Pain in the Achilles tendon is relatively common in recreational exercisers, individuals active in sports, and even occurs in inactive individuals. Tendinopathy is generally caused by overuse of a muscle-tendon unit.
Over time, the strain on the tendon causes structural changes within the tendon.
Overuse of the Achilles tendon can occur with activities such as:
Factors that may increase your risk of getting Achilles tendinopathy include:
Symptoms of tendinopathy may include:
Heel dropping exercises in both knee positions performed 2 times per day to tolerance are an effective way to restore strength and elasticity in a dysfunctional Achilles tendon. Loads can be placed in a back pack and worn during the exercise when exercising with the weight of the body is no longer painful.
Conservative treatment for mid portion Achilles tendinopathy has been proven effective. One of the most supported conservative treatments is a specific exercise program described by Alfredson in 1998. Alfredson's model of eccentric heel drop exercises emphasizes the need for patients to complete an exercise protocol of 180 heel drops per day (3 sets of 15 with knee extended and knee bent to 45 degrees twice per day) despite pain in the tendon. If the patient experiences no tendon pain doing this program, the load is increased until the exercise provokes pain. This 12 week program has been proven successful in approximately 90% of those with mid-portion Achilles tendinopathy.
In 2014 Stevens and Tann challenged this protocol by modifying the regime to a repetition volume that was tolerable to each participant. The new protocol used the same exercises as Alfredson but instructed the participants to do as many reps as was tolerable. Furthermore, they were told to exercise to discomfort but not excessive pain. Stevens and Tann compared this modified protocol to the standard 180 reps per day protocol over a 6 week period and found no difference between the groups, with both groups demonstrating improved function and reduced mid portion tendon pain. They concluded that patient tolerance of the exercise should be considered when determining proper dosage of eccentric heel drop exercises to address mid-portion Achilles tendinopathy.
Stevens, M., & Tan, C.-W. (2014, February). Effectiveness of the Alfredson protocol compared with lower repetition-volume protocol for midportion achilles tendinopathy: A randomized controlled trial. JOSPT, 44(2), 59-67.
Alfredson H, Pietlia T, Lorentzon R. Heavy Load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med, 1998:26, p. 360-366.
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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