What are the guidelines for treating Achilles tendinopathy due to consistent running?

From the Guidelines

Treatment of Achilles tendonopathy from running should begin with a period of relative rest, reducing running volume by 50-70% while maintaining fitness through low-impact activities like swimming or cycling, as this approach has been shown to promote healing and pain relief 1. The goal of treatment is to reduce inflammation, promote tissue healing, and gradually strengthen the tendon to withstand the repetitive loading that occurs during running.

• Apply ice for 15-20 minutes several times daily during the acute phase to reduce inflammation, as cryotherapy provides acute relief of tendinopathy pain 1.
• Take non-steroidal anti-inflammatory drugs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 7-10 days to manage pain and inflammation, although it is essential to note that NSAIDs have no effect on long-term outcomes 1.
• Implement a structured eccentric calf strengthening program, performing 3 sets of 15 repetitions twice daily for at least 12 weeks—stand on a step with heels hanging off, rise up on both feet, then slowly lower with the affected leg, as eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1.
• Proper footwear with adequate support and 8-12mm heel drop can reduce Achilles tension, and night splints may help maintain tendon flexibility while sleeping.
• Gentle stretching of the calf muscles should be performed 3-4 times daily, holding each stretch for 30 seconds. If symptoms persist beyond 4-6 weeks, consider physical therapy for manual techniques, ultrasound therapy, or extracorporeal shockwave therapy, as these interventions can promote proper tissue healing, reduce inflammation, and gradually strengthen the tendon 1. In cases where pain persists despite a well-managed conservative treatment trial, referral to an orthopedic surgeon for surgical evaluation may be warranted, as surgery is an effective treatment option in carefully selected patients 1.

From the Research

Treatment Guidelines for Achilles Tendinopathy

The treatment guidelines for Achilles tendinopathy due to consistent running are as follows:

• Conservative management options include:
  • Eccentric (lengthening) exercises, which is considered the gold standard treatment 2
  • Extracorporeal shockwave therapy (ESWT)
  • Topical nitroglycerin
  • Low level laser therapy
  • Orthoses
  • Splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma) 3
• Manual therapy, such as joint mobilization and manipulation, may also be beneficial in improving foot and ankle mobility, decreasing pain, and improving function 4
• A comprehensive treatment plan centered on progressive tendon loading is required to ensure full recovery of tendon health and to minimize the risk of reinjury 5

Key Considerations

• Achilles tendinopathy is a common musculoskeletal disorder that can be caused by overuse, especially in runners and jumpers 2, 6
• The treatment plan should be tailored to the individual's specific needs and should include a combination of exercises, manual therapy, and other conservative management options 3, 4, 5
• Early mobilization and progressive loading are important for improving recovery and preventing reinjury 6, 5

Treatment Outcomes

• Eccentric exercise training has been shown to be effective in reducing pain and improving function in patients with Achilles tendinopathy 2, 4
• The addition of manual therapy to standard care may enhance the rehabilitation of patients with Achilles tendinopathy 4
• A comprehensive treatment plan that includes progressive tendon loading can help to ensure full recovery of tendon health and minimize the risk of reinjury 5