From the Guidelines
To prevent Achilles tendon injuries, it is essential to gradually increase activity levels and incorporate specific strengthening exercises, such as eccentric heel drops, into your routine, as supported by the most recent and highest quality study available 1.
Key Prevention Strategies
- Gradually increase activity level to avoid sudden overloading of the tendon
- Incorporate eccentric heel drops into your routine: stand on the edge of a step with your heels hanging off, rise up on your toes, then slowly lower your heels below the step level for 3 sets of 15 repetitions daily
- Proper warm-up before exercise: spend 5-10 minutes doing light cardio followed by dynamic stretching
- Avoid sudden increases in training intensity or duration; follow the 10% rule by increasing your workout volume by no more than 10% weekly
- Choose appropriate footwear with adequate support and cushioning, replacing shoes every 300-500 miles
- Cross-train with low-impact activities like swimming or cycling to reduce repetitive stress
- Listen to your body and rest when experiencing pain or discomfort
Additional Considerations
- For those with previous injuries or biomechanical issues, custom orthotics may provide additional support
- Eccentric strength training is a particularly popular and effective option for preventing Achilles tendinopathy, as noted in 1
- Anatomic misalignment can be treated with shoe orthotics to correct overpronation or pes planus problems, which are often associated with Achilles tendinopathy 1
Evidence-Based Recommendation
The most recent and highest quality study available 1 provides guidelines on offloading foot ulcers in persons with diabetes, which includes recommendations for preventing Achilles tendon injuries. While the study focuses on diabetes, the principles of gradual increase in activity, eccentric strengthening, and proper footwear apply broadly to preventing Achilles tendon injuries. By following these evidence-based strategies, individuals can reduce their risk of Achilles tendon injuries and improve their overall tendon health.
From the Research
Prevention of Achilles Tendon Injury
To prevent Achilles tendon injury, several factors and methods should be considered:
- Regular physical activity: As athletes age, regular physical activity promotes tendon hypertrophy, increases nutrient delivery, and reduces collagen fiber fatigue, which can help prevent degenerative changes within the tendon 2.
- Avoidance of degenerative changes: This is the primary method to prevent rupture, and it can be achieved through a combination of regular exercise, proper training, and avoiding excessive stress on the tendon 2.
- Stretching and warm-up: While the evidence is not conclusive, stretching and warm-up may have an equivalent effect on Achilles tendon biomechanics, and prolonged and more intense protocols may be required for changes to occur 3.
- Rest duration: Long rest periods between loading cycles may be important for tendon adaptation, but the optimal rest duration is still unknown, and further research is necessary to identify the best approach 4.
- Pain-monitoring model: Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy may be a valuable option, as it allows for gradual increases in load on the Achilles tendon and calf muscle without negative effects 5.
Risk Factors
Intrinsic and extrinsic risk factors can contribute to Achilles tendon injury:
- Intrinsic risk factors: Include natural aging, which allows predisposing chronic degeneration of the tendon, and decreased blood flow and increased stiffness with aging 2.
- Extrinsic risk factors: Include sports participation, particularly running, jumping, and agility activities involving eccentric loading and explosive plyometric contractions 2.
Training and Rehabilitation
Proper training and rehabilitation are crucial to prevent Achilles tendon injury:
- Progressive training intervention: A 12-week progressive training intervention with isometric plantarflexion contractions can induce significant strength gains and Achilles tendon mechanical and material adaptation 4.
- Achilles tendon-loading strengthening program: A rehabilitation program that gradually increases the load on the Achilles tendon and calf muscle can demonstrate significant improvements in patients with Achilles tendinopathy 5.