How to optimise your activity levels for recovery of your Achilles Tendinopathy?

Achilles Tendinopathy is the overuse condition of your Achilles Tendon as a result of excessive high load activities such as walking, running, jumping etc.

Tendons are structured to be able to store and release energy, which is seen in the Achilles Tendon as force production for locomotion.

In order to function as a healthy tendon, optimal loading is required so that the tendon can function and adapt to become stronger. An example of this is starting a running program and slowly building up running distance and frequency.

In some cases, people get too excited and jump into an intense training program with a lot of running or jumping at a level that they are not capable to tolerate, because the tendons are unable to undergo the natural repair process with such level of loading.

When this happens, the tendon goes through three main stages:

1. Reactive tendinopathy:

Thickening of the tendon as a heightened response to take on load. Collagen or blood vessel structure remains normal.

2.Tendon disrepair:

Further thickening causes the extracellular matrix and collagen structure to become disorganised – This causes weakening of the tendon

3. Denegerative tendinopathy:

Progression of matrix disorganisation and cell degeneration and death.

It is important to implement optimal loading and modify your activity levels to return the tendon back to a healthy state. Complete rest will lead to weakening of the tendon and atrophy of the calf muscles. Continuing too much activity will cause your tendinopathy to progress past stage 1 and towards the later stages, where your symptoms will be much more severe, rehab will take longer and you may sustain irreversible damage to your tendons.

Firstly, reflect on the amount of activity you have been doing in the weeks leading up to your first symptoms of Achilles Tendinopathy.

• How much have you increased the distance (Kilometers), duration (Time per session or week), frequency (Sessions per week) and intensity (Hills, stairs, speed work) of your training program?

• Have you increased your workload significantly in a small amount of time?

As mentioned above, complete rest is rarely the ‘Optimal loading’ strategy. Aim to reduce your training parameters to what you were doing previously before you started noticing any symptoms. Another option is to cut back by one parameter at a time, and re-assess whether your symptoms remain or improve.

This should help to improve the acute soreness in your Achilles region. In the meantime, you still need to partake in specific programmed exercises to strengthen up the calves and Achilles tendon so that they can get stronger and increase overall capacity for load. With proper modification of load and exercise programming, you should be able to build-up your training intensity and load again, but the next time, without the re-occurance of an Achilles Tendinopathy.

To get Physiotherapy advice on optimal loading and specific treatment and prescription of strengthening exercises,

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