Strength Coach’s Guide to Achilles Tendinopathy – Greg Schaible

When working with athletes who are pushing their bodies to the limit, inevitability you will end up having a client who starts developing a tendinopathy. One of the most common tendinopathies that can develop is in the Achilles tendon.

This type of tendinopathy can be a frustrating area for a lot of people because it tends to linger on longer than most other tendinopathies. Before diving into what actions you can take, it’s important to have a general understanding of what a tendinopathy is.

Simply put, a tendinopathy occurs when either an acute or chronic overload to a tendon happens which exceeds its current capacity to withstand. While it’s important to remove the provocative factors to allow for healing to occur, its generally not a good idea to completely deload and just rest the tendon either. Complete rest does nothing to improve tissue resiliency and capacity. In fact, it generally worsens it!

It’s important to understand that you can load a tendon in a variety of different ways based on how sensitive the location of injury. For the Achilles tendon, symptoms tend to be present at the insertion to calcaneus or mid tendon portion of Achilles tendon. How you will work with the athlete will differ depending on this location.

Distal Achilles symptoms at the calcaneus can be more difficult to manage. It’s important to avoid high amounts of dorsiflexion in times the tendon is highly sensitive. This is due to the biomechanics and structure of the foot and tibia and how it influences compression to a tendon.

This position of closed chain ankle dorsiflexion may irritate an area which is already symptomatic. For this reason, it is generally not a good idea to be performing any stretches in this case. With strengthening exercises such as eccentrics, you also need to limit range of motion that they are performed in. More on this later….

For a mid-tendon Achilles tendinopathy, compression against the calcaneus is less of a concern.

Some light stretches may be warranted, and often you can strengthen the Achilles through a larger range of motion.

Below are 3 of my favorite ways to start loading the Achilles tendon again:

Isometric barbell

Eccentrics Gastroc Heel Raise

Eccentric Soleus Heel Raise

All 3 of these exercises can be performed in the weight room. For the isometrics I will usually perform longer duration holds 20-30 seconds depending on tolerance. Then if able perform a couple with ramping up intensity to 90-100% effort for 5-6 seconds.

The eccentrics can be performed on a step or on flat ground depending on location of symptoms. With the gastric heel raises generally being more tolerable than the soleus heel raise.

Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. Greg is the owner of On Track Physiotherapy and owner of the popular online education resource Sports Rehab Expert. Greg works with athletes and active individuals of all ages. As a former athlete himself, he attended The University of Findlay and competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American.

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