Achilles tendinopathy is a common condition that affects the Achilles tendon, a thick band of tissue connecting your calf muscles to the heel bone. As a condition most often caused by repetitive stress, it frequently occurs during and after activities such as running, jumping, and repetitive walking.
Identifying the Cause
The condition occurs when the tendon is used beyond its capacity and the natural internal repair mechanisms cannot keep up with the demand. This often occurs when there is a greater than 10% increase in exercise over a short period. Repetitive stress causes collagen to be deposited in inflammation cycles, which can lead to thickening but not strengthening. Over time, the tissue becomes hard and scar-like, losing the ability to absorb and distribute tension.
Stages of Achilles Tendinopathy
Reactive tendinopathy occurs as a reaction to a sudden increase in activity load. Pain most often arises two weeks after an increase in activity.
Dysrepair tendinopathy commonly develops between 6 and 12 weeks of unregulated loading. Pain and stiffness will ease initially with exercise but worsen as you continue. Pain is likely to persist after exercise, even into the night.
Degenerative tendinopathy occurs when the condition has been mismanaged for 3–6 months. All activities cause pain, including standing and walking. If not well managed, sudden dynamic movements could cause the tendon to tear or rupture.
Bracing Solutions
Bracing solutions for Achilles tendinopathy have historically been a challenge due to the tapered shape of the calf and the variation in people's calf sizes. The best option, until recently, has been rigid strapping tape. However, repetitive use of rigid strapping tape irritates the skin, negatively impacting rehabilitation adherence. The Orthopaedic Sleeve addresses all the pain points of conventional solutions — its patented design allows users to comfortably adjust the brace to offload the Achilles to varying degrees, depending on daily pain level and movement requirements.
Exercises for Achilles Tendinopathy
Isometric Exercise: A timed and sustained contraction such as a body-weighted calf raise hold. This controlled strain force prompts the tendon to recondition at a more tolerable load. A good starting point is 3 sets of 45-second holds with 2-minute rest between each set, once to twice daily.
Eccentric Exercise: Slow lowering of the heels from a calf raise position. This places greater strain on the tissue, prompting greater remodelling. A common program involves 3 sets of 15 repetitions, with 2-minute rest, once to twice daily.
Concentric Endurance Exercise: Three sets of 15 calf raises on a flat surface, used over many repetitions to build endurance.
Plyometric Exercise: Only incorporated when the tendon can tolerate high load and speed without pain.
Returning to Sport
Your health practitioner will test the capacity of the Achilles to determine when you should return to sport. To return to training, there should be less than 20% difference between injured and non-injured sides. To return to sport, less than 10%. The Knee To Wall test, Pain-Free Squatting, and Single-Leg Hops are common assessment tools.
From Pain to Performance — The Orthopaedic Sleeve Society (TOSS)