[MartinTopfer]

When listening to the podcast “Scott Johnston Talks With Physical Therapist, Pete Dickinson” I spotted there exactly my case with a reoccurring insertional Achilles tendonitis.

As mentioned in the podcast, when the problem is acute, I do some strength work – mostly eccentric heel drops (last time I got up to date with research and switched to weighted drops in both directions) and then I start slowly building up running mileage back. Because at that stage I would need really big weight for the heel drops to be somehow painful I mostly stop doing any real strength work for the Achilles tendon and use slow running build up as the primary stress for the Achilles tendon. Normally that works for me but then some inconsistency in my running volume occur (due to illness, injury of something else or just lack of time) and when getting back I have quite high probability of getting problems with the Achilles tendon.

What would be some good strength exercises to keep doing to condition my Achilles tendon when it is working fine and I’m able to run consistently? It seems to me that heel drops with roughly additional 50% of body weight (what I can conveniently do at home) would have almost no effect at that stage.

I have access to normal gym with legpress, weights etc. – but going there more than 2-3/week would be quite inconvenient. Could some plyometric exercises be the right way to go?

PS: I know that it could be all solved with slower running volume increase after any drop in running volume but that is sometimes hard to do (at least mentally). Also because I have the problem already for quite a long time, I would like to try some new and hopefully better strategy to cope with my Achilles tendon.

Topic

[alisonG]

alisonG on April 23, 2022 at 4:50 pm #66082

PT here- and, one piece of advice I have for you is to be consistent over time with your strength work for the Achilles.

In general, you get Achilles tendon degeneration/injury when there is a mismatch between the load you are applying to the tendon and your ability to deal with that load.

You use specific loading exercise (and recovery) as a positive stimulus to improve the quality and structure of the tendon. Additionally, with running and other plyometrics- the load on the tendon is rate-dependent, meaning that fast loading causes high load magnitudes. This is why a large component of Achilles tendon rehab utilizes heavy, slow loading.

How long does this take? Mild cases can improve with 12-16 weeks. I’ve seen severe cases take 6-12 month, and from what I can tell in the literature, with consistent, heavy loading- you get subtle improvements in the tendon quality at 12 weeks and more significant changes after 6 months of consistency. Plyometrics are appropriate at the end phase of rehab, but they don’t substitute for the base work, much like aerobic base building can’t be shortcut by doing sprints.

There really is no shortcut, and your commitment needs to be towards the regeneration process and not as much running during that time period, otherwise you run the risk of falling in the same hole, repeatedly. How much running you can do varies from person to person, and it should all be pain-free. You can use that time well, however, and one suggestion I’d have is finding a PT that specializes in running and gait mechanics to see if there’s anything about your running technique that is contributing to the issue, especially if your pain is on one side only.

Pete may have more to say or a different viewpoint- but this is just my two cents! Good luck and stay consistent!