How to treat Achilles tendonitis

Achilles tendonitis is the inflammation of the Achilles tendon. It usually occurs due to a strain or minor tear in the Achilles tendon, and is a common overuse injury among runners, soccer players, and other athletes. 

Achilles tendonitis is also known as Achilles tendinopathy, or Achilles tendonosis, which indicates that there is a persistent condition of sub-optimal function in the tendon. 

Achilles tendonitis is indeed a persistent injury and sidelines many athletes for months. 

Here are the steps I recommend to treat it. 

Acute Phase (first 48 hours)

1. Stop all running, or jumping, type of activity. Minimize walking. You can swim instead.

2. Above all, do not stretch it! It will make it worse by re-tearing (stretching) the healing/tightening fibers which have been torn.

3. Ice the inflamed and injured part of the Achilles tendon for 15min at least 3 times a day or more often. 

4. Self-massage with a cooling Sombra or Arnica gel, or another sports massage cream, in long gentle strokes over the whole calf area. 

5. Get more sleep than normal. Tissues heal during sleep. 

6. Minimize inflammatory drinks and foods. I have noticed that many inflammatory conditions including tendonitis are more persistent when one drinks coffee, sweet soda drinks, and consumes meat and processed foods.

Coffee is a particularly serious culprit in creating general inflammatory condition in the body. I realize that many runners rely on coffee as 'fuel', especially pre-race, so I am not saying that you should quit drinking coffee completely. I love good coffee myself. But if you are suffering from Achilles tendonitis, try giving up coffee for a few days, or a week, and see how it affects your overall well-being. 

Many other inflammatory conditions like Arthritis, Colitis, and heart burn subside significantly when reducing the coffee intake. 

Sub-Acute Phase (after 48 hours and until it's gone)

1. Everything from the Acute Phase.

2. Start doing Eccentric Heel Drop exercises; 15 reps on the injured leg x 2 for a week, and 3 sets of 15 on following weeks. Look up on Google or YouTube on how to do the Eccentric Heel Drop. This is the 'magic' exercise for most Achilles tendon injuries.  

3. Get a massage with a therapist specializing in Neuromuscular Therapy, or Graston technique. Your therapist must be able to thoroughly examine all the fibers of the Achilles tendon, locate the exact fibers that have been torn, and deeply strip along the line of these fibers to remove any possible scar tissue formations. 

This ensures that the tissue heals normally, without internal adhesions, and is not susceptible to further tears. 

If you feel a bump, or see a visible bulge in the tendon, that's where the adhesions are forming. Therapists will have to work through that area to smooth out any irregular bumps in the tissue.

4. Continue icing, especially after exercise (like the heel drops) and deep massage. 

5. Roll the calf once a day for 10 minutes on a Thera-roll, or a similar ridged roll, that can help smooth out the tissues, and send blood flow to the area.

5. At this point, walking is better than inactivity. Movement creates blood flow and instructs the healing collagen fibers to be placed in the correct location and in the right direction. 

6. Gentle stretching is OK at this point, but be careful not to stretch deeply, as it will re-tear the healing tissues. 

How long will it take to heal Achilles tendon tear or tendonitis

This depends on the following variables: 

1. How severe the tear is; 

2. How well/quickly your body tissue heals and responds to eccentrics, movement, massage, nutrition changes, and rest. Age is a factor. Young people in general heal a lot faster. 

3. How much you stress the injured tissue during the healing process. Obviously, any extra load on the injury will create a setback. It's best to stay off of it, until it heals fully. 

On average, in a perfect world, it takes 8 weeks to heal Achilles tendonitis. 

When to start running or jumping after Achilles tendonitis is treated 

1. After the pain is fully gone, and the Achilles tendon looks normal and smooth with no bulging, I recommend giving it a couple of more days of the eccentric exercises.

2. Then, go for a test run of 1-2 miles at a very light easy pace. Ice the tendon right after this test run for 15min. If the tendon looks normal and does not get inflamed, it's been healed. If it does flare up again, go back to the Sub-Acute Phase routine. 

3. Take at least 1 full day between runs/workouts that stress the Achilles tendon. So, if you run on Sunday morning, do not run again until Tuesday. Spend the next few weeks running easy, with low mileage of 1-3 miles at a time, at a very slow pace. Remember, you are not working on speed, or aerobic capacity. I call them strengthening runs, and they are part of the healing process. 

4. If the tendon feels good, begin a regular stretching regimen of holding a stretch for 1-2 minutes at a time (Lunge with one leg back, push against a wall or a tree, and sink into the back heel) at least 2 x a day. Long and strong (from heel drops) tendons will not tear again. 

This webpage was written by Slava Kolpakov, who is a running coach and neuromuscular therapist at East West Massage Cambridge and East West Massage Newton, in Boston, MA. 

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