You know the saying “no pain, no gain”? When it comes to Achilles tendinopathy, this phrase could be amended to “more gain, no pain.” The more strength you gain through the special exercise protocol we use for this condition, the less discomfort you’ll feel. It can be discouraging to hear that you’ll need 10 to 12 weeks of therapy before seeing results, but experience has taught us that, unfortunately, treatment for Achilles tendinopathy takes a while to pay off. Understanding what lies ahead is a good way to mentally and physically prepare yourself for Achilles tendon physiotherapy.
Once upon a time, this condition was known as “Achilles tendonitis,” but that term isn’t really accurate. While “tendonitis” suggests inflammation, this pain in the Achilles tendon is caused by a failed healing process,not an inflammatory one. That’s why the treatment protocol takes longer and is different from protocols for most tendon-related pain syndromes. Instead of merely finding a way to reduce the inflammation, we need to employ a strengthening program that uses gentle stretching and progressive loading exercises.
The most widely used treatment plan for Achilles tendinopathy is called the Alfredson protocol. It involves eccentric loading of the tendon (contracting the muscle and tendon while lengthening the muscle). Performance of two specific exercises for a total of 180 repetitions has proven to be highly effective in several studies.
However, performing as many of the exercises as you can, rather than adhering strictly to 180 repetitions, may be just as effective. A study in the February 2014 issue of the Journal of Orthopaedic & Sports Physical Therapy indicated that a modified version of the Alfredson protocol with a “do as much as tolerated” approach achieved similar positive results as the full 180-repetition protocol after six weeks.
We can design a program that works with your specific injury, physical condition and needs. The important thing is to be strengthening and stretching your tendon continually for approximately 12 weeks. We may also suggest that you refrain from high-impact activities to reduce your risk of further injury, until maximum strength is achieved.
If three months of therapy seems like forever, remember that it’s a small price to pay for a future filled with a healthier, pain-free Achilles tendon.