What is better to stretch or strengthen an Achilles' tendonosis?
What is better to stretch or strengthen an Achilles' tendonosis? In the literature recent evidence suggests a form of strengthening is the key to a long term solution to this common ailment.
In the case of an Achilles’ Tendonosis this condition is considered a degenerative process unlike an Achilles' tendinitis that is looked upon as acute injury with inflammation in and around tendon region requiring rest, gentle range of motion and taking anti-inflammatories. The approach is very different when treating a tendonosis that requires a very different approach.
In the case of a Achilles' tendinosis the injury is related to degeneration of the collagen and loss of blood supply to be the main reason for pain and weakness in the region of the mid- portion or attachment of the Achilles' tendon. In a true tendinosis anti-inflammatories typically don't improve the condition significantly because of the lack of inflammatory factors in the tendon and when improvements are experienced it may be time or the influence of the placebo effect.
Do we Stretch or Strengthen with an Achilles' tendinosis?
In the case of an Achilles tendinosis the recent research shows that there is greater evidence for strengthening or loading the tendon in a safe progressive manner especially in injuries lasting longer than 2 to 3 months. In addition, it is essential to avoid complete rest for the Achilles tendons because of the potential further weakening of the tendon from lack of activity and loading of the tendon. We want our patients to engage in strengthening activities that maintain the general strength of the lower extremities without excessive loading the Achilles' tendon.
All in all you may engage in stretching of Achilles' tendon and calf musculature as long as it is tolerated but more evidence points to strengthening being the key component to safely returning to your activities.
What strengthening do we start with?
In the beginning we will begin with gentle isometric exercises that can also lessen the pain and allow the patient to become more active. Isometrics are a form of exercise that causes a muscular contraction that can load the tendon without any movement of the associated joints. It is often a safe start for many patients and helps gauge the tolerance of the tendon moving forward.
Isometric exercises performed at the calf and through the Achilles' tendon can provide pain relief which allows many another strategy to avoid the use pain medications or anti-inflammatories. In the case of anti-inflammatories they have been shown to inhibit the ability of develop new collagen in the tendon delaying or stopping its recovery. It is not clear why isometric exercises have this effect but appear in many cases help reduce tendon pain. One of the common prescriptions is do daily loading of the tendons for 6 x for 45 second hold with one minute rests in between reach repetition. In cases of a "true" tendinosis if we have the correct load of the tendon we should first notice pain and each repetition a decrease in pain levels. It is safe to have mild discomfort but not excessive pain during or after the completion of these exercises.
We are going to provide three types of exercises you will see prescribed in early phases of physical therapy for a tendinosis. In later stages we will advance to both isotonic, eccentric to plyometric exercises for a return to the patients goals of activity. Those exercises will be covered in future videos. In certain sports having greater flexibility will help in the performance of their sport but it all depends on the demands of that sport. Engaging in light stretching in many cases will not reduce the benefits of the strengthening exercises.
Here are the three Isometric Exercises in order of degree of difficulty:
(1) Standing Bilateral Heel Raise with two up
(2) Standing Bilateral Heel Raise with two up and one down hold
(3) Standing Unilateral Heel Raise with raising up and holding on one
• All exercises should be done 6 x 45 seconds 1-2 daily depending on tolerance.
What are signs of improvement?
In 2-3 weeks we should see a few things to tell if we are seeing progress. First, we may see changes in our strength, endurance and later less pain during the performance of the exercises. I will also provide functional baselines to help the patient gauge their progress. Those include comfort with a bodyweight squats, stair climbing, distance walking prior to onset of pain, or degree of discomfort after standing or sitting for extended periods. All these baselines can give the patient cues on whether they are improving and will increase the compliance. Simply the absence of pain does not always indicate a patient is able to return to a certain activity.
What is better to stretch or strengthen an Achilles’ tendonosis? In the literature recent evidence suggests a form of strengthening is the key to a long term solution to this common ailment.
In the case of an Achilles’ Tendonosis this condition is considered a degenerative process unlike an Achilles’ tendinitis that is looked upon as acute injury with inflammation in and around tendon region requiring rest, gentle range of motion and taking anti-inflammatories. The approach is very different when treating a tendonosis that requires a very different approach.
In the case of a Achilles’ tendinosis the injury is related to degeneration of the collagen and loss of blood supply to be the main reason for pain and weakness in the region of the mid- portion or attachment of the Achilles’ tendon. In a true tendinosis anti-inflammatories typically don’t improve the condition significantly because of the lack of inflammatory factors in the tendon and when improvements are experienced it may be time or the influence of the placebo effect.
Do we Stretch or Strengthen with an Achilles’ tendinosis?
In the case of an Achilles tendinosis the recent research shows that there is greater evidence for strengthening or loading the tendon in a safe progressive manner especially in injuries lasting longer than 2 to 3 months. In addition, it is essential to avoid complete rest for the Achilles tendons because of the potential further weakening of the tendon from lack of activity and loading of the tendon. We want our patients to engage in strengthening activities that maintain the general strength of the lower extremities without excessive loading the Achilles’ tendon.
All in all you may engage in stretching of Achilles’ tendon and calf musculature as long as it is tolerated but more evidence points to strengthening being the key component to safely returning to your activities.
What strengthening do we start with?
In the beginning we will begin with gentle isometric exercises that can also lessen the pain and allow the patient to become more active. Isometrics are a form of exercise that causes a muscular contraction that can load the tendon without any movement of the associated joints. It is often a safe start for many patients and helps gauge the tolerance of the tendon moving forward.
Isometric exercises performed at the calf and through the Achilles’ tendon can provide pain relief which allows many another strategy to avoid the use pain medications or anti-inflammatories. In the case of anti-inflammatories they have been shown to inhibit the ability of develop new collagen in the tendon delaying or stopping its recovery. It is not clear why isometric exercises have this effect but appear in many cases help reduce tendon pain. One of the common prescriptions is do daily loading of the tendons for 6 x for 45 second hold with one minute rests in between reach repetition. In cases of a “true” tendinosis if we have the correct load of the tendon we should first notice pain and each repetition a decrease in pain levels. It is safe to have mild discomfort but not excessive pain during or after the completion of these exercises.
We are going to provide three types of exercises you will see prescribed in early phases of physical therapy for a tendinosis. In later stages we will advance to both isotonic, eccentric to plyometric exercises for a return to the patients goals of activity. Those exercises will be covered in future videos. In certain sports having greater flexibility will help in the performance of their sport but it all depends on the demands of that sport. Engaging in light stretching in many cases will not reduce the benefits of the strengthening exercises.
Here are the three Isometric Exercises in order of degree of difficulty:
(1) Standing Bilateral Heel Raise with two up
(2) Standing Bilateral Heel Raise with two up and one down hold
(3) Standing Unilateral Heel Raise with raising up and holding on one
• All exercises should be done 6 x 45 seconds 1-2 daily depending on tolerance.
What are signs of improvement?
In 2-3 weeks we should see a few things to tell if we are seeing progress. First, we may see changes in our strength, endurance and later less pain during the performance of the exercises. I will also provide functional baselines to help the patient gauge their progress. Those include comfort with a bodyweight squats, stair climbing, distance walking prior to onset of pain, or degree of discomfort after standing or sitting for extended periods. All these baselines can give the patient cues on whether they are improving and will increase the compliance. Simply the absence of pain does not always indicate a patient is able to return to a certain activity.
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Remember this is phase 1 of treatment for Achilles' tendonosis! Please tell me if these exercises help you out. If they do please subscribe and like our video. Any questions please place in the comment section! Thanks for watching our channel! Have a great day! CORRECTION- the exercises demonstrated should be performed from the floor and not off a step or riser. #achilles#achillestendonosis#tendonosis#apexorthorehab#tomwillemann. If you liked this video you may like this one as well on ankle mobility. https://youtu.be/HT9CTO10QbE
Very informative video. How long does it take for achilles tendinosis to heal? I do crossfit and is there any exercise to avoid ( other than jumping and running) .
Excellent videos…thank you so much. I am a softball player, who for years has had achillies pain. I play a game on a Sunday, and have trouble walking until Weds and then start to feel better.
This year the pain has been linguring and I have trouble walking after games and when I get out of the car.
Please don't tell me I am getting old 😃😃😃
I messed up my foot before my birthday in may while skating. I recall rolling my foot the opposite of a common sprain yet the pain felt like a normal sprain. My foot was really bad the first day I couldn’t even balance on my bad foot without shaking but the pain went away a week later and I was able to balance again however I noticed that if I extend my foot down too far it would cause a pain in the crease that forms on the back of your foot near the achilles. On my normal foot my achilles is defined and distinct and I’m easily able to pinch it but on my bad foot It’s hard to tell where my the rest of my foot ends and achilles starts.
I can still skate but I can do it without worrying about and experiencing pain if I land on my feet a certain way or possibly worsening my foot.
My injury has also been affecting my mental health negatively.
Will I ever be able to fully recover and skate comfortably again or should I move on?
This really helped with my pain thank you ! Do you have a video for phase 2 and 3?
Also should I purchase the mat you are using?
How many times a day should I do the Phase I strength training?
Can you tell me how many times a day you should do the first phase strengthening routine?