The Best Exercise for Insertional Achilles Tendon Pain
Achilles tendon pain is very common among runners and non-runners alike. It can affect people at any stage in life. There are two main categories of Achilles tendon pain and injury. They are:
- Mid-portion Achilles tendon pain (pain in the middle of the Achilles)
- Insertional Achilles tendon pain (pain at the bottom of the Achilles tendon where it inserts into the heel)
In the below video I demonstrate a key exercise that I prescribe to help people suffering from insertional Achilles tendon pain rehabilitate their injury.
Hi everyone, Brad here with a little physiotherapy tip of the week. This week’s tip has to do with sore Achilles tendons.
Your Achilles tendon spans the back of the calf and inserts down into the heel bone. There are two sorts of Achilles tendon problems, the first is an insertional Achilles problem, and the second is what we call a mid-portion Achilles problem.
Today we are actually going to talk about how to address the insertional Achilles problem. So the exercises as a physiotherapist I give for insertional Achilles tendon problem is very different from the exercise that I give for the problem being further up in what we call the mid-portion of the tendon.
Let’s talk about the exercise that is best for the soreness down low (at the insertion). We call these the isometric holds – so what we do is we come up on the toes and we hold that there for a period of time and then come back down. So, you come into a calf raise, holding, use a wall for balance and support, and then come back down. Now there is an ideal protocol to follow with this, and that is, to begin with, 10 lots of thirty-seconds. After a weak progress to 5 lots of 1 minute, and beyond that over subsequent weeks at your physios discretion move to 3 lots of 2 minutes, 2 lot of 3 minutes, and lastly 1 lot of 5 minutes.
This is a great conditioning exercise for the Achilles tendon, and it will start to get you moving in the right direction in getting you back running and doing the things that you love and enjoy. Over and out! Have a great week.
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Avoid eccentric exercises for insertional Achilles tendon
As a physiotherapist, I regularly see runners (and non-runners) performing tendon rehabilitation exercises that are not in their best interest. Often-times an eccentric exercise (where the heel drops below the horizontal-eg heel drops off a step) are being performed. The problem with eccentric exercises for insertional Achilles tendon pain and injuries is that the dropping down phase of the exercise (ie where heel drops below horizontal) will actually create tendon tension on the already sore Achilles tendon insertion. In cases where a patient engages me to assist them with their Achilles tendon rehabilitation, I will recommend that they immediately cease eccentric loading exercises and commence with just the isometric exercises as described above.
A note on calf strength
I also find that developing calf strength and endurance is also key in the rehabilitation of Achilles tendon injuries. Video below:
Prescription and Progressions
Commence with: 10 x 30s holds
Progress to: 5 x 1min holds, 3 x 2mins, 2 x 3mins, 1 x 5min hold.
For further help please refer to the below resources
- Listen to tendon expert physiotherapist and researcher Associate Professor Dr Peter Malliaras discuss the rehabilitation of tendon injuries on Episode 62 of The Physical Performance Show podcast HERE>>
2. If you would like to learn more about how to best rehabilitate your injury click through and read this post The 3 Stages of Achilles Tendinopathy Exercises HERE>>
Brad Beer (APAM)
Physiotherapist, Author You CAN Run Pain Free!, Founder POGO Physio