Managing Achilles Tendon Pain

The Benefits of Eccentric Exercise on Achilles Tendons

Do you have Achilles pain? In my chiropractic clinic, I treat many runners’ with a condition called Achilles Tendonopathy.   This condition in runners is not an easy one to treat, primarily because runners as a species are insane.  They often times run through an injury.  Their reasoning seems to be as follows:  “Last time, it hurt when I ran.  Now it hurts when I run and don’t run.  Therefore, I am going to go for a run and see if that helps.  And, if I physically can’t go for a run, I’m going to find someone who will remove the pain so that I can go for a run.” 

And then repeat. 

Like a gerbil on a wheel, we must admire this persistence.  And being a runner myself, I can certainly empathize.     

Now, returning to the issue at hand: What is Achilles Tendonopathy?  The Achilles is the attachment point for your calf muscles onto the top of your heel bone (gastrocnemius and soleus insert distally into the superior portion of the calcaneus: see black tape in figures 1-4).

Tendon is a unique tissue with interesting properties.  It connects muscle to bone, and typically has a poor blood supply, which means it can have difficulty healing.  When a tendon is newly injured, we call that injury a tendonitis (-itis means to inflammation, swelling).   Early on, ice, compression, rest and anti-inflammatory medication are often effective treatments.

However, when a tendon is injured repeatedly, over a longer period, the inflammation is no longer the pain generating culprit.  The tendon changes in nature, and it becomes very disorganized and degenerative.  We now call this long standing condition: tendonopathy (opathy suggests disorganized, diseased or crappy). To be clear, I’m not suggesting the condition is no longer painful, because it is very painful.  Persistently painful.  But the way to treat the condition changes drastically.

Eccentric exercises are the gold standard for rehabilitation of this type of tendonopathy.  Combining certain treatment methods with the exercise may speed up recovery.  Performing the exercises before a condition develops in the first place may very well be preventative.

For a midbelly Achillies Tendonopathy such as the one marked by black tape in the photos below, one should use the Alfredson Eccentric Heel Drop protocol. 

Figure 1 Start Standing on Toes

Figure 1 Start Standing on Toes


Figure 2 Remove the healthy leg, and begin to slowly lower the injured achilles tendon

Figure 2 Remove the healthy leg, and begin to slowly lower the injured achilles tendon

Figure 3 Let the heel drop below the step

Figure 3 Let the heel drop below the step

Figure 4: Return the healthy foot to support your weight.  Primarily, use the healthy calf to return you to starting position, Figure 1. 

Figure 4: Return the healthy foot to support your weight.  Primarily, use the healthy calf to return you to starting position, Figure 1. 

The Eccentric heel drop protocol is:

                                3x15 eccentric straight-leg heel drops

                                3x15 eccentric bent-knee heel drops

                                The two exercises are to be performed twice a day, every day for                                            twelve weeks.

                                Continue the exercise even into moderate pain, but stop if the pain                                       becomes debilitating.

                                When you are able to do all three sets without any pain, add weight                                       using a backpack.

Figure 1: Start by standing on the balls of your feet on the edge of a step.  This is                              your starting position.

Figure 2: Remove the healthy leg so that the injured leg must support your weight.

Figure 3: Slowly lower the injured leg so the heel drops below the step (3 seconds).

Figure 4: Replace the healthy leg.  Primarily use the healthy leg to return you to standing on your toes (Figure 1). *It is important that you do not raise yourself both upward and downward on the injured leg.  Only the lowering (eccentric) component is beneficial to the injured tendon.

Always seek advice from a healthcare professional prior to beginning a new exercise, and for accurate diagnosis.  For a live video, check out www.therunnersclinic.com.au .  Or, if you have questions about this or any other injury, please ask Matt at a Woodstock Training Session.  He’s happy to offer free suggestions, it makes him feel useful J