Eccentric exercise has proven itself as one of the most effective treatments for Achilles tendinopathy. Studies have proven it superior to both sham exercise and other commonly utilized interventions such as heel lifts and cryotherapy.
Eccentric exercises target muscles and tendons during their lengthening phase to increase force within them and help relieve tendinopathy-related discomfort.
Heel-to-Toe Walk
Heel-to-Toe Walk is a simple exercise to eccentrically strengthen your Achilles tendon, providing relief from pain and tightness commonly associated with Achilles tendinitis.
Start this exercise by standing with feet shoulder-width apart and hands resting on a counter or chair for support. While keeping a small bend in both legs, lift both heels into the air for two to three seconds at a time before returning them down over a 2- to 3-second period. Perform this same movement again using your other leg.
Repeat each movement 10 to 15 times on each side, and once completed progress to walking forward and backward on your toes without letting your heels touch the ground. This will eccentrically strengthen your soleus muscle which forms part of your Achilles tendon and research has demonstrated how strengthening it may reduce risks for Achilles injuries while running.
Alongside eccentric Achilles tendon exercises, leg press machines are also effective ways of strengthening gastrocnemius and soleus muscles. To begin using one, sit comfortably on the footplates with feet shoulder-width apart on them; your knees should remain straight throughout this exercise. Next, using handles as support, slowly raise your heel off of the footplate onto toes for stretching your calf muscle before returning it back into starting position for repeat.
Heel-drop Walks are another effective way of eccentrically strengthening calf muscles and Achilles tendon, as well as alleviating symptoms associated with Haglund’s deformity – an unpleasant condition characterized by an excruciating bump at the back of your heel. To perform this exercise, stand on a step with railing support. Using the balls of your feet slowly slide backwards until heels and center feet hang off edge; using balls of toes raise into tiptoe position using balls of feet – then rise using balls of toes again until heels and center foot are back over edge; then use balls of toes balls on toes to raise into tiptoe position using balls of toes on tiptoe position by balls of your toes.
Single-Leg Walking
One of the easiest eccentric Achilles tendon exercises is single leg walking on an elevated surface such as stairs, steps or benches. Simply stand on your balls of feet and slowly lower yourself (this is known as eccentric contraction phase) until your heels touch the step or bench below you; then shift weight onto one foot and raise back up – repeat this cycle 10 to 15 times before shifting back onto other foot and repeating this process!
This eccentric exercise aims to strengthen both your gastrocnemius muscle and soleus muscles and lower the risk of Achilles tendinitis and calf strain. To perform, stand on your non-dominant foot while holding onto something for support; slowly bend and lower yourself as if marching in place while keeping ankle as straight as possible – repeat this pattern several times while paying special attention to maintaining good form.
Exercise to treat musculoskeletal disorders has become an increasingly popular choice in orthopedic and sports medicine settings. Early research suggested that eccentric training could improve outcomes for various injuries; more recent data have also demonstrated potential benefits from additional forms of physical activity, including non-eccentric exercise methods like yoga or Pilates. A narrative review was performed to analyze outcomes data from seven randomized clinical trials that integrated eccentric exercise either alone or combined it with co-interventions (co-interventions).
Clinical Decision-Making
Eccentric exercise tends to improve symptoms and tendon structural characteristics when compared with control groups; however, any improvements must be interpreted within the context of each specific patient and injury history.
An 18-year old male with reactive Achilles tendinopathy as the result of poorly trained marathon training likely would not benefit from eccentric training. His localized Achilles pain is in the mid portion and worsens when exposed to controlled loading such as hopping or heel raises.
As soon as the pain has stabilized, eccentric exercises to increase tendon capacity and simulate functional activities like running or jumping should be implemented to further relieve it.
Single-Leg Stair Climbing
Climbing stairs requires using many muscles of the lower body, particularly those in the calves and ankles, which these exercises aim to strengthen safely while keeping you balanced on each step. Furthermore, these exercises help increase flexibility of both calf muscles and plantar fascia – two factors which are known to cause heel pain when climbing.
The single-leg stair climbing exercise is an eccentric Achilles tendon exercise you can easily complete at home. Simply stand with feet shoulder-distance apart in front of a set of stairs. Bring one leg backwards until it rests on the lowest step, pushing off with your other foot while at the same time stretching out your left calf muscle; repeat until reaching desired number of rungs climbed.
Your physical therapist may suggest the use of arch supports in order to reduce Achilles tendon stress when climbing stairs, however there is limited scientific support for this practice and there may even be evidence that orthotics increase stress on Achilles tendons.
Achilles tendinitis symptoms typically range from mild to severe pain in the back of your leg above your heel, caused by inflammation in your Achilles tendon that attaches to your heel bone (calcaneus). The tendon acts like a thick rope connecting gastrocnemius and soleus muscles of the lower leg with your heelbone (calcaneus).
Eccentric training of the calf muscle has been shown to be effective at alleviating symptoms of chronic Achilles tendinitis while simultaneously improving function, strength and stability. Eccentric exercise improves muscle and tendon force production during shortening movements while simultaneously strengthening and stiffening tendons on a microscopic level; creating stronger, stiffer tendons which can withstand higher loads without activating an inflammatory process leading to Achilles tendinitis.
Your physiotherapist will begin with some straightforward non-weight bearing Achilles tendon exercises. He or she may encourage you to push through any discomfort and continue until your Achilles tendon has fully recovered and stabilised itself. Once this step has been accomplished, he or she may progress onto more challenging plyometric exercises designed to build your strength and endurance.
Single-Leg Jumping
One-leg jumping is an effective exercise to build explosiveness and athleticism. Additionally, this eccentric Achilles tendon exercise can strengthen lower body muscles if performed with the appropriate technique. Be careful when performing this activity and always listen to advice from physical therapists in order to avoid injury to yourself or others.
Physical therapists can teach the right techniques to avoid injuries when jumping. Plyometric exercises – high-speed muscle movements that help you jump higher and faster – are great for increasing explosiveness and strengthening in lower body muscles, making these exercises beneficial to athletes of all types.
Physical therapists can help injured patients strengthen their tendon through eccentric loading exercises to make it stronger. This could happen before an injury has healed or after so as to enhance speed and explosiveness. Physical therapists will also work with you to prevent future injuries by making sure you’re doing the appropriate training sessions.
Eccentric exercises have been shown to alleviate tendon pain by strengthening its structure. When tendon inflammation occurs, its thickness tends to be thicker than normal with extra blood vessels growing into its tissue (known as “neovascularization”). A 12-week program of eccentric heel raises was found to decrease both tendon thickness and improve neovascularization which led to decreased symptoms overall.
Eccentric exercises may also reduce pain sensitivity in the tendon. A study with asymptomatic participants demonstrated this benefit with eccentric exercise increasing pain thresholds during pressure pain tests and heat temporal summations tests, while those suffering mid-portion Achilles tendinopathy experienced decreased discomfort after participating in an eccentric heel raise program performed daily for 12 weeks.
Silbernagel’s method offers an alternative treatment approach that uses slower eccentric loading that may actually provide relief to sufferers of tendinitis and chronic Achilles tendinopathy. This newer approach has proven more suitable and is currently being employed in treating such conditions.
