Achilles tendinopathy is a condition I see commonly in clinic. It can be tricky to treat. This is why I developed my online course to share with you everything you need to know and do to resolve this problem and prevent it from coming back.
Although I’ve written numerous blogs on the subject there are still things I get asked by many, I thought it would be helpful to share these in the hope they may help answer some of your questions – so here we go.
Does Achilles tendinopathy ever heal?
It can take weeks or even months to recover from Achilles tendinopathy. For most people, the pain and movement improve after around 12 weeks of self-help measures and physiotherapy exercises. I like to think of it in 2 stages the very painful acute stage, which if you do all the right things generally settles in a couple of weeks. Stage 2 which aims to change the structure of the tendon improving the health and reducing degeneration will often take 3-6 months. This stage is essential to ensure the tendon is properly healed.
Is Achilles tendinopathy permanent?
If the problem is not correctly managed then tendinopathy can be permanent. Many people will settle the acute and painful tendon down thinking that the problem has gone. Not realising that they still have Achilles tendinopathy which simply means that their tendon has chronic changes in it making it weaker and risking a recurrence of pain as well as rupture. If you follow the correct rehab then you can regain the health of the tendon and return to full strength and function.
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Should you massage Achilles tendinopathy?
I am unaware of any evidence that massage will help improve this problem. Last week I had a new patient in the clinic with this exact problem, he had been struggling for 4 months and was getting worse. His sister had very kindly been massaging it and had only seemed to make it sorer after. This didn’t surprise me, as in the early stages they are often too sore to even light touch. I would not use massage for these problems, but you can do plenty of things to help.
Should you use a Walker boot, innersole, or night splint with Achilles tendinopathy/tendonitis?
I’ve never felt the need to advise the use of a walker boot for this problem, and it can be settled down without it. The walker boot would offload the tendon and in theory, would work but the use of a boot alters the way you walk and can lead to other issues. However what I do use regularly is innersoles that help align the foot off loading the tendon, normally with medial arch support. Not everyone needs these and in the Achilles tendinopathy online course, you complete a biomechanical assessment which will tell you if this is important for your tendon. It also identifies any other issues with your biomechanics that you will want to address. Enabling quick recovery and return to tendon health. A night splint can also be a helpful adjunct if you are struggling to settle the pain down as it prevents microtrauma of the tissues when you take your first steps in the morning or after a long rest. This is covered in the course.
What exercises should I avoid with Achilles tendinopathy/tendonitis?
Some everyday activities that will aggravate your Achilles include:
- Sporting activities involving jumping, running, and sprinting. More about Achilles Tendons and running here.
- Walking on uneven ground for long periods.
- Walking up and downhill.
- Gardening, or other activities involving squatting, and stretching the tendon
- Walking up and down ladders for work.
Resolve Pain Quickly On My Physio Led Program. Click to learn more.
What is the fastest way to heal Achilles tendonitis?
The first stage is to settle down the acute pain. POLICE (protection, optima loading, ice, compression, and elevation) is the gold standard combined method of managing acute soft tissue injuries. Early stage Achilles tendinopathy. (from research by Bleakley, Glasgow and MacAuley 2011). I take you through the fastest way to settle this problem in my Achilles tendinopathy (tendinitis)Program, but here are the basics.
- Protection – To prevent further injury reduce walking for a while support and offload the tendon with an innersole if appropriate. use of a night splint may also help.
- Optimal loading – Initially activity especially on your feet will need to be reduced but don’t rest, rest makes tendons more unhealthy. Doing too much will also aggravate the tendon making things worse – so it’s all about managing load. not too little not too much. Once things start to settle the key to regaining tendon health is correctly loading the tendon. Find out more about this here.
- Ice – The use of ice for 10-20 minutes has been shown to help. Please refer to the blog on how to apply ice safely.
- Compression – Swelling tends to be localised in this case so I don’t find that compression in my experience is much use.
- Elevation – This is to reduce swelling, but this tends not to be too much of an issue so not essential to do.
The 3 main points are ice, and optimal loading and protection initially. Then it’s all about LOAD and doing the right thongs at the right time to regain tendon health.
What are the symptoms of tendinopathy/tendonitis?
The main symptoms of tendonitis are:
- Pain at the heel or just above.
- Warm-up pain – Pain is often worse at the beginning of a walk/run and often will ease off after a while, sometimes returning again towards the end of the activity.
- Delayed pain after an activity – sometimes the pain is not too bad during the activity but later that day or the next day pain increases.
- Stiffness within the tendon – first thing in the morning or after resting for long periods – eases off with movement.
- Creaking/squeaking of the tendon when you move your ankle.
- Tenderness within the tendon there tends to be a particular part that is sore.
- Swelling/thickening of the tendon. Have a feel of the tendon is it thicker than the other side?
What triggers tendinopathy?
Tendinopathy is generally caused by overuse of a muscle and tendon. Over time, the strain on the tendon causes the structure of the tendon to change becoming degenerate and more prone it causing pain or rupture.
How can I speed up my tendinopathy recovery?
It’s all about doing the right things at the right time. My Achilles Tendinopathy Program guides you through this step by step.
Should I rest tendinopathy?
The main emphasis is not to completely rest the tendon but to appropriately load it. Find out more about the appropriate loading of the tendon to settle things down before increasing the load to improve tendon health in this blog.
Should you stretch with tendinopathy?
Stretching your tendon generally feels nice. But be careful as overstretching can irritate a sore tendon and overstretching can negatively impact tendon health. Just like with loading it’s all about doing the right amount. My Achilles tendinopathy Program assesses the length of your calf and tendon so that you can appropriately stretch as needed. This is part of the biomechanical assessment I lead you through looking at foot and knee position and glutes and core strength before moving on to address any issues we find. This is an essential part of settling down the problem and preventing it from returning.
Do you need surgery for tendinopathy?
Tendonitis if treated correctly rarely needs surgery. The first course of treatment after settling the initial pain is based on a loading program. Shockwave therapy also has good evidence of being effective but is only advised after completing the treatment pathway found in the Achilles tendinopathy Program, the advice is then for the exercise to continue alongside shockwave therapy, as per NICE guidelines.
Does a hot bath help Achilles tendinopathy/tendonitis?
Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis. Heat can increase blood flow, which may help promote the healing of the tendon. Heat also relaxes muscles, which can relieve pain.
However, in the early acute stage of tendinopathy ice is more beneficial. Find out if you have Achilles tendinopathy and how to treat it here.
Do calf raises help Achilles tendinopathy/tendonitis?
Calf raises are the best way to load the tendon which is essential in the successful treatment of this problem, especially once the acute pain has settled and you are beginning to improve your tendon health. However, it’s not quite as simple as this. There are lots of elements that need doing and adding at the right time to make this calf raise effective in regaining health in the tendon. My Achilles Tendon Program tells you what to do and when. we need to look at factors such as 2 feet or a single leg, on or off the step, when to add external load, and how much. Knee bent or straight or both and the importance of different types of loading at different stages, eccentric, concentric, and isometric. just to start. Find out more in my blog about eccentric loading.
Resolve Pain Quickly On My Physio Led Program. Click to learn more.
What is the prognosis for Achilles tendinopathy?
What is the prognosis? Most people with Achilles tendinopathy improve quickly with a course of treatment as per my Achilles Tendinopathy Program. Typically within a couple of weeks most see a significant improvement in their pain. Pain and function usually improve after 12 weeks of treatment [Asplund, 2013]. However, in some cases, symptoms of Achilles tendinopathy may last for up to 2 years [Morton, 2016]. No one wants to wait 2 years! – get started today and you will soon be back up and running.
Why won’t my Achilles tendonitis get better?
It’s tricky to get this problem resolved without guidance because it’s all about loading the tendon to return it to health. However, too much load makes it worse as does too little load! here lies the problem. As well as this if you have not worked out why you got the problem in the first place and then taken action to resolve this then as soon as you start the increasing activity again it will flare back up as the underlying issue is still there. In the Achilles Tendon Program I lead you step by step through the process ensuring you do the right thing at the right time. We also look at your risk factors and complete a biomechanical assessment before working to resolve any underlying issues. Get started today and you will soon be back up and running.
Is Tendinopathy the same as tendinitis?
Achilles tendinopathy is caused by an over or underloading of the tendon resulting in degenerate changes and poor tendon health. Historically this problem was referred to as tendonitis (inflammation of the tendon). As our understanding of this problem has evolved we realise that it’s not true inflammation that we are treating but poor tendon health. The term tendonitis is no longer factually correct but is still widely used even by health care professionals, no wonder we are confused. However, this more recent change in our understanding has helped improve the way we treat this problem. We are no longer treating what we thought was inflammation (tendonitis) but actively changing the structure and health of the tendon. Find out if you have tendinopathy here.
What age is tendonitis most common?
Although tendonitis can occur at any age, it is more common in adults over 40 years of age. As tendons age, they tolerate less stress and are less flexible. Find out if you have tendinopathy here.
Is tendonitis a form of arthritis?
No. Although within a tendon that has tendinopathy, you do see degenerative changes. Mainly changes in the collagen structure which is what gives the tendon its strength. Find out more about Achilles tendinopathy here and how to treat it.
Can Achilles tendinopathy cause rupture?
Unfortunately, yes. Tendinopathy creates poor health within the tendon, especially within the collagen fibres which give the tendon its strength. Ruptures often occur in people who have tendinopathy but are unaware of it. Read my case study about a chap that this happened to, we can learn a lot from his experience. You can also find out if you have Achilles tendinopathy here.
With the correct treatment, you can improve the health of your tendon and prevent pain and rupture. Take a look at my Achilles tendinopathy Program It has everything you need to return your tendon to full health.
Take care, Helen
Helen Manders BSc (Hons) MCSP HCPC
Chartered Physiotherapist Since 2001
