The steps I’ve taken in my Achilles rehab.. In particular insertional Achilles tendinopathy. Some guidelines which may help you with your achilles troubles.
One of the problems with the Achilles tendon is as you get older it can get a lot weaker. Running alone will not provide the strengthening required.
What’s made my case harder is it’s an insertional Achilles tendinopathy.
Where the Achilles joins the heel you start involving the bone and bursa. The bursa is a fluid-filled sac that usually creates a bit of glide and cushioning. This becomes inflamed and you end up with bursitis. This will create further damage.
In the acute phase of injury the most important part is don’t cause
further damage. So I stopped running, took the load off it
avoided stretching the Achilles. Kept it elevated and used iced the injury for 15 to 20 minutes about every 2 hours with 2 days worth of oral
Tendon injuries require loading to get better. After we get past the first 2-3 days of the acute phase there are 2 key points to follow:
- applied load to strengthen the tendon
- don’t cause anything to aggravate the injury
One of the biggest problems with an insertional Achilles injury is when you stretch it pulls the tendon across and presses up against the bursa. Any stretching we usually do for our calves will likely aggravate the injury. Doing calf exercises where you drop the heel down below level will stretch the tendon.
Limiting movement and stretch of the tendon while applying load is the early plan.
How do we do that?
You have 2 main muscles in your calves .
The gastrocnemius which is the main muscle that goes from the tendon itself up across the back of the knee and joins just above. You strengthen that mostly with a reasonably straight leg. The other muscle is
the soleus, which joins below the knee. To target that we need to take the gastrocnemius out of it. So you need to do the exercises with a bent knee.
The isometric protocol I used was an isometric calf raise straight leg
and an isometric calf raise bent leg. The plan was to increase the load every week on the proviso that 24 hours after a training session I didn’t have increasing pain. There could still be some discomfort but not an increasing pain from the previous day.
The aim was to do these exercises at least once a day, preferably
Loading initially was holding 30 seconds with 30 to 60
seconds rest in between. Do that for a week then increase that to 5 times 1 minute with 30 to 60 seconds rest. Progress to 3 x 2 minutes with 30 to 60 seconds rest in between finally ending on 1 x 5 minutes.
After isometrics we moved on to the next level and start introducing some movements.
I kept the isometric training going but this time the training sessions started with some actual movement of calf raise both a straight leg and bent leg.
With body weight the aim was to do 3 sets of starting
at 10 reps and building that up to 20 reps for each exercise. Taking 30-60 seconds rest between movements. The aim was to get it done
almost every day, but I was happy with 5 days a week.
Next progression was to add extra weight to the loading. Using a barbell across the shoulder for the straight leg calf raises. Or across the knees for seated calf raises.
The Achilles’ tendon requires loading to improve. It takes time. Longer than we all want it to. Plus this post only covers the early stages. Beyond these first weeks you will need to start addressing power, elasticity and reactive strength. But that is for a future post.
For a look at earlier stages of my Achilles Injury check out the video below