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The Achilles Tendon attached the calf muscle group to the heel bone and the lower aspect of the Achilles Tendon is known as the Achilles Tendon Insertion. There is a natural element of compression on the tendon as it wraps around the heel bone so when it develops into a tendinopathy it is important to avoid this position. Compression of the Achilles Tendon insertion occurs primarily when the heel drops below neutral, i.e. off a step so for the majority of the rehabilitation protocol for Insertional Achilles Tendinopathy, none of the exercises should go below neutral.
Isometric Exercises are primarily used for very painful tendons that find it too difficult to take the ankle through full range. Historically there has been some moderate level evidence that this works well as an analgesic but there have been some studies questioning this since. However, clinically we have found these exercises beneficial for those with constant Insertional Achilles Tendinopathy pain.
A classic study by Alfredson et al, 1998, highlighted the importance of eccentric exercises for Achilles Tendonitis but since then we have found that isotonic strengthening (through range) is as beneficial and has greater compliance as it only needs to be done 3 times a week. However, we will share the eccentric exercise below.
Isotonic strengthening exercises are the most effective form of treatment for Insertional Achilles Tendinopathy. Exercises should be to ground level and above, never going below neutral. As a rule of thumb, it is okay to have some pain during the exercise once it settles within 24 hours of completion. It the pain remains greater after this period, it is a sign of an overload, and repetitions or weights should be reduced when carried out again. Wait until pain levels have returned to their baseline before recommencing.
Insertional Achilles Tendinopathy Exercises are beneficial for the rehabilitation of the tendon but exercises, where the heel drops below neutral, should be avoided. This includes heel raises off a step below neutral and calf raises on a leg press machine where only the forefoot is on the plate.
Consider avoiding plyometric exercises such as hopping, jumping and box jumps. Cardiovascularly sprinting and hill sprints should be avoided.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.