There are many different ways to treat Achilles tendinitis. I will talk about the most effective treatment according to research (good work based on several studies) and about some treatments I think are interesting because of results in my clinic , but different studies do not show enough evidence.
Before any treatment we need to establish our goals:
1. Fight pain and inflammation
- Relative rest
To begin with, the most important thing to treat Achilles tendinitis is to have relative rest from activities that involve repetitive ankle plantar flexion loading weight. You should stop any high-impact activities or sports. Never a complete rest, as prolonged complete rest can be worse for the injury ( no movement = poor circulation = more pain = more stiffness and so on).
To maintain fitness, cross training, swimming, cycling and aquajogging are the best options. In very mild cases, you can decrease the intensity, time and kind of training ( for example, no hills if you are a runner) but still exercise. It should be pain-free during and after your training and also the following day. If painful, stop exercising.
Ice will reduce inflammation and pain. During the first 72hrs you should apply ice for around 20 minutes, never less than 10 minutes as it doesn´t have any effect, or more than 30 minutes as it might damage your skin. Repeat every 1-2 hours. Another way is to apply ice for 10 min then remove it for 10 min and apply it again for 10 min, repeating this every 1-2 hours. A bag of frozen peas is my favorite option, but an ice pack made of ice cubes wrapped in a plastic bag or towel is another good option (don´t put ice directly on your skin, if you don´t want to burn it).
After 72 hours I usually recommend the “hot/cold immersion therapy” or contrast bath which is a form of treatment where you have to immerse your leg in a bucket with warm water for 3-4 minutes and then in a bucket with cold water for 1-2 minutes. This sequence should be repeated for about 20 minutes finishing with the cold water bucket ( some professionals think that finishing with warm water is better though). Warmth causes the small arteries to open and cold causes them to close. The rapid opening and closing of the arteries near the site of your injury creates a pumping action which means a better blood flow.
I always recommend adding salt to the warm water which works quite well to reduce the inflammation even more (by the phenomenon of osmosis).
- Manual Therapy
Soft tissue mobilization is useful to relax calf muscles, alleviating pain and preparing muscles for posterior techniques, such as stretches and heel drops. At the same time the circulation will be improved by this mobilization.
Achilles tendon mobilization is usually recommended to avoid adhesions which would limit ankle dorsiflexion, causing pain and stiffness.
Taping attempts to limit longitudinal strain (offload) on the Achilles tendon and could help to limit ankle overpronation alleviating pain and improving function , as patients with Achilles tendinitis frequently present with increased pronation.
There are not many studies that support this, but some of my colleagues and I can report that taping provide good results in the early stages.
- Heel lifts
Although evidence is contradictory for the use of heel lift, as with taping, the use of heel lifts on a temporary basis is recommended to reduce stress on the Achilles tendon. The question now would be: “how many centimetres should the heel lift have?” Well, there are many opinions for this, but in general heel lifts of 12 to 15 mm are advocated.
- Foot orthotics
It seems logical to incorporate the use of foot orthotics in people who present with increased pronation. It makes sense, but in my view it should never be the first option.
I always say that a “natural way” (strengthening, stretches, etc) is the best option and, if this is not enough, insoles or shoes with support for the arch would be the next step, followed by orthotics.
I have to say that some of my customers wore orthotics before visiting me for treatment and they told me that orthotics reduced their pain and made their daily life more bearable.
I think that if we can´t improve our patient´s biomechanics, orthotics might be a good option.
There is much controversy about this matter, but I will talk about it in future posts.
- Night Splints
Some of you might have heard something about night splints. Apparently, they might be beneficial to reduce pain, but it is no clear and there are many different options which present better results.
- Laser therapy and iontophoresis
Treatment with low-level laser therapy or iontophoresis is another way to improve tenderness on palpation, crepitation, morning stiffness, and active dorsiflexion range of motion; but unfortunately they are not really accessible treatments.
Probably you don’t know what these treatments are about, so here you have the explanation:
Iontophoresis is a treatment that delivers medicine through the skin, driven by an electric field.
Painkillers such as paracetamol and NSAIDs ( anti-inflammatory) may help to relieve pain as well.
However, I have to tell you that I don’t like my patients to take drugs to alleviate pain, I prefer a more natural way. but I think you should have all the information to be able to decide for yourself. I am sure you wonder why. Well, they may mask symptoms which could delay healing and NSAIDs may reduce the ability of the tendon to heal, apart from other numerous side-effects you might have.
The first part of Achilles Tendinitis treatment finishes here. Click on Achilles tendinitis treatment: part II, Achilles tendinitis: treatment part III and Achilles tendinitis treatment: part IV to know more about the treatment of this injury or here to know its causes.
Please feel free to leave comments. I appreciate your help, as it will make this blog become better.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.