For many years we have used the term tendinitis to describe an overuse injury to a tendon. Still today, many people are incorrectly blaming their symptoms on “tendinitis”. The suffix “itis” on the end of the word tendon implies there is an inflammatory process occuring, but we now know this is not the case with tendon pathology. Another term some of you may be familiar with is tendinosis, which refers to degeneration of a tendon, and this too is incorrect histopathologically (ie. at the cellular level). A much more accurate diagnosis is the term tendinopathy, which indicates pain or pathology of the tendon.
So tendinopathy it is!
For those who have suffered from a tendinopathy of any area, you’ll know what a frustrating injury it can be. Often taking months to heal, residual weakness can be common even after the bulk of the pain has disappeared. The Achilles tendon, joining the calf muscles to the back of your heel, is a frequently injured tendon in running. Interestingly, recent evidence has shown that there are in fact better ways to manage an Achilles tendinopathy than the traditional “Alfredson” eccentric exercise model which physiotherapists have been prescribing for many years.
It has come to light that concentric exercises (muscle shortening as it contracts) are just as beneficial as eccentric ones (muscle lengthening as it contracts), providing they are both performed at a slow speed. Recently, Silbernagel’s model of incorporating both eccentric and concentric exercises, has been the preferred approach used by physios, rather than eccentric exercises alone.
So your calf raises over the edge of a step are still a fantastic tool to apply a safe amount of load on a damaged Achilles tendon. But now you can concentrate on both the up (concentric) and the down (eccentric) phase, performing the movement slowly in both directions. Your physio should progress you safely from double leg to single leg, while slowly increasing your reps and speed, as appropriate. The Silbernagel model incorporates calf stretches for both the gastrocnemius (with a straight knee) and soleus (bent knee), as well as balance exercises, toe- and heel-walking and plyometrics. As the symptoms reduce, the tendon capacity can be regained by increasing the load further.