A Brief Guide to Physiotherapy Management of Achilles Tendinopathy

Achilles tendinopathy, characterized by pain and dysfunction in the Achilles tendon, can be a challenging condition to manage. However, with the right approach, relief and recovery are within reach. In this comprehensive guide, we'll explore evidence-based physiotherapy interventions aimed at alleviating symptoms, improving function, and promoting healing in individuals with Achilles tendinopathy.

Understanding Achilles Tendinopathy:

Before diving into treatment strategies, let's understand what Achilles tendinopathy entails. This condition involves degeneration or damage to the Achilles tendon, which connects the calf muscles to the heel bone. It's commonly associated with activities involving repetitive or excessive loading of the tendon, such as running or jumping.

Eccentric Exercise Programs:

One of the cornerstone treatments for Achilles tendinopathy is eccentric exercise. These exercises involve lengthening the calf muscles while under load, which has been shown to stimulate tendon remodeling and improve function. A structured eccentric exercise program, tailored to the individual's needs and capabilities, is essential for achieving optimal outcomes. If you are an athlete, it is also important to include plyometrics as a late stage rehab program in order to retrain your body to be explosive and quick. 

Load Management:

Managing the load placed on the Achilles tendon is crucial for promoting healing and preventing further injury. Load management is the process of slowly adding weight or demand to an exercise in order to prevent injury or additional flare ups. It is important to note that when you increase load, there may be some discomfort. As a general rule of thumb,  if your pain is below a 6/10 on a pain scale, it is most likely safe to keep doing the exercises. 

Biomechanical Correction:

Addressing biomechanical factors that contribute to Achilles tendinopathy is another important aspect of treatment. This may involve gait analysis to identify abnormal movement patterns and footwear modification to reduce stress on the tendon. Correcting factors such as excessive pronation or limited ankle dorsiflexion can help alleviate symptoms and improve tendon health.

Adjunct Therapies:

In some cases, adjunct therapies may be incorporated into the treatment plan. Shockwave therapy and corticosteroid injections are two examples that are commonly used in conjunction with exercise-based interventions. However, it's important to weigh the potential benefits and risks of these therapies and use them judiciously as part of a comprehensive treatment approach.

Reference:

Malliaras P (2022) Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy 68:221–237]