Rehabbing Achilles Tendinitis

Recently asked on the Slack #rehab channel: “I was diagnosed with Achilles tendinitis… Besides resting and taking a hiatus from playing, does anyone have any other recommendations to alleviate the...

Recently asked on the Slack #rehab channel: “I was diagnosed with Achilles tendinitis… Besides resting and taking a hiatus from playing, does anyone have any other recommendations to alleviate the tendinitis?”

Here are the responses from our coaches

Zi:

Injury on the feet sucks, but tendinitis is temporary so let’s go through a few points that may help:

– Adjustments to workout via regressions or substitution.
– Tissue quality emphasis above and below the injured area (calf, soleus, bottom of feet)
– You can still work on throwing, try to do it from kneeling stance to ensure the injured ankle is not at risk.

Overall, you want to give the ankle as much “breathing room” as possible to heal. When pain has gone, we still need to work on strengthening rehab before re-introducing yourself back to sport.

So, let’s go through the points again but with some details:
– Do tall-kneeling or half-kneeling stance variations. This puts the ankle joint out of the picture, so you can still train but the ankle is not at risk.
– Foam roll, but *do not stretch* your gastrocnemius and especially soleus (both form the calf) muscles. Also do the same with the bottom of your feet (arch, close to heel, ball of foot, between metatarsals). Different sized balls and a hard roller work well, just find stuff that works to give relief. Do this every other day so that the effect of manual therapy can settle.
– If you choose to throw, might be worth focusing on the hip/torso/arm relationship by eliminating your feet from the picture. You’ll be surprised what you can learn about body mechanics when you don’t have compensation from below the knee.

Tim has had Achilles tendon issues for the most part of his athletic life. He will have far better personal insight.

Tim:

Sure it is likely a volume issue but we also need to figure out what where the dysfunction is upstream (or it could be downstream at the foot, example: missing big toe mobility) … in order to correct it long term.

No matter what the case … we should ALL be doing Eccentric Heel Drops as it will help REHAB your Achilles by strengthening/remodeling the tendon while it will also help to make us more elastic for purposes of decreasing ground contact time in Top End Speed.

Here is the Alfredson protocol which has helped me tremendously:

Do the heel drops everyday, add load as you go, get that tendon and heel cord strong and elastic again. A lot of research also suggest you should do it through the pain. I can’t tell you to do that but I can say that it helped me and eventually the pain went away.

Follow up questions: “What’s the rationale behind doing it through the pain, just want an elaboration of why?
Also doesn’t this contradict not stretching the calf muscles?”

Tim:

Heel drops are loaded stretching. I think we need to define “stretching” in order to make sense of Zi’s suggestion.

Leg Lowers COULD be defined as “stretching”… should definitely be doing the SP.Zero Mobility & Activation Sequences.

In short, Manny, start with the BIG ROCKS and passive stretching isn’t a big ROI selection for what you need… you need to rebuild into function and load the heel cords consistently to remold the tendon.

Anna:

The concept is that with a chronic tendon injury it’s more that its tissue quality changes (ball of scar tissue that’s like a ball of yarn) instead of actual inflammation. Scar tissue doesn’t load like regular tissue and has decreased tensile strength. You will do soft tissue work above and below the area (on it if you can tolerate) so thinking of kneading some dough so that it can lengthen and contract better (roll out the dough better). Then the idea of the heel drops or slow eccentrics is that is stretching the tissue under load instead of just stretching. Stretching under load helps remodel the tissue even more so than concentrics so it’s important to focus on a four-count lower and even assist to come out of it in the concentric.

The idea of going to some discomfort (4/10) pain is that the good inflammatory process has become stale so you want to stimulate it again to help get old tissue out and new tissue in. You want to make sure that the discomfort doesn’t last after the exercise though because that’s too much. Then you want to make sure you have good hip and core strength and hip/ankle range of motion to eliminate the cause of it to begin with.

Here is an eccentric calf raise instructional video from Anna:

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