RecoverRx Performance and Recovery Blog
This blog is dedicated to all things from recovery to performance. Our industry expert Physical Therapists provide evidence based information and opinions educating our readers on how to optimize their health in order to be able to overcome injuries and live the life they were meant to live!
Dr. Sarah Greenwell, PT, DPT, CSMPT
Medical advice can be confusing at times. Seems like the answer changes over the years and depends on who you talk to. Like what should you do after an injury to a tendon: Should you use ice or heat? Should you rest or should you push through the pain?
Well, I'm here to help clear up some of that confusion. And this time I have the evidence to back up the recommendations.
Achilles tendinopathy is one of the most common overuse injuries to the foot and ankle in sport, especially in runners. It presents as pain and swelling, tenderness with a possible lump, weakness during heel raises, difficulty running and jumping, and symptoms usually are worse with the start of movement and improve with light activity.
One of the most common causes is a sudden change or increase in training intensity or duration. However, contributing factors include decreased plantar-flexor strength, decreased hip control, abnormal ankle and midfoot range of motion, increased pronation (or flat foot), and increased body weight.
Typical passive (non-active) treatments involve rest, ice, ultrasound, cryotherapy, heel lifts, orthotics, and nonsteroidal anti-inflammatory drugs (NSAIDs). However, research indicates that heel lifts, night splints, orthotics, and taping are not recommended due to lack of evidence that they actually provide positive impact (3).
Rather, the treatment with the highest level of evidence for Achilles tendinopathy is physical therapy (1). Activity modification (cross training such as cycling instead of running or modifying run programs), stretching, and eccentric training can decrease pain while maintaining aerobic capacity, improving ankle mobility and correcting strength deficits. (3)
So when it comes to tendon recovery, rest is catabolic and activity is anabolic. Taking 2 weeks to 3 months off running/exercising does not lead to tissue repair. Rather, tissues just get weaker and lack the oxygen rich blood flow that helps promote healing. On the other hand, appropriate and progressive exercise and activity levels help to stimulate healing.
The first step is to modify the training regimen for appropriate load management and avoid aggressive stretching early on (excessive compression). Then, provide appropriate load to the tendon to promote remodeling, decrease pain, improve calf muscle endurance, and strengthen the lower leg. This can be achieved through a variety of exercise techniques (isometric-strengthening without movement, concentric-strengthening through muscle shortening, or eccentric-strengthening through lengthening muscle and tendon) and should be tailored to the individual’s needs and tolerance. Accepted guidelines are to maintain pain levels below 5/10 during therapeutic exercise and/or recreation/sports (swim, bike, run, walk). Finally, address any biomechanical issues (running mechanics, neuromuscular control/stability, proper footwear) that could contribute to symptom return.
It is important to note that depending on the severity of the tendinopathy, full recovery can take a year or longer, and reinjury is common if return to sport is rushed (1). However, if symptoms are addressed early, severity can be reduced with smaller effect on sport performance and a shorter recovery time.
Therefore, if you are feeling pain or stiffness in the back of your calf/Achilles:
Thanks for reading and reach out to me if you have any questions!
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Dr. Luke Greenwell, Dr. David Bokermann, Dr. Sarah Greenwell, & Dr. Ariel Sernek are Performance Based Physical Therapists with extensive backgrounds in treating the injured athlete. At RecoverRx, they are passionate about returning people to the sports & activities they love. Check out more about them by visiting our About Us page.