In the third part of the series focusing on the Achilles tendon, physiotherapist Mark Buckingham advises on timescales for healing, rehab and running again.
If you have decided that continuing to try to run whilst struggling with treating the tendon is simply not working then resting and treating the tendon properly has to be your main focus. However, there is little point in stopping running but continuing to spend all day on your feet or cross training until it is painful. Rest properly!
You might feel that you are not doing much, but the continued symptoms are a clear indication that you are, regardless of your perception. It comes to a point where you have to listen to it, however much you don’t want to.
Mobilising and early heel rise type of strength work takes 2 to 3 weeks to have an initial effect and then another 2 to 3 weeks to become good. This means that you should consider at least 3 weeks of rest as a starter in an Achilles problem that has been lingering for several weeks or more.
This timescale is determined by how long the body takes to improve tissue strength and structure. It is simple physiology that you cannot cheat any more than how long it takes you to get fit.
As discussed in Part 1 of this Achilles series , the tendon has poor blood flow and hence poor nutrient supply which impacts on healing times.
A simplified time scale and rehab program would be:
| Stage of rehab | Action | Exit criteria to move onto next stage |
| Stage 1. Boring rest, strength and mobilising work | 3 to 5 weeks of rest, heel rises and mobilisation |
3 x 25 with 15kg single leg heel rises Much less tender Achilles to walk and go upstairs 10 minutes of early morning stiffness only |
| Stage 2. Dynamic work | 3 further weeks of hopping drills. As described in Part 2 Addition of extra weight to the heel rises Continue to mobilise Continue to work on the foot and glut strength |
3 x 25 heel rises with 20kg plus Much improved foot strength (Tibialis Posterior) and Gluteal strength Pain free hops and backward lunges |
| Stage 3. Return to Running! | Continue to work on the heel rises and hops on alternate days to runs Add a rest day every 5 days so – Exs – Run – Exs – Run - Rest Run an easy 5 minutes on grass Build to 10, 12, 15, 18, 20 minutes on alternate days to the exercises. Be worried if the pain is sharp or the tendons swells up Don’t be worried if there is an ache and a bit more morning stiffness |
This process takes you over another 2 weeks and you can build it up to 30 minutes if all ok.
Once 30 minutes has been reached then maintain the exercises and drop the rest days to every 7th day. Keep the heel rises exercises up for another 2 months at least.
This is a suggested guide. Everyone will respond to this differently and each Achilles issue is different. Listen to your body. If it feels fine then you can accelerate it, if it is sore then slow it down by adding in more rest days. Be led by the exit criteria and if it takes a week or two longer then so be it.
However, if you wish to have more individual guidance then please consult and chartered Physiotherapist with specialist knowledge of Achilles issues.
Physiotherapy
Your physio should look at your gait pattern, assess the lengths and strengths of the foot, calf, thigh and hips and feel closely the quality of the tendon. Attention should be given to the lower back and pelvis. Many of the strength and imbalance issues in the leg stem from issues in the spine and any Achilles assessment is not complete without a thorough spinal examination.
Further spinal issues in chronic problems come hand in hand with rib and breathing dysfunctions as well as issues in the neck. I often also look at visceral (abdominal) issues that link to all these structures.
Mobilisation – the tendon needs to be worked hard to improve the tendon mobility and the slide and glide of the tendon sheath. It is hard to do this to yourself properly. Most Physio sessions should include some deep mobilisation.
Shockwave Therapy – is a new way of mobilising the tendon tissue and is showing good results. This is the use of a probe which imparts high force impacts to the tendon tissues and has an ‘irritant’ effect – rebooting the inflammatory and thus healing process as well as improving the plasticity of the tendon tissues. Especially useful in the Stage 1 phase.
In my view, proper hands on mobilisation does the same but for those therapists unable or unwilling to do this then it is a good alternative.
Acupuncture – this can be very helpful although the exact mechanism is not understood. For some specific local spots of ‘stickiness’ of the sheath to the tendon some local ‘pecking’ or ‘dry needling’ of the tendon can give good results.
Electrotherapy – in my view it is fairly useless in all but the most acute stages although some clinicians say they get results from laser.
Achilles Tendon Part 1 - Why Achilles Injuries Occur And Are So Difficult To Treat -->
