Load management: the most effective way to treat Achilles Tendinopathy

Load management is crucial for managing Achilles Tendinopathy.

So much so, that if you don’t apply this principle, there’s a good chance you simply won’t heal.

The good news is this:

Nearly every tendon will respond well when you learn to load it well.

So what is load management?

There will always be an optimal load for your tendon – whether you train or not. This optimal loading will produce tendon adaptation without causing harm from too much load.

Injury will occur when your normal activity exceeds your tendons capacity to bear the load.

So this means that any activities like hiking, running, cleaning, or any other activity that loads the Achilles has the potential to cause injury to the tendon.

It depends how much of that activity you are exposed to. If you have been doing that activity for a while your tendon will cope with more load before injury compared with someone who never does that.

What occurs after injury?

After an injury, the amount of loading your tendon can tolerate is decreased. This means you will not be able to perform the same activities you are used to doing. This is what we are calling – load management.

Now it can be easy to just do nothing here because your normal activity hurts. The key to managing this injury is to find the loading zone after injury and then slowly increase as your body heals.

This loading zone will change as shown in the below graph:

Graph displaying optimal loading zone and 'after injury' loading zone for Achilles Tendinopathy

So, we need to determine early on, what sort of load your tendon can tolerate and this will determine what exercise you begin with to treat it and what activities to avoid with work/leisure time.

Even the shoes you wear can have an impact on load through your Achilles tendon. Things like taping for achilles pain or braces can help to change the load on the tendon, however we still need to manage all the other day to day activities.

Now we understand what load management is, I want to answer this:

Why do we need to employ load management for Achilles Tendinopathy?

The first thing to understand is that your tendon needs time to heal – the reason it’s painful in the first place is that too much load or compression has been placed on the tendon. This can often result in lumps in the Achilles Tendon.

So, if we don’t change our normal activities then we aren’t giving the tendon a break.

Now there are two things to weigh up here:

  1. The tendon needs time to heal and rest from loading
  2. The tendon still needs gentle load to allow the fibres to re-align correctly (load management).

The big difference is the amount and type of loading we give the tendon. Tendons hate compression, so if you spend lots of time climbing hills or ladders, this will flare-up the tendon.

You will probably be asking;

How do I determine the appropriate load for Achilles Tendinopathy?

This is a great question, and one that will be very dependent on the individual person. The marker I use to determine what load is appropriate is the amount of pain you are in about 30-60 minutes after the activity.

So, for example, if you start doing heel raises, but 30 minutes after you’re in a lot of pain, this exercise is loading the tendon too much. This is very different from doing heel raises, even if it’s hurting a little at the time, and having no pain one hour later. The term we use for this is latent pain. Pain after an activity.

You can use latent pain to help you with work and leisure activities as well. If you find a little while after an activity that you are in pain, trace back one hour or more before to work out which activity would have caused the pain.

Also keep a tab on how much morning pain you are experiencing as this will give an indication on how flared up the tendon is.

There are certain activities that will simply stir up the tendon:

I have created a cheat sheet of these activities for you all. If you would like access to this, and everything else you need to recover from Achilles Tendinopathy, please click the link below, otherwise keep reading for some tips anyway.

Tendons will not respond well to any quick activities like jumping, running, hopping or any other fast movement.

Depending if your Achilles is insertional (double check the problem isn’t Plantar Fasciitis) or mid-substance they wont like being compressed either. Compression at the heel happens when the foot is bent forward like this. This means going uphill, climbing ladders, riding bikes all have the potential to flare-up your pain.

(Hint – if you do climb ladders for work, or ride, move your foot to the centre of the rung and it will decrease the load through your Achilles)

Any walking that is way outside normal for you, or if you’re a runner, running what you’re used to running will probably flare up the pain. Find out how to reduce heel pain with running here.

Some shoes with firm heels could cause some discomfort through pressure to the back of the heel.

What changes do you need to make today?

Right now, I want you to pause this blog, look at the cheat sheet for things that aggravate the tendon. If you are doing any of these, you must work out a way to modify them. It’s essential that you give your tendon the ability to rest!

If it’s simply impossible to change the task I would recommend you book an online physiotherapy appointment to talk about potential strategies to minimise any risk to your tendon.

Online physiotherapy can be an amazing tool to help you recover without even leaving home!

After saying all this it’s very important that you don’t just sit down and do nothing!

Also while your here, think of other strategies you can employ to help with your pain.

Even acute tendon injuries should not result in complete bed rest!

What you will find is that when your injury is loaded well, your tissue tolerance will increase. This means you can gradually increase your loading to normal again. That’s why it’s so important to find an exercises that works for you and become regular in doing that one.

If you are used to walking or running, don’t stop completely. You may have to reduce to only doing 500m, but that’s better than nothing, and if the tendon can cope without causing latent pain, it will help in the long run.

The last message I want you to grab hold of is this..

Finding an exercise your tendon can tolerate without flaring up pain is only the starting point…

Lots of patients will find an exercise that helps a little, but they will stay here for the next three months and won’t recover. The idea of finding the right load is hard because your tendon is always adapting. That means you need to adapt as well, and your exercises need to increase in difficulty.

If you remain on the same exercise, your tendon won’t be able to make the required adaptations. So, after you find a baseline exercise, make sure you push yourself every week. If you need some tips for this, check out our motivation blog here.

We have made this easy by giving you one chain of exercises and when one is easy you simply increase the reps, or if you’re on maximum reps then progress to the next one.

Keep in mind, every time you make an exercise more difficult, you need to back off the number of repetitions, so you don’t overload the tendon.

The take-away message for load management:

  1. Understand the importance of load management for your Achilles tendon and look at ways to modify your work/training environment.

  2. Have a good understanding of the activities that aggravate your tendon and have strategies to avoid them.

  3. Find a base-level exercise you can begin with and always progress as you are able.

Other Articles of Interest:

Best shoes for Plantar Fasciitis in 2021