Mid-Portion Achilles Tendinopathy Exercises Handout

What is Achilles tendinopathy?

The Achilles tendon connects the heel bone to the calf muscle. Achilles tendonitis is the inflammation of this tissue, usually due to overuse and excessive chronic stress on the tendon structure (Cleveland Clinic, 2021). Achilles tendon injuries are a common condition in runners; when an individual runs, calf muscles are used to help raise you up on your toes; as time goes on, this repetitive motion, combined with not giving your body enough rest, can cause painful inflammation.

The precise cause of tendonitis remain unclear, although it is more commonly connected to athletes, it still occurs in people who do not practice sports. It is shown that a lack of flexibility or a stiff Achilles tendon can increase the risk of injuries, with the biggest cause leading to excessive overburdening of the tendon (Clain & Baxter, 1992).

Achilles tendinopathy can be described as mid-portion or insertional tendinopathy, depending on the location (Opdam et al., 2021). Tendon pain in the middle portion region can be one-sided or over the belly of the tendon itself. The focus of this handout is on this mid-portion. This occurs when the fibers in the middle of the tendon start to thicken, swell, and break down, typically affecting those who are more active (Cleveland Clinic, 2021).

Mid-Portion Achilles Tendinopathy Exercises

There are a number of exercises that can be used for managing Achilles tendinopathy. A study by Grävare Silbernagel & Crossley (2015) mentions eccentric calf muscle training as the most advocated treatment for patients with Achilles tendinopathy; these eccentric exercises require only body weight or minimal equipment. Here they are:

Heel drop

This exercise should be performed in 2 different positions: knee straight and knee bent. Start on the side that is injured. Ask the patient to stand on the edge of a step with their knee straight and their heels hanging off the step. Lower the heel as far down as possible. Rise back on the toes with the assistance of the other foot. Continue doing this exercise even if it gets painful, but stop if the pain is disabling. Once pain-free, the patient can progressively load weight, either by wearing a loaded backpack or carrying something in their hands, until the exercise becomes painful again. After that, do the exercise again with the knee bent.

Heel rise

This exercise should be performed in two different positions: two-legged and one-legged. Ask the patient to stand with their feet flat on the ground, then have them lift the heels as far up as possible. Ask them to hold for a few seconds before lowering them back down. Encourage them to continue doing this exercise even if it gets painful, but stop if the pain is disabling. When performing the one-legged exercise, start with the leg on the floor that is injured with the other leg raised.

Sitting heel rise

This exercise requires sitting on a chair with the affected foot at a 45-degree angle, the heel slightly raised, and the foot touching the ground by the toes. Ask the patient to lift the heel as high up as possible and lower to the ground.

Heel rise on a step

This exercise should be performed in two different positions: two-legged and one-legged. Start with the two-legged version first. Have the patient stand by their toes at the edge of a step, with their heels hanging off. Then, ask them to lift the heels as far up as possible, holding for a few seconds. Then, let them slowly lower it back down, stretching the heel past the toes. Encourage them to continue doing this exercise even if it gets painful as it will eventually get less painful, but stop them if the pain is disabling. When performing the one-legged exercise, have them start with the leg on the step that is injured with the other leg raised.

How to use our Mid-Portion Achilles Tendinopathy Handout

This handout of exercises for tendinopathy treatment comes with images to make the instructions easier to follow for patients. To integrate this handout into your practice, follow these steps:

Step 1: Download the template

Access the Mid-Portion Achilles Tendinopathy Handout template by clicking "Use template," allowing you to edit the resource via the Carepatron app. For a PDF copy, choose "Download."

Step 2: Familiarize yourself with the template

Review the Mid-Portion Achilles Tendinopathy Handout template to understand its structure and content. The template allows you to customize the number of seconds for holding, repetitions, and sets if your patient wants to do the exercises at home.

Step 3: Use the template during consultations

Follow the template when treating the patient's mid-portion Achilles tendinopathy injury. It will help ensure you provide clear and comprehensive details so that the patient has the correct and necessary information to understand their treatment plan following their injury.

Step 4: Give a copy to patients

Share the Mid-Portion Achilles Tendinopathy Handout template with the patient to reinforce the information discussed. This allows them to review the details at their own pace and to do the exercises on their own in between sessions.

Importance of Mid-Portion Achilles Tendinopathy Exercises

Exercise therapy has the highest level of evidence of efficacy against chronic Achilles tendon pain. It is recommended that all patients be treated with exercise for at least three months prior to considering other treatment options. The exercises work to manage tendon healing, improve tendon strength, and promote functional recovery by gradually loading the tendon to stimulate adaptive remodeling and reduce pain.

If treatment is not sought or you don't have adequate rest, patients may experience complications. These include chronic Achilles tendinosis, where the Achilles tendon starts to break down, or Achilles tendon rupture, where the Achilles tendon separates from the heel bone or tears or breaks completely (Cleveland Clinic, 2021). Physical therapy management of chronic Achilles tendinopathy should factor in specific interventions to ensure comprehensive treatment of the condition.

References

Clain, M. R., & Baxter, D. E. (1992). Achilles tendinitis. Foot & Ankle, 13(8), 482–487. https://doi.org/10.1177/107110079201300810

Cleveland Clinic. (2021). Achilles tendinitis: Achilles tendon pain, treatment. https://my.clevelandclinic.org/health/diseases/21553-achilles-tendinitis

McCormack J. R. (2012). The management of mid-portion achilles tendinopathy with ASTYM® and eccentric exercise: A case report. International Journal of Sports Physical Therapy, 7(6), 672–677.

Opdam, K. T. M., Zwiers, R., Wiegerinck, J. I., & van Dijk, C. N. (2021). Increasing consensus on terminology of Achilles tendon-related disorders. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 2528–2534. https://doi.org/10.1007/s00167-021-06566-z

Grävare Silbernagel, K., & Crossley, K. M. (2015). A proposed return-to-sport program for patients with midportion Achilles tendinopathy: Rationale and implementation. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 876–886. https://doi.org/10.2519/jospt.2015.5885

Mid-portion Achilles tendinopathy is commonly caused by repetitive strain from activities like running or jumping, leading to overuse injuries, poor biomechanics, or inadequate stretching and strengthening of the calf muscles.