Hopefully people have found this thread beneficial. I wanted to provide some resources that I found useful and helped me with recovery from (self diagnosed) achilles tendinopathy. I read a number of research papers and blog posts from PTs and developed a little protocol based on my findings. I even spoke to a couple of sports PTs via email. I think you could likely save yourself some time and money by doing the same. However, I’m not a doctor and these are just tips/exercises that worked for me.
A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy
This article really detailed it all. It hits on all of the points you’ll likely find elsewhere, but offers a nice return-to-sport protocol.
The takeaways are this:
1. Load the tendon eccentrically in the form of heel drops
2. GO SLOW
Each drop should be done on a 3-5 second count. This really emphasizes the eccentric load on the tendon.
3. Start with 3 sets of 15 reps at bodyweight 2x per day
This was actually surprisingly difficult for me for the first week. My calf and surrounding ligaments and tendons were not ready for this and became quite tight. Foam rolling was essential.
4. Progress by adding weight, reps or sets.
The key is to add load so that you’re consistently strengthening the calf muscles and adding load to the affected tendon.
5. Incorporate seated heel raises in addition to the eccentric calf drops.
While elevating my foot 5-7" I would sit on a chair with my hamstring/quad parallel to the floor and a perfect 90º bend in the knee. I used a 35lb kettlebell on the top of my knee and would raise and slowly lower as many reps required until a solid burn in the calf was felt. I wish I had more weight available because 35lb wasn’t enough.
6. Foam roll
This was so crucial to keep the calf loose (not tight) as tightness is the enemy here and can lead to further injury. I would foam roll 2-3x daily. At first most of the calf pain and tightness originated at the Gastroc head up near the knee, but as I continued to do these exercises it shifted to the mid-portion of my lower leg. I found that a Nalgene bottle worked really well. I have the hard plastic version that can bear load. Great little thing for rolling out the tendon and calf.
7. Incorporate proprioceptive exercises
Keep the tendon moving and loose by working on balancing and body weighted proprioceptive movements.
8 Incorporate dynamic exercises
After 4-6 weeks I started jump roping and doing small jumps to load the tendon(s) in other ways. I think this really helped keep things fresh and offer different stress on the affected tendon. Just take it easy. I started with double leg hops (3 sets of 10x) and progressed to single leg hops (30-60 reps, 3x)
Some other things that I did throughout recovery were related to my bike. I dropped my saddle by 1/2", moved my cleats back to the furthest possible point, and continued riding my bike at endurance/recovery pace to keep the tendon used to that motion.
I took a good 12 weeks before the swelling, creaking, and soreness to dissipate. Just keep at it. Be ruthless about recovery and know that full rest can often be the enemy of repair.