Expert Interview - Physio on Achilles Tendinitis

1. Early Stage Treatment

Achilles tendonitis must be treated early and you must listen to your achilles when you start to feel any kind of problem. If the injury becomes chronic it is really hard to get rid off. Whereas if you catch it early it is more often easily treated.

As soon as you feel any pain or thickening then start with the rest, ice, compression (although this is hard with this area) and elevation (if there is any swelling).

Monitoring activity levels is important as complete rest may not be possible due to daily walking around. Just listen to your body. If it still swells up then you're doing too much.

Other treatments might include ultrasound or laser. Friction massage can be helpful to break down adhesions. This can be started quite early, depending on pain levels.

2. Rehabilitation

It is very similar to a calf strain in that you are loading it every time you walk or run. The only other exercise Neal uses is the eccentric calf drop. This involves doing  a calf raise but focusing on the lowering phase. This helps to increase the tensile strength of the achilles so that it can withstand load.

Keep looking at the swelling and pain levels and if these are ok then keep slowly increasing the load. You may work up to as many as 180 a day which may seem a lot. The exercises should always be under control.

Over time the pain and swelling will decrease and you can carry on these exercises throughout your return to sport.

3. Late Stage

Outside rehab for an achilles tendon injury is all about watching how it reacts as there is nothing inparticular which is going to aggravate it (i.e. jumping or twisting). It's more the amount of work and can the player and the achilles withstand the amount of work required from them. 

The key thing is to see if there is any pain not only during exercise, but also immediately afterwards and the next day as well. If there is then the achilles isn't ready and needs to go back a step.