Achilles Tendinopathy / Tendinitis / Exercise / Best treatments / Recovery
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- Опубліковано 11 лют 2025
- In this video, you will learn everything you need to about Achilles Tendinopathy. Get the best tips for recovery and avoid treatments that do not work.
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TIMESTAMPS
0.00 Introduction
0.59 PART 1: WHY YOUR ACHILLES HURTS
0.59 What is the Achilles tendon?
1.29 What’s the main job of the Achilles tendon?
2.20 What is Achilles tendinopathy?
3.06 What are the symptoms of Achilles tendinopathy?
4.01 Why did you get Achilles tendinopathy?
6.06 What is the causing the pain?
7.17 How is Achilles tendinopathy diagnosed?
7.52 Typical worries among people with Achilles tendinopathy
9.09 PART 2 HOW TO HELP YOUR ACHILLES TENDON RECOVER
9.51 So which treatments are evidence-based?
10.42 A sensible active approach to help your Achilles pain
10.53 Step 1: Check if your activity triggers your pain and modify your activity if it is
12.43 Step 2: Replace modified activities with less stressful options
13.21 Step 3: Address common activity problems
15.04 Step 4: Address other things that can slow down your recovery
16.25 Step 5: Build strength and confidence with calf exercises
17.44 Reasons why you may not improve with exercise
18.07 Sports-specific exercises
18.28 Scheduling your calf and other exercises
18.51 Simple treatments that can help your pain
19.24 PART 3 WHAT TO EXPECT ALONG THE WAY
19.37 So what does recovery from Achilles tendinopathy look like?
20.45 Signs that you are making progress
21.17 What if I have a flare up?
22.16 Barriers to your progress to watch out for
23.33 Tips to stay on track
24.28 Conclusion
I love the fact that a doctor has a Vault-Boy on the desk.
Subscribing just for that alone, but seriously--thank you for the information on the condition. I now have a much better idea of how to manage, recover, and get stronger.
Haha! Thanks for noticing that! I tis actually the desk of our amazing video guy at Monash University.
Everyone with Achilles issues needs to listen to your channel very very well explained. In my situation when I was 16 I ended up having a bilateral Hagglunds correction surgery, Which took me a very long time to recover from.I had psoriasis as a young girl and many people with that condition, 3% of people with psoriasis go on to get Psoriatic arthritis.Most common sign of psoriatic arthritis is Achilles enthesitis. All my life I never knew it was related to psoriasis in my early 50s I was diagnosed with this condition still no one said that my Achilles issues were related. I’m 55 now and have all sorts of things going on down there at times I can’t walk for up to a week longer.
Hi Lynda, thanks for your comment. Unfortunately, your story is a really common one. The thing is that sometimes people have psoriasis and other autoimmune signs but they don't fit the classic picture for autoimmune driven tendinopathy, so diagnosis can be really delayed. You are absolutely correct, spondyloarthropathy like psoriatic arthritis is a very common cause of enthesis issues like Achilles insertion problem. Wishing you all the best with it!
Great video thanks
Thanks for this, definitely the best one I found on the subject so far. It describes all symptoms perfectly. Information overload is indeed a big problem, the downside of the ease of access to information is that you have to filter it somehow. With loads of conflicting ideas on a matter it's easy to just give up and do nothing.
So true that there are conflicting ideas. There are conflicting ideas among patients so it is really easy to understand how patients can be confused.
Such a great video to pass onto patients to help them during their experience of this condition. This will certainly help my clinical practice - thank you!
I had a major bone spur right in my lower Achilles had surgery doing very well.
OUTSTANDING. Thank you, Dr. Malliaras.
Can you tell please how to identify between insertional achilles tendonitis and retrocalcaneal bursitis
Hi there, insertional Achilles tendinopathy presents with pain at the bottom of your Achilles tendon where it inserts into the heel bone. The difference with midportion Achilles tendinopathy is that for this one the pain is in the middle rope-like part of the tendon.
In terms of differentiating insertion Achilles tendinopathy from retrocalcaneal bursitis, this is harder. The reason it is harder is that where the pain is for these two issues is the same. And generally what you feel is also the same. Achilles insertional tendinopathy is far more common. The way to think about it is that insertional Achilles tendinopathy sometimes involves the bursa, The bursa is rarely affected without the tendon being involved.
I hope that helps.
extremely helpfull!
Glad to hear!
That's a pretty good general overview. However, it is missing important information. Treatment and recovery in insertional tendinopathy is different from that in mid-section one. Definitely, dropping the heal in stretching/building strength in muscles is not recommended for the former (I know it first hand unfortunately)
Hi John, you are absolutely right. However, at the right time, dropping the heel lower than parallel can be very therapeutic. It is just about ensuring you do it at the right time.
Thank you for the informative video. I got diagnosed today with bilateral insertional achilles tendinopathy today so I'll be waiting to hear from physio to start the rehab programme. Wanted to start with the exercises you discussed in the mean time but I can't even do the toe stands, it's too painful!
I am glad you enjoyed the video! Sometimes the standing toe raises are too painful initially, especially if you do one leg at a time. Usually if you do do them on both legs at the same time the pain is much less. You can then progress to one leg. Sometimes we use non-weightbearing options initially which can be easier to start with. Good luck with your recovery!
My achilles pain is much higher. Right where the calf becomes the achilles. Is that an unusual location?
Do achilles ruptures occur at that point?
This video is great
Thanks so much!
I have midsection and insertional on both heels. Insertional tendonothfor 8 years after breaking my left ankle and spraining my right ankle at the same time. Lumps appeared on the midsection area last year and the area was extremely sore to touch. This caused me to stop dancing all of this year to prevent flaring them up and give them a chance to recover whilst attempting to do rehab exercises. I am having difficulty with the raises due to arthritis in my big toe joints being aggravated. I persevere with the pain while doing the exercises although I only need to do a few and it causes my toes to not bend up or down and then I have to walk by lifting my feet up and placing down, not rolling through heel to toe for days afterwards and this puts me off doing the exercises. I have arthritis causing pain in my hips and knees and some other issues with my pelvis and groin with barely any strength in my glutes as well. So I am really only up to doing the heel raises on both legs. I am only 56 and have lost my ability to squat, lunge, jump, hop and now dance. Refraining from dancing has allowed my lumps to reduce and I am able to touch there now but even a short walk flares them up and causes overnight pain.
Would you please advise me where I should start? Do seated heel holds and raises help strengthen the Achilles enough? I would greatly appreciate your feedback as I would dearly love to return to dancing and become active once again.
Hi Lynda, thanks for the message. It can be a very slow process and I feel your frustration. It is particularly frustrating when you are unable to do things like dancing. I would persevere, it is very common for these things to take months to get better. I would suggest trying to progress you calf loading progressively over time, eventually getting to reasonably heavy wait whilst you are doing them. Sometimes for dancing you need to also progress to more intense loading like some basic jumping, hops, and faster movements replicating the type of dancing you do. I hope that helps. Email me if you need more specific help. peter.malliaras@monash.edu
I have a connective tissue disorder. Can this have set me up for my problems with the Achilles?
Hi there, yes it can. It depends on the actual connective tissue disorder and your individual case/manifestation. In general though, connective tissue disorders (like Marfan Syndome for example) can be associated with tendon symptoms.
Hi Peter, great video!
Don’t you recommend seated calf raises now instead of standing calf raises? I think I heard you say that on a previous course I did with you.
Cheers
Thank you! Yes seated calf raise is very useful for some people but not essential. Useful when they are really poor at doing a single leg standing calf raise, and also useful to provide a different muscle-tendon unit stimulus.
Thank you for this. Months ago a car pinned my ankle under a tire as I was exiting the rear passenger side. They had to back up to release my foot. It was very swollen & badly bruised. MRI & xray showed nothing broken or nerve damage, just inflammation. I walked for months on it until it became unbearable. Podiatrist thought it was plantar fasciitis & gave cortisol shot. Worked great for 3 weeks then pain in the back of my ankle came with a vengeance and I am limping & can barely walk by the end of the day. Just started going to PT for the achilles but it is so frustrating since I haven’t walked for exercise in over 3 weeks and pain hasn’t reduced at all. I’ve been biking but now it’s getting too cold. I must stay active for my physical & mental well/being. You mentioned that it is highly unlikely a rupture could occur. Should I resume walking (3-4 miles daily) as long as I can stand the pain and limp through it? Could I cause more damage? Thank you
Hi Lisa, thanks very much for the message. It is not a good idea to push through with the walking if you are limping. Although it is true that it is unlikely to cause a rupture or worsening tendon tissue changes if you do this, the issue is that it may well cause your pain and disability (limping) to get worse and worse over time. This would then be worse for you in the long term. I would recommend trying to do progressive exercise and in the short term modifying your walking to the level that does not cause you to limp. Over time as you develop confidence and tolerance in the calf , your Achilles and generally, you will then be able to get back to walking. I hope that helps. Email me of you need more specific help. peter.malliaras@monash.edu
are the exercises for insertional type the same as mid portion ?
Hi there, yes, the exercises are very similar for both insertional and midportion Achilles tendinopathy. The only difference is that sometimes we delay going into calf raises with the heel dropping down over a step for insertional as this can be too painful at the start of treatment. However, it is important to progress to this over time. I hope that helps.
What kind of shoes help-insertional type but mixed.
Hi there, the type of shoes that help vary a bit, but most people feel more comfortable in shoes with a small heel, or a pitch (this means the heel part is higher off the ground than the toes part). Most trainers have a pitch between 8-12mm. Another options is the HOKA trainers. They don't have a pitch at all but people still find them very comfortable. I hope that helps.
Thank you for the information. I have a question, my Achilles tendons on both feet bulge out and are swollen. The swelling has spread to my ankle bones also. Do I need to take any special measures to address this before I try the exercises? I've had this problem in both feet for about 8 years now. I do wear supportive shoes with an elevated heel. It helps me with getting through a work day, but unfortunately I can attest that it's not actually healing my tendons by just doing this and giving it time!
Hi Suzanne, yes, you often do not get longer term healing by just doing the heel wedges and shoe modifications. I would encourage you to try the exercises in the video, regardless of the swelling, as they are safe. I would also encourage you to see you doctor to try and find the cause for the swelling. I hope your pain is improving.
Thank you so much for sharing those valuable Informations. I really appreciate it. But I have one question: Is this a Fallout Boy Figure next to the Screen? :D
Thank you! It may be. This is the office if Jim our very talented design and video guy at Monash Uni! He has wonderful decorative flare!
I signed up for a sponsored walk of 300 miles over October. I was doing really well... however, I overdid it last week, walked 6 miles fast having not given myself enough time to rest from the previous fast walk. I believe I have insertional tendonopathy. I have 33 miles left to do this week. I've found that putting heel raisers inside my shoes helpful. It's definitely caused by me pushing off my toes. Is that likely to be rectified with calf strength exercises in the long run? Or do I need to look at getting a foot specialist to investigate? I'm doing a 50k ultra in March...
Hi there! Yes, the push off part of walking or running involves high forces for the Achilles tendon, so i can painful. You can try the following: 1) heel raisers as you have done already; 2) try and reduce the length of your strides during walking (this has been shown to reduce Achilles force when you push off); 3) try the calf exercises I talk about in the video and make sure you progress the weight you are holding as you are able to). These strategies are enough for many people. Otherwise, consulting a good physical therapist or physiotherapist in your area is the next step. I hope that helps.
@TendinopathyRehab thank you. I've had a rest and it's feeling much better. Totally agree with you regarding step length, I had been focusing on higher cadence but got carried away and increased stride length on the walk I injured myself! My calf is very tight on that side too. So focusing on loosening and like you say, strengthening. Will increase weight training over the next couple of weeks. Thank you for responding 🙏
Wonderful to hear - hope it is going really well!