By Annika Piros, PT DPT
Do you ever experience pain in the back of your heel? Does this pain limit your ability to walk, run, and carry out daily tasks? You may be experiencing a condition called Achilles tendinopathy. Achilles tendinopathy is a common and painful condition, often endured by runners and endurance athletes, that results in functional limitations due to pain.
As part of my doctorate studies at George Fox University, I conducted research on individuals with achilles tendinopathy. As you may be experiencing, this condition makes it difficult to resume regular activity and exercise.
What Causes Achilles Tendon Pain?
Many tendon injuries fall under the umbrella term of tendinopathy: this term covers tendonitis (inflammation of the tendon) and tendinosis (degeneration of the tendon). Achilles tendon pain is The mechanism of injury for this condition falls into a cycle of acute-on-chronic injury where the tendon can never fully heal prior to being re-injured again.
This continuous re-injury leads to the eventual degeneration of the tendon (tendinosis), meaning it can no longer effectively tolerate and transfer load to your muscles for optimal force production. This decreased load capacity can often result in heel pain and muscle weakness (tendon connects muscle to bone) making it difficult to operate at former levels of physical activity.
Treatment for Achilles Tendon Pain
The good news is that physical therapy can help with this condition! A specific type of Achilles tendinopathy known as mid-portion Achilles tendinopathy, responds very well to a progressive loading program.
A revision to the physical therapy clinical practice guideline for this condition was released in 2018 and outlines the efficiency of current interventions for this condition. Exercise (specifically a heavy-load, slow-speed concentric-eccentric program) was deemed the most beneficial, receiving a “Grade A” recommendation – the highest level of recommendation.
To put this into perspective: no other type of intervention received a Grade A recommendation! This is very exciting for physical therapists as we are licensed healthcare professionals and movement experts that prescribe exercise in the rehabilitation of injuries.
Exercise Recommendations for Achilles Tendon Pain
The most effective exercise for relieving Achilles tendinopathy pain is an eccentric calf raise. The key to this move is to progressively load the tendon to induce adaptation. In a pathological tendon, collagen cross-bridging (the elastic materials that make up your tendon) are disorganized which results in poor load tolerance. In order to promote healing of the tendon, a progressive loading program is necessary.
A physical therapist can help you recover from this condition. Physical therapists have extensive training – all physical therapy programs now award a Doctor of Physical Therapy degree – and are the most well-equipped in the treatment of this condition. A physical therapist can help you restore mobility, strength, and function that is often lost when suffering from tendinopathy.
Your physical therapist will perform a thorough evaluation of your condition and any mobility issues you may be having, educate you on modifiable risk factors, and perform interventions such as corrective exercise.
Other Interventions to Reduce Heel Pain
Other interventions such as manual therapy may be used to help modulate pain. A physical therapist will evaluate neighboring body regions – i.e. the hip and knee that may be contributing to physical dysfunction and restriction at the achilles. It is important that a physical therapist prescribe the appropriate dose of exercise to help you recover from this condition and get you back to enjoying the activities you love!
If you are suffering from Achilles tendon pain and are looking for relief, contact your nearest Therapydia physical therapy clinic.