The dreaded heel pain. For any avid runner, or on-court athlete, you will probably deal with this injury at sometime in your life. In recent years there has a been a plethora of good research published on the different types, causes of, and treatment for achilles tendonopathy. Below is a summary of what you need to know.

1. Achilles tendonopathy is rarely an inflammatory response, hence why the conventional rest and anti-inflammatory drugs do not work. The swelling is caused by a different cellular process involving different cells to inflammation. This being said Ibuprofen has been shown to be affective for pain amongst other things!

2. The body is under constant degeneration and repair. With achilles pain the tendon has degenerated and activity modification must occur. The first sign of pain is a good wake up call to adjust your load, re-strengthen, and address any bio-mechanical problems. If you are unable to back off and manage the pain your physio can help with this. Ideally you chose to come in during the early signs so that we can work through a preventative program.

3. It is important for your therapist to differentiate between early and late stage tendon dysrepair. In the early stages (normally in younger populations) the focus should be on load management. In older populations a more aggressive strengthening program may be appropriate. Discuss with your therapist to ensure you are getting the best advice.

4. As you go through the healing progress be cognizant of the pain during as well as after activity. Tendons have been shown to produce latent pain up to 24 hours after activity.

5. Don’t over stretch the tendon. You may need to do this but not in the early or reactive stage. Massage and ball rolling along the calf are probably a better idea for the first 2 weeks.

6. A strength program is designed considering your position on the dysrepair continuum. You may have to do isometrics (contractions with no movement) or eccentrics (strengthening while lengthening – see video here). Imbalances and assymetries within the body may predispose you to achilles over use. These should be addressed in your home program as well.

Most of this short summary is taken from Jill Cook’s research. Thanks for reading and I hope this helps.

Dave Carter

Khan, Karim M., et al. “Histopathology of common tendinopathies.” Sports Medicine 27.6 (1999): 393-408.

Rees, Jonathan D., Nicola Maffulli, and Jill Cook. “Management of tendinopathy.” The American journal of sports medicine 37.9 (2009): 1855-1867.