In our previous article we discussed exercise rehabilitation techniques for mid tendon Achilles Tendinopathy with a big focus on eccentric heel drops. In this article we’ll explain why modifications to these heel drops are necessary for people who suffer from insertional Achilles Tendinopathy.
In contrast to mid tendon Achilles Tendinopathy which is felt usually 2-6 cm up from the insertion of the heel bone, insertional Achilles Tendinopathy is felt directly at the insertion onto the calcaneus. Previous research has shown individuals with mid tendon Achilles Tendinopathy have very successful return rates to full training and competition following traditional eccentric heel drop protocols. However, individuals with insertional Achilles Tendinopathy have much lower success rates in returning to exercise. It’s believed as the foot drops below parallel on the step it causes compression at the insertion point of the tendon and therefore aggravates the area.
To account for this, modifications need to be made to the way the eccentric heel drops are performed. The heel drops should be done on flat ground to prevent the heel dropping below the level of parallel and the exercise should also only be performed with a straight knee. This is in contrast to mid tendon Achilles Tendinopathy where the exercise was performed with both straight and bent knees. Avoiding the bent knee component of the exercise prevents excess compression occurring to the area.
As with mid tendon Achilles Tendinopathy the exercises should be performed twice daily consisting of 3 sets of 15 repetitions and as the individual becomes adjusted to the exercise they should still look to add resistance to the exercise in the form of a weighted back pack.