Preventing Recurrence of Achilles Tendinopathy and Return to Sport
In prior posts we described risk factors for an initial episode of achilles tendinopathy including muscle imbalances, calf weakness (concentric and eccentric), and loss of mobility within the foot and ankle. Once the tendinopathy is established, patients demonstrate significant deficits in range of motion, strength, balance, endurance, and jumping ability (Silbernagel et al. 2006). These impairments and the duration of symptoms until complete tendon healing, 12 months, create obstacles for the athlete looking to return to sport following an episode of achilles tendinopathy. At Mend Physical Therapy we often see patients who describe a recurrent nature of symptoms including pain, stiffness, and an inability to return to their sport. These athletes are not alone with re injury rates ranging from 20-44% based on the literature (Gajhede-Knudsen et al. 2013). Common risk factors for re injury include inadequate rehabilitation, short recovery periods, and those who were not given guidance/assistance in their return to play (Hagglund et al. 2007). To reduce risk patients should seek the advice of a Physical Therapist to advise the patient on the proper tendon loading schedule.
Authors have reported up to a 90% success rate with return to sport after a rehabilitation program (Silbernagel et al. 2015). We know exercise is essential for promoting healing of the injured tendon, as well as, preparing the tendon and lower extremity for the demands of a patient's sport. The key question remains the prescription of exercise volume (loading type, amount, duration, intensity, frequency, rest periods) to train the tendon the meet the demands of the sport. In running alone, the tendon must be able to handle 6-12 times the body weight of the patient (Fukashiro et al. 1995). Silbernagel et al. recommends consideration of a patient's symptoms with activity, stage of tendon healing, recovery of impairments including range of motion, strength, endurance, and balance, as well as, the demands of the patient's individual sport.
We would encourage those who have a history of achilles tendinopathy to seek the evaluation and guidance of a Physical Therapist to assure lower quarter impairments have been treated, as well as, to receive a game plan for their return to sport. If left up to the patient or athlete, this condition may return.