Achilles Tendinopathy - What to Avoid

Signs of Achilles Tendinopathy include localised pain in either the mid-portion of your Achilles tendon (mid-portion tendinopathy), or directly where the tendon inserts into the heel (insertional tendinopathy).  The pain is often worse in the morning and when first starting activity but it does tend to warm-up.  The pain can cause difficulty for activities including walking, running, and jumping.  Tendinopathy is usually a result of overloading the tendon. This may be a result of a change in your exercise routine (increased hill running, distance, jumping in a class etc).  Or it may be a result of a sudden introduction of a new activity such as training for a fun run or walk. 

Important things NOT to do when you have Achilles tendinopathy

Below is the latest research on the best practice to managing Achilles tendinopathy. 

1.     Rest: it’s normal to assume rest is the best thing when you are feeling pain.  Rather than complete rest, activity modification is normally required.  If you stop activity completely, you stop the tendon taking on load.  Tendons need load in order to repair.  Complete rest will make you feel better initially but as soon as you return to any activity the pain and weakness will also return.

In the case of the Achilles, you may need to manage high load activities such as fast walking or running (especially with an over stride), jumping, skipping etc, it’s important to implement loading but the type of loading you do is the key.  Your health professional is the best person to assist you in developing a program for your individual needs.

2.     Ignore it: If you continue overloading the tendon (running, jumping etc), you will continue to have pain.  Pain is the body’s way of telling you to stop and decrease the load.  A customised exercise program will find the best load for you to work with.

3.     Cortisone Injections: There is no good clinical evidence for the effectiveness of cortisone injections, some studies show they may even accelerate tendon degeneration (Coombes et. Al. 2010).  Any effect they have is often short-term, up to 2 months.  They are also invasive and can be uncomfortable to have. It is encouraged to persist with a good exercise based rehabilitative program before embarking down this route.

4.     Stretch your tendon: When you stretch you compress the tendon; this compressive load may aggravate it further.  With insertional Achilles tendinopathy (when the pain is located towards the heel), stretching the calf will put excessive compressive loads on the tendon.  A small amount of stretching may be okay as long as it does not cause pain.  If you are symptomatic (if it hurts to stretch) it is wise to back off the stretching for now.

5.     Massage the tendon: massaging an irritable tendon will only aggravate the tendon and increase the pain. Massaging the surrounding muscles may be of benefit. 

The key to a good tendon rehabilitation program is getting the load right for the individual, everyone is different and everyone tolerates different loads.  You can speak with us regarding the best approach to your Achilles Tendinopathy.