5 reasons your Achilles tendon exercises are failing!
“I’ve tried Achilles tendon exercises, but they didn’t work for me”, is a phrase I’ve heard too many times over my career as a physiotherapist.
It’s sad when so many people could be seeing such improvement because there are exercises that won’t hurt your Achilles Tendon. Yet for one reason or another, their Achilles tendon exercises failed them.
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Rehabilitation of Achilles Tendinopathy (tendinitis) is one area of physiotherapy that I’m extremely passionate about. Probably because, when done well, most people should have great results with exercise alone.
There are many exercises that won’t hurt the Achilles tendon!
Through this article, I want to highlight some common areas where people go wrong when it comes to Achilles tendon exercises. Although this is simple to treat, there is a certain finesse that is needed for the appropriate management of this condition.
So what are the 5 reasons your Achilles tendon exercises are failing? Let’s get straight to reason #1!
Prefer to skip ahead?
- Stretching the tendon is aggravating your pain
- You have gone too hard, too fast with Achilles tendon exercises
- You haven’t loaded your tendon enough
- You just didn’t progress the exercises
- Your lifestyle factors are irritating the tendon
#1 Stretching the tendon is aggravating your pain
I always like to tackle the most contested topics first. There will be many doctors who still prescribe stretching as part of their Achilles tendon exercises. So why then am I saying this may aggravate the tendon?
Before I can answer this question, we need to distinguish between two distinct types of Achilles Tendinopathy (tendinitis).
This form of Achilles tendinopathy affects the middle of the tendon. It is not sore where the Achilles joins into the heel, but rather in the mid-portion of the tendon. There is usually a thickening in the middle of the tendon as well.
Insertional Achilles Tendinopathy
Insertional Achilles Tendinopathy affects the Achilles tendon as it joins into the heel. You can pinpoint your pain right down near the bone. There may be redness, swelling and pain in this area. This can also be part of a condition called Haglund’s Deformity.
You need to differentiate this pain from Plantar Fasciitis which occurs on the pad of the heel, instead of the back.
This type of tendinopathy is usually harder to treat and can be associated with bony spurs and bursitis around the heel.
So why can’t we stretch the tendon?
In recent years, researchers have found that tendons do not respond well to compression. Compression can in fact, be a major contributing factor to tendon injury. That’s why it’s important to avoid this where possible.
For mid-substance tendinopathies, stretching may not be so bad as there is no way the tendon can be compressed. If you have an insertional tendinopathy, then stretching the tendon will compress it against the heel. This could be increasing the pain.
The challenging part about aggravation of Achilles pain is you may not feel it immediately. Most pain from tendons is what we term ‘latent’ pain, meaning you may feel it an hour or two later. This is why it’s important to keep track of which exercises you do. You also need to see how your tendon feels a few hours later.
So to stay safe we would recommend that you stay away from stretching. Even if it’s not detrimental, there are no added benefits for stretching the tendon. The benefits come from adequate loading to help the tendon recover, which brings us to our next reason:
#2 You have gone too hard, too fast with Achilles tendon exercises
What do I mean saying ‘too hard, too fast’?? There are many people that still apply the good old saying ‘no pain, no gain’ to their Achilles tendon exercises.
Unfortunately, this old school way of thinking will get you in more trouble when it comes to tendon rehabilitation.
Tendons do not respond well to rapid changes in load.
To ensure we don’t load the tendons too quickly, we need to listen to our body. We talked about latent pain earlier, this pain response can help to guide your rehabilitation. You may even have to use external braces to modify the load if the tendon is extremely flared up.
When you perform your Achilles tendon exercises, watch for pain in the tendon a few hours later. If you get this response it means you have loaded the tendon too much.
It’s time to re-think how much load you have subject your tendon to.
Another guide is morning pain in the heel, as this can be an indication that the tendon is flared up.
Even the shoes you wear can have an impact on the load going through your Achilles Tendon!
Think of exercise prescription like any medication. You would take the recommended dose on the packet – and that’s because too much of a good thing, can be a bad thing.
The reverse can also occur, and you can end up not loading your tendon enough..
#3 You haven’t loaded your tendon enough
Tendons need a healthy amount of load in order to stimulate healing of the inner fibres. The fibres in a tendon become mal-aligned in a tendinopathy. Load helps to re-orientate these fibres to run parallel once more.
If you have been doing exercises and felt no pain whatsoever, you may not have pushed hard enough. Now I don’t want to sound contradictory. I have just stated above that too much pain is a bad thing, and it is. The main thing to watch out for, is when are you experiencing this pain?
Experiencing mild pain with exercise, which then goes away and doesn’t return later is acceptable. The main thing to avoid is latent pain. Some pain whilst exercising is ok, and may even be expected.
#4 You just didn’t progress your Achilles tendon exercises
Some people start out perfectly with their rehabilitation and then just forget the most important step, which is load progression!
Perhaps you were scared of going backwards, or just lacked motivation to continue. Either way, a lack of loading for the tendon will cause increase in pain as you resume your normal activities.
How do we load with exercises that won’t hurt our Achilles Tendon?
Loading your tendon effectively first begins with finding a baseline level of load that isn’t aggravating your pain. There are a few exercises that wont hurt the Achilles tendon. These Achilles tendon exercises are:
Seated calf raise:
The seated calf-raise is a gentle Achilles Tendon exercise that is bound to see results. Sitting with your elbows resting on your knees, you want to slowly lift your heels of the ground. Hold this position for 10 seconds and return your feet flat again. You can choose how much weight by leaning more through your elbows.
Lying Toe-point with resistance band:
This differs from the seated calf raise as your knee is fully straight, changing the load on the Achilles tendon. Start by lying on your back, holding a resistance band that loops around your toes. You want your feet off the ground, I use a rolled up towel under my calf muscle. From this position, point your toes slowly and then return to normal.
Standing calf raise:
The standing calf raise is a more advanced Achilles tendon exercise. Standing with you back against a wall, gently lift your heels an inch from the ground. Hold for 10 seconds and return back slowly.
Achilles Tendon Exercise progressions:
You will need to progress your Achilles Tendon exercises far beyond a standing calf raise to achieve adequate results.
For most, they plateau here because pain levels reduce. The problem is that the tendon structure still needs to adapt, otherwise you will get a flare-up in a couple of months time.
Many people will get on top of their pain, only to have a flare-up down the line. Most of the time it’s because they didn’t finish loading correctly.
There are many protocols out there, but Silbernagel’s is a good place to start. It will introduce loaded calf raises, and finally plyometrics like jumping.
The key is to find an Achilles tendon exercise that is slightly uncomfortable whilst performing the exercise, but quickly settles and doesn’t flare up later. Once this is achieved, stick with it until it becomes easy. Then you need to work to a harder exercise.
You will start very basic but depending on your activity you may end up progressing to activities like jogging, then onto hopping, jumping and sprinting.
For specific help for you rehabilitation have a read of how online physiotherapy can help you, and if your interested we have an Achilles online course that goes through specific Achilles Tendinopathy rehab.
#5 Your lifestyle factors are irritating the Achilles tendon
We can be doing everything right but still not progress if lifestyle factors aren’t considered. Remember, your feet carry your everywhere and your Achilles tendon is working whether we are exercising or not.
Some common activities that will aggravate your Achilles include:
- Walking up and down ladders for work
- Walking on uneven ground for long periods
- Walking up and downhill
- Gardening, or other activities involving squatting
- Sporting activities involving jumping, running, sprinting
To get really good results with your Achilles tendon exercises you need to modify your activity. This doesn’t mean you won’t ever play again but you may have to modify for a couple of months.
Jogging can be a big risk factor for Achilles pain, so it’s important to understand how to appropriately progress this activity. You can find out how to reduce heel pain with jogging here.
If you are simply unable to modify some activities it’s then important to look at how you can best protect your tendon from injury. You may try taping the Achilles to support it during activity. Another idea is to try heel lifts for Achilles pain to see if they will help settle the irritation.
When can I return to sport?
As your heel pain begins to settle, keep up with the exercises. The point where you can consider sport is when you are able to perform tasks like hopping and jumping without pain.
You will find that your pain will flare up if you attempt to return to sport too early. If this does happen, just stop what aggravated your pain and continue with exercises. Eventually the tendon will settle.
The bottom line
Achilles Tendinopathy can usually be managed well with exercises when they are performed in the correct manner. Begin applying some of the above strategies for the best outcome with exercises.
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Frequently Asked Questions
Does stretching help Achilles pain
This depends on if the damage is in the middle of the Achilles tendon or right on the heel. Stretching is not recommended in early stages of Achilles tendinopathy and has the potential to make the pain worse.
How often should I perform exercises?
The frequency will vary depending on the extent of your symptoms. Twice a day is a good place to start, however if you experience an increase in pain, you may only start with one set of exercises per day.
Whats the best exercises for Achilles pain
Exercises will vary depending on pain levels and your tolerance to load. It's best to start with a low-level exercise like sitting calf raise leaning on elbows, and progress to harder exercises like calf raises.