Whilst it can be argued that foot pronation or ill footing shoes can create a local demand on certain parts of the tendon (I don’t dispute this), the general consensus is that if you overload a tendon above its current capacity then you are likely to create an issue.  The same way if you were to overload a shelf at home with too much for it to handle then it will likely break.  I am not for a second comparing tendons and book shelves as the same thing here, but it hopefully helps get my point across.

So, if something is overloaded (lets take our book case example) the first thing we do is unload it, to stop it breaking down further.  The same is true for the AT.  Controlling your load is paramount in the first stage.  Once we have removed this load the repair process would begin.  In the case of our book shelf we would most likely take it off its hooks and then create a possible bigger hole which has more structural integrity to hold the books/load we wish to place upon it.

In the case of our AT, many ask the question ‘well how do I repair it then without surgery?’. The body has the most incredible healing potential.  I always say to people that ‘the body will rarely fail you’.  It is just important to know what to do when it does (such as in AT cases).

The key to successful management of AT issues is to actually load it!  I know, it sounds crazy and completely counterintuitive when I have just said the first thing to do is unload it (book shelf example).  However, the loading of the AT is what helps to repair the area.  And ultimately we want to repair it so that we can get it back to its former glory.

How do we go about this then when the first bit of advice is to unload the tendon?  This is a great question.  The first point to consider is that there is, unfortunately, no magic recipe for cases such as this (you may hear me say this a lot!). Each of us respond differently to different stresses which is why each of us get injured in different ways (for example, you may get injured whenever you run 3 miles whereas your friend can run 3 miles easy – we are all unique).  The research though points to either Heavy Slow Resistance training or Eccentric training to target the tendon.  Now the purpose of this post is not to go into which exercises are best, etc…., instead it is to highlight that if we want to get these tendons better then loading them is key.

Rest will ultimately reduce pain.  It does in most cases of anything you have ever suffered from.  However, rest can be detrimental too as the tendon can deteriorate in strength and when you come to load it again you may notice the pain is still present.  This is due to the tendon becoming weaker.

A research paper by Beyer et al. 2015, concluded the following;

 

The results of our study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

 

The results showed that one method were better than the other and I would encourage you to read this paper to find out more about the exact protocol used.  BUT, do consider the fact, as I have already mentioned that there is rarely a one size fits all.  The protocols used here can be a good reference point but trial and error is key in these conditions to find the right dosage for your current capacity.  This is the Holy Grail.

If you are suffering from what you believe is an Achilles Tendinopathy then you should consider seeing your healthcare professional at your earliest convenience.  Understanding the pathology of tendon degeneration is vital to ensure your condition doesn’t progress into one of a chronic one as the 3 stage process of tendon break down becomes irreversible at stage 3, in which time it is often too late to stop it and you have to just manage it the best you can, which can sometimes mean reductions in activity or stopping altogether.

I hope this information here is of use to you all and I will be back next week to discuss some other cases and injuries that we can help you try to avoid.