Leo asked the Guru about his ongoing achilles tendinosis and wanting to run again!

August 27, 2014


I have had recurring Achilles tendinosis in my right heel for about seven years now. It occurred when I began running regularly and over-enthusiastically trained too much. Since then, whenever I try to run consistently, my Achilles flares up – so I have hardly done any running for the last few years.

I saw a physio early on who prescribed a programme of eccentric heel drops. I did these religiously but when I tried to run again the Achilles pain returned.

I would love to get back into running and I wanted to ask what you would recommend I do next? Is the treatment still the eccentric heel drops, in which case should I give that another try and see how I get on? Or would you recommend I book an appointment and get checked out again? Maybe there’s more going on in my heel or the treatment is different now?

Thanks for your help.


August 27, 2014

Hi Leo

Tricky call – there is lots of new and interesting research coming put from the tendon geeks. Some is well proven, some is proven and some is…well!

Eccentric loading is only part of the accepted protocol – and never the be all and end all. Cause of why your tendon is continually breaking down is key, and your treatment protocol should follow a degenerative tendon, and not a reactive one.

What I think is acceptable to all, involves that the tendon must be able to handle load, evenly across the entirety of its structure.

Eccentric load, with high load, repeated is important. As is concentric, isometric and ballistic load too.

Any rehab [or physio sport trement] protocol must be multi faceted to fully load your tendon up. Calf release, big toes mobility, glut control, lower limb endurance, soleus and gastroc strength etc….the list is big and really important to control the load in the tendon.

There is also how you run, in what and why…..

On the more invasive side of things there is some good results coming from high volume injections to knock out the persistent neovascularisation that seems to be the issue.

You need to see someone [maybe a sports physiotherapists] who can talk you through and more importantly clinically reason you through your options.

The Guru

Six Physio

Guru Responded

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