This blog outlines my successful return to sport from an Achilles Tendinopathy. To read more about the onset of my tendon pathology and early management, read part one and part two of my blog.

After two weeks of careful, graduated strengthening exercises, with no recurrence of Achilles tendon pain, I decided I was ready to commence running. It’s important to note that a return to running significantly increases the overall load on the Achilles tendon. This must be considered as part of an overall rehabilitation program. In my case, I reduced the frequency of my strengthening exercises to two sessions per week and introduced two running sessions per week. I was still able to perform isometric strength exercises on the other days.

I was very careful with my initial run, jogging at a comfortable speed for three kilometers. I also had heel lifts in my running shoes to reduce the force absorbed by my Achilles tendon. I was aware of a tension in my soleus muscle (lower calf) but did not experience any pain. There was a very mild tenderness when squeezing the tendon immediately after the run but this subsided the next morning. Note that an increase in tendon pain the morning after exercise can be a cause for concern.

Over the next two weeks, I gradually increased the distance of my runs to five kilometers and maintained a constant speed. As I had no issues with this increase in distance, I decided to increase my intensity. Over the next month I gradually increased my running speed and maintained the five kilometer distance. On a couple of occasions, I noticed a mild increase in Achilles tenderness the morning after my run. It was important to recognize the tenderness as a warning sign that my tendon couldn’t cope with that increase in load. I rested for an extra day or two until the pain subsided and reduced the intensity of my next run.

I continued to progress my calf strengthening exercises by adding resistance in the gym. My Achilles tendon responded well to these strengthening exercises and although my calf muscles often ached the next day, my tendon felt normal.

Finally after performing five kilometer runs at a high intensity for a few weeks, I was able to progress to a less structured, more sports specific training program. For me, this involved some football training, long runs, sprint training and agility training, all on a combination of different surfaces including soft sand, grass and road.

Fortunately, I responded well to that training and am now satisfied to report that I’ve made a successful return to playing football with no Achilles tendon discomfort.

Key Points

• Load management is critical in the prevention and management of tendon injuries.
• Tendon pain demands respect and aggravating activities should be ceased immediately.
• Physiotherapists are tendon experts and should be consulted as soon as possible for assessment and management advice.
• Even mild tendon injuries can require a structured rehabilitation over the course of at least three months.