Treatment of Achilles tendinopathy

The terms ‘Achilles tendon inflammation’ or ‘Achilles tendinitis’ are often used when speaking of Achilles tendon complaints. However, this chronic condition does not involve inflammation but degeneration of the tendon. Here we speak of an Achilles tendinopathy.

  1. What is an Achilles tendinopathy?
  2. What causes an Achilles tendinopathy?
  3. Treating the tendinopathy – stimulating the Achilles tendon
  4. Other forms of treatment for an Achilles tendinopathy
  5. Causal treatment of the tendinopathy – aside from the Achilles tendon
  6. Working against the tendinopathy with the right training plan

1. What is an Achilles tendinopathy?

An Achilles tendinopathy is a condition of the Achilles tendon that becomes apparent due to recurrent pain and problems. Over 50% of all Achilles tendon complaints refer to a tendinopathy. This affects the tendon itself and not its gliding tissue or bursas. There are also no signs of inflammation (such as redness), instead the ‘material’ of the Achilles tendon has deteriorated with time.

2. What causes an Achilles tendinopathy?

  • Constant (slight) overexertion of the Achilles tendon with insufficient recovery time (regeneration)
  • Tendon injuries that have not fully healed, normally micro injuries

The Achilles tendon has ‘got stuck’ in or is in healing phase 3, the remodeling phase.

In this remodeling phase the tendon tissue mostly still consists of lower quality material, collagen type III, and must be transformed into collagen type I.

3. Treating the tendinopathy – stimulating the Achilles tendon

Different studies have shown that mechanical stimuli on the Achilles tendon are essential for stimulating the formation of new, healthy tendon tissue and so helping the treatment to progress. Here it is important to use the right stimuli in terms of exercise and intensity when treating the tendinopathy. Here is an overview of suitable forms of treatment:

a) Movement and if possible, sporting activities

During sport, the Achilles tendon is constantly placed under strain. Weight-bearing exercise in moderation is an effective stimulus and helps in Achilles tendon treatment. Important: don’t exaggerate it and pay attention to signs of pain!

b) Strength or stretching exercises for the Achilles tendon

To date, eccentric strength training has been the subject of the most research and has shown good results. But concentric and isometric training are also justified in the treatment of the Achilles tendon. We talk about concentric training when the muscle contracts when under tension; in the case of the Achilles tendon, this is when the calf muscle contracts. Isometric training is when the calf muscle is only tensed, without shortening or being lengthened like in eccentric training.

c) Heavy slow resistance training also has good treatment results

In the case of treatment using heavy slow resistance training, the load is gradually increased, that is, work is carried out with weights and movements are slow with fewer repetitions. As with all types of training, enough recovery time is very important, but in heavy slow resistance training more so. At least 36 hours!

4. Other forms of treatment for Achilles tendinopathy:

  • low-level laser therapy
  • shock wave therapy
  • ultrasound therapy
  • massage – friction massage – trigger point therapy
  • acupuncture and acupressure
  • elastic taping – kinesiology tape
  • soft tissue mobilization
  • warming
  • sensorimotor training
  • wearing a FALKE Achilles sock

What is sensorimotor training? This refers to coordination training to improve posture and movement, always related to the corresponding sport.

5. Causal treatment of the tendinopathy – aside from the Achilles tendon

When making a diagnosis it is not only a matter of where which complaint appears in the Achilles tendon, but also where it may come from. Causes of tendinopathy can be close to or further away from the Achilles tendon. This is where causal treatment comes in:

  • custom-made insoles and trainers
  • myofascial release throughout the whole ‘human’ system (along the anatomical chains)
  • stretching exercises in other areas of the body
  • acupuncture, acupressure
  • a change in diet
  • treatment of mental components
  • healing of microinflammation in the body (e.g. teeth, intestine, toenails, etc.)
  • adapted training plan

6. Working against the tendinopathy with the right training plan

Those with no specific training plan should at least think about when and how long they should take a break for between loading periods. Without enough breaks, the Achilles tendon is not able to recover. It needs 36 hours to fully recover.

Those who do have a training plan and follow it should check whether there is a chance of overexertion and where there might be too little recovery time. The plan will then be adapted according to the results.