Our understanding of tendon pain and injuries has changed significantly over the last two decades and has driven changes in Physical Therapy treatment selection. As a profession we have moved away from a rest and immobilization approach and replaced it with an active approach designed to first strengthen the tendon’s muscle and secondly heal or remodel the injured tendon. The prescription of strengthening exercise for patients with achilles tendinopathy is strongly recommended given the evidence on this topic beginning with Alfredson’s trial in the late 1990s. A recent review of the available literature describes which treatments are most effective for patients with achilles tendinopathy.
The British Journal of Sports Medicine recently provided an update on their living or ongoing systematic review of the available evidence on treatments for patients with achilles tendinopathy (van der Vlist et al. 2020). They included 29 scientific studies on 42 different treatments and reported on their pooled outcomes. Any active approach (strengthening) was found superior to a wait and see approach at short and long term outcomes. Based on literature the vast majority of patients will have relief of symptoms by 12 weeks, but tendons can take up to 12 months to completely heal. Thus, a long term strengthening and load management program is required for optimal outcomes.