Achilles Tendon Pain: Rehab, Pain Management & The Severs Sleeve

Achilles tendinopathy is a common condition that affects the thick band of tissue, the Achilles tendon, connecting your calf muscles to the heel bone. As a condition most often caused by repetitive stress on the Achilles tendon, it may present itself in activities such as running, jumping, or walking on hard surfaces. The result is an inflammatory stress response that can't be regulated effectively by the body's healing system. 

Think of it as a car engine and wheel situation. When the engine is more powerful and doing more work than the rubber can manage, the rubber will wear away faster. To combat this, we need to turn those 10" rims into 22" rims to increase traction and withstand the stress the muscles are placing on it. The good news is, with proper treatment and rehabilitation, most people can recover from Achilles tendinopathy.

Identifying the Cause
Achilles tendinopathy is commonly seen in repetitive stress sports that include running, jumping, sudden propulsion, or when an increase in exercise exceeds 10% progression every week, usually for 4-6 weeks. The condition occurs when the tendon tissue, which lacks blood vessels and nutrient supply, is used beyond its capacity and the natural internal repair mechanism can't keep up with the demand placed upon the tendon. Collagen (the body's variable cement/elastic type material) is deposited in inflammation cycles, which can lead to thickening, but not strengthening. Over time, the tissue becomes hard and scar-like and loses the ability to absorb and distribute the tension applied to it.

Diagnosis of Achilles Tendinopathy
A diagnosis of Achilles tendinopathy typically involves your physiotherapist or podiatrist performing a physical and biomechanical examination of the affected area. 

Common signs and symptoms include a recent increase in load or exercise, pain onset during or after exercise, aching and stiffness when stationary for long periods or after sleeping, tenderness to touch at the middle of the tendon or at the attachment to the heel bone. Walking on the toes or stretching may help relieve pain, but the benefit is often temporary.

Your physician may also recommend imaging tests such as an ultrasound or MRI to better understand the severity and grading of the pathology. It's commonly understood that there are three stages of Achilles tendinopathy at three locations.

Types and Locations of Achilles Tendinopathy
Reactive tendinopathy usually develops after acute increases in exercise load that the tendon is unprepared for, often occurring between 2-4 weeks of faster than usual increase in load amounts. Most people start to experience pain after about two weeks.

Dyrepair tendinopathy commonly develops between 6 and 12 weeks of unregulated loading that causes pain. The pain and stiffness will ease with exercise but gradually worsen as you continue. Pain is likely to persist after exercise and into the night, with the Achilles taking longer to warm up after progressively shortened periods of rest, making it stiffer and more painful.

Degenerative tendinopathy occurs when the condition has been unregulated for 3-6 months, and all activities cause pain. If not well managed, sudden onset or dynamic movements could cause the tendon to partially tear or fully rupture.

This little infographic explains a little more how the rehab world is aligning with tendons and the rehab structure we follow to help patients recover.

Bracing Challenges and The Solution: The Severs Sleeve
Bracing solutions for Achilles tendinopathy have been a challenge due to the tapered shape of the calf and the variation in people's calf sizes. The best option, until now, has been rigid strapping tape. Unfortunately, the tape causes skin irritation with repeated use and, in some instances, can negatively impact Achilles tendinopathy rehabilitation.

A good brace should be comfortable, designed to assist the healing phase of inflammatory tissue response, deload the tissue to reduce pain, and facilitate an earlier return to pain-free activities. That's where the "Severs Sleeve" comes in. This product addresses all the pain points of conventional solutions. Its patented design allows users to comfortably adjust the brace, offloading the Achilles tendon to various levels depending on their daily pain level and exercise/movement requirements.

Most importantly, as the Achilles tendon progressively heals, the "Severs Sleeve" is designed to be less and less required. Its primary function is to provide support in the early stages of recovery, allowing for a faster integration back into desired activities. As time goes by and your tendon strengthens, you'll find yourself needing the "Severs Sleeve" less and less. For more information on "The Severs Sleeve", please click the link and find out if it's the right choice for you.

The Path to Recovery: Exercises for Achilles Tendinopathy
Different exercise loading strategies are crucial to prompt your body to appropriately respond and heal the affected tendon area. Here, we outline a few beneficial exercises and provide guidelines for safely incorporating them into your recovery plan.

Isometric Exercise: A timed, sustained muscle contraction against force, such as a body-weighted calf raise, puts a stretch and strain force on the tendon tissue, prompting it to reload at a more tolerable load for sustainable periods. A good starting point would be 3 sets of 45-second holds with 2 minutes rest between each set.

Eccentric Exercise: A slow lengthening of muscle contraction against force is best used to grow tissue size, as it increases the micro-tear ratio per rep compared to other exercise types. An example would be the eccentric heel drop, where you'll raise yourself onto your toes on both feet, lift the unaffected foot and lower yourself slowly with the affected foot. You should aim for 3 sets of 15 repetitions daily.

Concentric Endurance Exercise: The shortening phase of muscle contraction, used over many repetitions, aims to build endurance and oxygen utility in the tissue. Start with 3 sets of 15 calf raises on a flat surface daily and gradually increase the volume and intensity.

Plyometric Exercise: A rapid stretch and rebound contraction exercise, such as jumping from a box to the ground, and immediately jumping forward to land as far forward as you can. These should only be incorporated when the tendon can tolerate the high load and speed of plyometric activity without pain.

Returning to Sports/Full Exercise
Your physician should be testing the capacity of the Achilles tendon to help determine when you should return to play/exercise and not risk re-injury. This may involve various tests such as a Knee to Wall test, Pain-Free Squat, Pain-Free Countermovement Jumps, and Single Leg Hops.

The tests' performance indicators should be below a 20% difference side to side for a return to sports training and less than a 10% difference for a return to sports play. 

In conclusion, navigating Achilles Tendinopathy can be a challenging journey. However, with the right knowledge about the condition, an effective treatment plan, a well-planned exercise regimen, and supportive aids like the "Severs Sleeve," you can successfully rehabilitate your Achilles tendon and return to your regular activities. Remember to reach out to a healthcare professional to guide you on your path to recovery. From Pain to Performance, the journey is yours to undertake.

From Pain to Performance

The Orthopaedic Sleeve Society (TOSS)

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