General rehabilitation guideline for Achilles Tendinopathy

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Achilles Tendinopathy: General term to tendon dysfunction or tendon pain. (We will be using this term to explore tendon-related management strategies)

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Types of Achilles Tendinopathy:

- Midportion (2-6cm above heel)

- Insertional (back of the heel)

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Physiotherapy management during different phases of Tendinopathy

Phase I: Reactive Tendinopathy (Early stage).

• Acute inflammation of the tendon.

• Able to return to normal with reduced load.

Management:

• Load management: Rest couple days from basketball, running

or jumping. After symptoms have settled, be mindful to GRADUALLY

build up the time on the basketball court

• Minimal therapy is needed. Can do some isometric exercise for 

tendon health (demonstrated below).

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Phase II: Tendon dysrepair (Later stage. If it doesn't resolve with 

load reduction and it started to flare up constantly)

• Load rate > Repair rate.

• Tissue repairing slowly and incompletely. Keep returning to high

intensity activities TOO SOON!

• Able to return to normal with a proper tendon rehab program.

Management:

• Load management: Take couple weeks time off basketball, running or jumping.

• Strengthening exercises for the Achilles tendon​

 

Phase III: Degenerative changes (Chronic stage)

• Load rate >>> Repair rate.

• Tissue unable to repair properly leading to degeneration

• Still able to rehab but takes longer time 

Management: 

• Similar to Phase II but need longer time off high-intensity activities

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Other management considerations for Insertional Achilles Tendinopathy:

• Choose footwear with minimal compression at the back of the heel, and wear heel lifts (3-4cm) to reduce irritation on the Achilles tendon for a minimum of 6-8 weeks

• Insertional Tendinopathy may not like dorsiflexion at the end of range when loading. Start with a smaller ROM then gradually progress to FROM pain free.

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Easy way to track your weekly load to achieve proper load management:

• Write down the time and frequency of basketball being played, high-impact activities like running, jumping, and strength training to the lower leg throughout the week on a template/notebook. 

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Achilles tendon strengthening exercises

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IF PAINFUL DURING HEEL LIFT, DO: 

Isometric standing heel hold

• Dosage: Aim for 3 sets of 20-30 sec each

• Frequency: 2 times a day

• Instructions: Hold the heel raise in one position for time.

Suggested to stand on the edge of a surface with balls of feet​

• Modifications: Different heel position with a specific point of weakness

or pain reproduction. Can do straight or bent leg.

• Usage: Earliest phases of rehabilitation.​​

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AS SOON AS PAIN IN HEEL LIFT IS MINIMAL, DO:​​​​​​

1. Standing STRAIGHT leg 'two up one down' heel raises

• Dosage: Aim for 3 sets of 12-15 repetitions.

• Frequency: 2 times a day. Do daily for ~12 weeks depending on severity of injury

• Instructions: Lift heels high with both legs. Lower down with the injured one only. 

Suggested to stand on the edge of a surface with balls of feet

• Range of motion: Start with smaller range then full range when pain is tolerable

• Speed/tempo: 2 seconds up, 3 seconds down

• Regressions: Do double leg throughout whole movement 

• Usage: Earliest phases of rehabilitation if painful during heel lift movement

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2. Standing BENT leg 'two up one down' heel raises

Dosage: Aim for 3 sets of 12-15 repetitions.

Frequency: 2 times a day. Do daily for ~12 weeks depending on severity of injury

(same as the straight leg version)

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Goal: 20-25 pain-free repetitions with bodyweight, add external weights to further progress tendon strength. Meanwhile, continue with Functional lower body exercises similar to those shown in  ​​​​

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Go to                                                     to see if you are ready to do progress to later stage rehabilitation exercises.