Achiles injury can be divided into three phases
1. Reactive- due to rapid increased loading, mileage,or trauma.
2.Dysrepair- follows the reactive stage if the tendon is still loaded. What will happen is a breakdown in the tendon matrix.
3.Degeneration- often seen in older athletes with chronic overloading. The collagen becomes disorganised with increased vascularity making it appear thickened. There is an increased rupture risk in this phase.
Management of an Achilles problem requires accurate identification of which stage the tendon is in.
Managing the Reactive/early degen phase
Number one and most important load management. especially compressive load i.e. anything which gets the tendon rubbing on the calcaneum in dorsiflexion exercise (running for instance). Research has also shown that ibuprofen is NOT detrimental to healing.
Number two is Isometric exercise. That is exercise where there is no joint movement but muscle contraction. After this a slow progression into functional exercise follows. Walking and being comfortable. Jogging on the spot without discomfort
Finally improved strength must follow. Starting with simple heel drops through eccentric , concentric exercises to balance and pylometics. Then ultimately onto slow heavy resistance of squats and leg press.