Rehabilitation of Achilles bursitis or retrocalcaneal bursitis is based on reducing pain and inflammation, identifying possible causes and gradually returning to full fitness.
The guidelines below are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation. Stage 1 is to reduce pain and inflammation. Stage 2 involves identifying and eliminating the causes of bursitis. Stage 3 restores flexibility and strength to enable a return to full fitness.
Reducing pain and swelling
This involves rest from activities that aggravate it. If running makes it worse then refrain from running until such time as pain allows. You may be able to swim or cycle. It is important to try to maintain some kind of fitness. This stage may take anything from a couple of days to a couple of weeks.
Wear shoes without backs to them which can relieve the pressure on the heel. A foam ring cut to fit around the bursa to protect it from rubbing on the shoe may take the pressure off the bursa and allow it to heal faster.
NSAID or Non steroidal Anti-inflammatory drugs (e.g. Ibuprofen) may be prescribed to help reduce the inflammation. You should check with a Doctor before taking any medication. Ibuprofen should not be taken by anyone with asthma.
Apply cold to the site of pain. This will help to reduce the inflammation. Ice can be applied although not directly onto the skin - wrap in a wet tea towel. Ice can be applied for 10 to 15 minutes every two hours depending on severity of pain and time available. You should aim to apply cold therapy three times a day at least. When the initial pain and inflammation has died down, progress to stage 2.
Identify and correct possible causes
Common causes of Achilles injuries include tight calf muscles and overpronation. Both of these are easily correctable.
One method of identifying tight calf muscles is to have the patient sit on a table with the legs out in front and feet hanging over the edge. The therapist then applies a gentle stretch
Insoles can be worn in the shoes to reduce overpronation, placing less strain on the tendon. Wearing the correct running shoes is also very important. If unsure, visit a podiatrist, or a specialist running shop for a gait analysis.
Stretching the calf muscles should be performed regularly, every day, in order to increase their flexibility. Both the Gastrocnemius and the Soleus muscles need stretching.
Return to fitness
When pain has gone, slowly build back to your original level of exercise. Aim to start back at 50% of your original workload, although this may be less depending on your fitness and the amount of time you have spent resting. It is important to remove any irritation to the bursa. Check that the shoes are not rubbing on the bursa or cut away any material that might cause irritation of the bursa.
If you have looked after yourself you should be back to full training within two to three weeks. Be patient and allow about a week of active rest for the bursa.
The following is a basic guideline for returning to training. This will vary depending on previous fitness and extent of the injury.
Day 1: Walk 4 minutes, jog 2 minutes, repeat four times
Day 2: Rest
Day 3: Walk 4 minutes, jog 3 minutes, repeat three times
Day 4: Rest
Day 5: Walk 3 minutes, jog 4 minutes, repeat four times
Day 6: Rest
Day 7: Walk 2 minutes, jog 6 minutes, repeat four times
Continue this gradual progression until you can confidently run and resume normal training.