Achilles Tendinopathy

A recent article examined two different methods (eccentric loading and heavy slow resistance training) for treating Achilles tendinopathy. 

What is Achilles tendinopathy?

The Achilles tendon is located at the bottom of the calf inserting into the heel. Pain in this region can be described as a tendinitis, tendinosis, or tendinopathy. A tendinitis is an acute or recent inflammation from overloading – typically lasting 3-7 days; tendinosis is typically due to chronic overloading – typically lasting weeks to months; tendinopathy is a general term used to describe the entire duration of a tendon injury. Pain in the Achilles tendon is typically located centrally in the tendon but pain can also be experienced in the heel at its insertion. 

Runners who are typically more prone to Achilles tendinopathy are those  who are a forefoot striker, have increased running volume quickly, or who have recently switched to a minimalist/zero drop shoe. 

Which program had the best result?

Both programs (eccentric loading and heavy slow resistance training) resulted in decreased pain and increase in physical activity level. However, the heavy slow resistance training had a higher reported patient satisfaction and adherence to the program. 

Take away:

Heavy slow resistance and eccentric load can help reduce pain from Achilles tendinopathy. 

Eccentric examples

1. Straight leg heel drops: standing on one leg on a stair slowly (3 sec) lower heel to ground. Step off and bring foot to top of stair. 
2. Bent leg heel drops: standing on one leg on a stair slowly (3 sec) lower heel to ground. Step off and bring foot to top of stair. 

Heavy Slow Resistance: *key is slow progression from higher reps and lower weight to higher weight and lower reps, for each exercises 3 sec to raise heel and 3 sec to lower heel (total of 6 sec for rep completion)

1. Heel raises with bent knee
2. Heel raises with straight leg
3. Heel raises with straight leg on step
   

For more information check out:

Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2015;43(7):1704-1711. doi:10.1177/0363546515584760

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