The cycle of deconditioning in Achilles tendinopathy: Rest is not best!
Achilles tendinopathy is a painful condition of the region between the calf muscle and the heel. While it can occur in those that are less active, it has a high rate inactive individuals – it accounts for s 15% of all injuries in recreational runners, and will occur in 24% of athletes at some point in their lifetime. Usually, it will creep up, starting gradually as some stiffness and pain first thing in the morning or after a run/walk. But across time these symptoms increase, resulting in pain with most lower limb weight-bearing activities. In people that are active, this can impair their ability to continue participating in sport or activity.
The cause is often a spike in activity – longer, faster or more frequent runs, tackling that hill or another substantial increase inactivity. This spike may be immediate (a single session), or maybe across a longer time span of weeks or months. Tendons have a capacity to tolerate physical stress – think of this as a threshold, which can increase across time provided we exercise just below it. If, however, we cross this threshold too far or too often (before the tendon has time to adapt) the tendon starts to grumble with symptoms.
So how should Achilles tendinopathy be managed?
It would make sense that if the tendon is painful with activity, that rest would help alleviate symptoms, right? While in the very short term this may reduce some pain, it is not recommended practice! The problem with rest is that on re-commencement of activity, whether it be walking, running or sports, the tendon will have deconditioned further for having not been worked – the capacity of the tendon will be lower, meaning it will take less physical stress to exceed the threshold. The age-old adage of if you don’t use it you lose is not too far from the truth. For example, prior to rest, the tendons physical stress threshold may have been above those two 5km runs per week you were managing. After a period of rest, this threshold would have decreased ( the amount is dependent on the time rested). So, if you attempt then post-rest period attempt the same two 5km runs the tendon will likely flare and give you more pain.
The best management is often a combination of load management (this may be a more modest decrease depending on symptom severity) and strengthening exercise to INCREASE tendon capacity. Gradually across time as you get stronger, training loads can be increased gradually as a reflection of your tendon’s capacity. This would mean that rather than complete rest, your physio can determine an appropriate amount of exercise that will best maintain your capacity in the short term while allowing symptoms to gradually decrease.
The team at Peninsula Sports Medicine Group are expert in load management and exercise prescription for tendinopathy, if you have an Achilles (or any tendon) injury book in and we can help develop a plan to rehabilitate your tendon.
Written by Patrick Vallance
To make a booking with Patrick, please call
Langwarrin Sports Clinic: Ph: 03 9789 1233