free, move on to this stage.
• Concentrate on improving the flexibility of the calf muscles (Gastrocnemius and Soleus). This will reduce the strain on the achilles tendon.
• Two stretches 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.

Strengthening

• The aim is to strengthen the calf muscles and the achilles tendon. It is important that you strengthen the tendon in the stretched position. See strengthening exercises.
• There has been a lot of research into strengthening exercises during the rehabilitation of achilles tendinitis. The current concept is based around eccentric contractions. These are muscle contractions where the muscle lengthens to control a downward movement.
• Heel drops and raises are used in the rehabilitation of achilles tendonitis.
• Particular emphasis should be placed on the downward phase as this is the eccentric contraction.

Improving Proprioception (neural co-ordination)

• 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.
• 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.

Returning to Full Fitness

• When you have gone at least a week without pain and the range of motionat the ankle has improved then you can begin to return to training.
• If you feel pain when returning to training 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.

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 programmes. 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.
• You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return.