Achilles tendinopathy is the most common tendon injuries seen in our Boulder Physical Therapy practice. Patients often present with pain along the mid portion of the achilles tendon during walking, hiking, running, or jumping activities. The greatest risk factors for this condition include a loss of ankle flexibility (dorsiflexion) and calf weakness. Both of these impairments are thought to place abnormal tensile loads through the achilles tendon leading to an overuse injury within the tissue. Physical Therapy, including activity modification, manual therapy to the restricted joints, and lower quarter strength training, remains the first line intervention for this condition. Of all the indicated treatments, progressive, optimal loading of the injured tendon is most critical for healing of the injured tissue. Although eccentric training initially started the loading conversation more recent research indicates many contraction types (isometric, eccentric, and concentric) are therapeutic for this condition.
A recent review of the evidence regarding heavy eccentric calf strengthening for patients with mid portion achilles tendinopathy was published in the British Journal of Sports Medicine (Murphy et al. 2019). Authors reviewed seven studies on the use of this exercise compared to natural history and other Physical Therapy treatments. Murphy and colleagues reported eccentric training was more effective than natural history or a wait and see approach, as well as, other Physical Therapy interventions. Consistent with our current understanding on exercise use in this condition, eccentric training was not superior to other exercise interventions. Thus, strict adherence to a one size fits all model of heavy eccentric is not necessary. Instead patients are encouraged to work with a Physical Therapist to find a loading program most appropriate to their specific condition.