Strengthening Exercises For Achilles Tendinitis



Achilles Therapy

Achilles Tendinitis


Its summer, and the time for road races. Whether it is a 5K, 10K or 15K, the warmer weather is inspiring people to participate in running. A significant amount of training programs exist guiding the coach potato or seasoned runner. Their focus tends to be on how to increase mileage and/or time with an effort to avoid injury. However, sometimes a little too much running, not enough strengthening and stretching and poor form can result in injury. Runners appear to have 10 times greater frequency than their controlled age group with respect to Achilles injuries, with Achilles tendinitis being more common. Understand Achilles tendinitis treatment and prevention, requires understanding tendinitis and it possibly being misdiagnosed for tendinosis.

 

Tendinitis refers to an acute inflammation of the tendon. In other words, an inflammation that has recently occurred, and that has not been present for a long time. When there has been a tendon injury with poor healing and pathology of degeneration over a long period of time, this is called tendinosis. Think of this injury as chronically healing poorly. Tendinopathy refers to injury to a tendon, but is more general as to the pathology. More frequently, clients are presenting with a longer history of Achilles pain versus an acute injury. Understanding tendinitis versus tendinosis allows for an appreciation of treatment’s intention. A tendonitis will focus on decreasing the acute inflammation, and restoring strength and function. A tendinosis will also focus on restoring strength and function, but also recognizing what factors are contributing to continued tendon breakdown. Tendinosis recovery can take several months to achieve results, as it can take up to 100 days to lay down new collagen. In other words, if you have recently injured your Achilles, get treatment sooner than later. And for those who have a chronic Achilles issues, be patient and respect the healing phase, otherwise injuries will continue.

 

As mentioned above, injuries can occur from a multitude of factors. For example, footwear, foot mechanics, to strength and mobility, and types of running surfaces can influence the Achilles tendon. Thus treatment recommendations for one person may not work for another. However, in all cases, there comes a phase of strengthening and stretching. Strong glutes and core are needed to stabilize the hip and back and help absorb running forces. In the beginning phases of healing, focus on strengthening the hips and core. If strengthening exercises like squats, lunges, and dead lifts are increasing Achilles pain, then leg lifts on hands and knees or on the belly or side may be the place to begin. The following are a list of ideas of how to gradually progress a strengthening program. Reps can be 8-12 with sets 1-3. Keep to the lower end of repetitions and sets until you know how your Achilles will respond.

 

Initial Phase:

Straight Leg Raises

  • On your back lifting a leg up and down
  • On your side lifting top leg up
  • On your side lifting bottom leg up
  • On your belly lifting the leg up
  • Bridging

  • One legged or two legged
  • Clams

  • On your side knees bent, lifting and lowering the top knee while keeping the heels together.
  • Core exercises

  • Heel slides inverted
  • Pull over crunch
  • Toe taps with a pull over crunch or with triceps press
  • Scrunch
  • Knees facing forward
  • Knees angled to the side
  • When you start to progress into strengthening, the next challenge is balancing strengthening with returning to running. When returning to running, only 1-3 times a week may be all that is recommended. Below are some considerations. Be honest with how your body feels, and implement changes slowly to avoid setbacks.

    Running Considerations:


    1. You need good mobility at the ankle, including the heel, big toe, and hips.
    2. Core and hip strength are needed for dispersal of forces, and off load increased stress to a hypermobile, too flexible foot.
    3. Improper shoe wear can lead to chronic strains or can help prevent injuries. Shoes should still allow you to feel your foot on the ground to allow proprioceptive changes. Shoes are constantly evolving, thus working with a person who understands these changes is important. If using barefoot shoes, recognize that the foot needs time to adapt. The arch of the foot can increase and the weight bearing load may increase from quadriceps to calf.
    4. Injury is associated with training errors:

  • Too much mileage or intensity, variable surface, and lack of consistency and/or rest days.
  • Mileage should increase no more than 30% weekly. Progress only 10% every 2 weeks and then a week to back off or hold at that level.
  • Intensity, pace and effort with only 2 of 6 runs are intense with racing equating to an intense run.
  • Avoid speed work until 4 weeks of tempo and hill running are completed consistently and without injury.
  • Ideally get off the road. Running on the road increases forces throughout the body.
  • 5. Suggested Benchmarks to achieve without pain to return to running

  • Walk before jump for at least 45 minutes.
  • Jump before run for at least 3-5 minutes.
  • Run before miles for at least 2k per day.
  • Run uneven surface mileage before hills.
  • Run hills 4-6 times for 1 minute each before sprinting.
  • Train fully before competing.
  • 5. Dynamic warm up (see video)

  • Hip 3-D stretching (see video – Hamstring, Hip Flexor, Adductors)
  • Calf 3 way stretching (see video – Knee drivers hands on wall or on glideboard)
  • Hip Swing Forward/Backward, side to side
  • Skipping
  • 6. Strengthening routines can gradually increase in complexity with respect to movement patterns, as well as, the routines incorporating more agility work. Below are two less complex routines. As your progress, you can begin to incorporate more agility drills, which can be introduced in 20, 30, 45 and 60 second bouts. Strengthening sessions may be 1-3 times a week with 1-2 days between sessions.

    Strength Routine 1: Squat Focus


    Squats

  • Bilateral (Both Legs)
  • Unilateral (One leg, toe touch for partial assistance)
  • Bridging

    Side Lying Squat

  • Heel at the edge of the platform
  • Wide squats

    Side Lying Squats

  • Foot in the middle of the platform.
  • Wide Squats on Toes

  • Bilateral (Both Legs)
  • Unilateral (One leg, toe touch for partial assistance)
  • Calf Raises

  • Knees can be straight
  • Knees can be slightly bent to focus on the deeper calf muscles
  • Bilateral (Both Legs)
  • Unilateral (One leg, toe touch for partial assistance)
  • The focus is on slowly lowering the heel
  • Sprinter Start

    Chugs – standing straight leg pulls in all directions with or without resistance

    Planking with lower body reaches (see video)

  • Heel lifted for more core focus
  • Heel down to incorporate more of a heel stretch
  • Strength Routine 2: Lunge focus


    Lunging facing away from tower

  • Initiate the motion with the buttocks
  • Keep pelvis facing forward
  • Single leg dead lift/ teeter totter (see video)

  • Pelvis is facing parallel to the floor
  • Back leg can stay on the glideboard
  • Back leg can lift up then reach forward
  • Lunging Facing Tower

  • Full range of motion
  • Hold lunge and focus on back leg straightening and bending (see video)
  • Lunging Standing Sideways (straight leg splits)

     
     

    Monster walk

  • Criss cross theraband in front of legs and behind the thighs) sideways (see video)
  • Cross Pattern Lunges

  • across the body and to the front to behind the body to the back (see video)
  • Single arm pull up with opposite leg lift (see video)

  • Leg can be straight or bent
  • Focusing on stability of the hips and back
  • Bridging with feet on the floor and the hips staying lifted throughout the motion

    Feet in straps to stretch

  • Scissor legs – Back of the leg
  • Feet in a V – inner thigh stretch
  • Low kneeling

  • shoes off to stretch the foot and facilitate mobility of the big toe. (see video)
  • Lunge Hip Flexor / Runners stretch

    Agility Drill

    Skater

    Jump both legs: forward/backward; side to side; rotating right and left

    Jump one leg: forward/backward; side to side; rotating right and left

    Karaoke

    Elizabeth Leeds, DPT

    Elizabeth Leeds, owner of Seaside Fitness and Wellness, combines her background in physical therapy, personal training, and Pilates in her practice and teaching. As a pelvic floor physical therapist working at Comprehensive Therapy Services in San Diego, her passion for pregnancy and postpartum is seen in her mission to empower women with knowledge and understanding of their physical changes, and how to address them to prevent future issues.Additionally, Elizabeth is a Master Trainer and developer for Total Gym’s GRAVITY education.

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