Eccentric Heel DROPS for Insertional Achilles Tendonitis

By | August 6, 2013
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If there is one thing you want to get out of this article it is this: notice the title of this post is “Eccentric Heel DROPS,” not “Eccentric Heel Raises.” Very important distinction.

eccentric_drop

If you’re like me, you’ve scoured the web looking for research and/or anecdotal evidence of a cure for insertional achilles tendonitis. And you may have discovered like I have that there is very little real science out there on this variant of achilles tendonitis. Unfortunately for me, it seems all the research money is into the typical tendonitis that afflicts runners.

Fortunately, in 2008 a group of researchers did do a limited study and documented it here. Unfortunately it is on PubMed, so no free access.

Fortunately, John David over at runningwritings.com has a great summary of the article along with the protocol that the researchers recommend:

  • 3 sets of 15 straight-legged eccentric heel drops on flat ground, twice a day for twelve weeks
  • Starting with the heels raised and your weight on the injured leg, use the calf muscles to slowly lower your heel to the ground, keeping your knee straight.
  • Use your good leg to return to the starting position.
  • Exercise into mild or moderate pain, but stop if pain becomes excruciating
  • Once you can complete all three sets without pain, add weight using a backpack.
  • Once you have recovered, it is not a bad idea to keep doing these exercises for maintenance/prevention.

If you read the comments on the above article, there are lots of clarifications. Basically, in simple terms, people seem to have not understood that you have to avoid “pushing up” using the leg with the injured tendon.

So this is the protocol I’ll be following. Below is a video of me performing a single set. Note that I am performing three sets of what you see in the video, two times per day.

So that takes care of the strengthening re-building/aligning of the tendon fibers…which leaves the million-dollar question: stretching of the tendon. I’m still not sure what I’m going to do about stretching the tendon, if anything, at this point. Why? Because there is so much conflicting advice out there on the subject. John David mentions in the above link to avoid stretching for acute (i.e., still painful) insertional tendonitis.

My Sports Med doctor has been very contradictory, as are the physical therapists I’ve consulted. One on hand, they say, often in the same conversation, to:

  • Use heel lifts to alleviate stretching of the tendon
  • Minimize pain as much as possible during the healing process
  • Do not wear minimalist shoes (e.g., shoes with little or no heel to toe ‘drop’) as they put tension on the tendon

Then, they’ll say:

  • You’ve got to stretch the tendon, to alleviate the tightness/pressure
  • Massive amounts of strecthing/mobility
    • All of the physical therapists I’ve consulted with prescribed, to various degrees, a static stretching protocol; one in particular had me spending over 2 hours per day doing static stretches (after 5 weeks of that, it resulted in increased tendon pain and no healing, but damn was my mobility much better everywhere else in my body!)

So which is it? Do we need to shorten the tendon or lengthen it? It makes sense that we would want to lengthen the tendon to alleviate the tightness that caused the problem, but how does one do that without incurring pain and, more importantly, causing further damage to the tendon? If you figure it out, leave a comment and let me know!

In the meantime, I’m going to do the eccentric heel drop protocol as prescribed above, and also perform static stretching at least once per day. More on that in a separate post.

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  • Tolunay D

    I have it in both feet. Would this still be effective? And insertional
    achilles tendonitis is that on the lowest spot of the achilles tendon?

    3 sets of 15 reps everyday, do you recommend other stuff beside it?
    Thanks man!

  • Tolunay D

    Really inspiring post that you have healed yourself. I have been suffering for 4-5 months now. In july I went skateboarding with school. Bad idea, my tendons werent conditioned so ever since Ive had sore achilles/very tight calves. I didnt try anything besides waiting…
    Now I am committed and will do this.

    Dont you think 2 x 3×15 is way too much volume a day?
    Isnt just 3×15 once a day enough? What did you do?

    I hope you answer back!

    • mark2741

      I recommend you read the Johnson paper – it outlines the rationale. Truth be told I did NOT do 2 x 3×15 consistently. I often did it just 1 x 2 x 15, and only on Mondays, Wednesdays, and Fridays. But the first 3 weeks I did do it everyday, at least 1 x 2 x 15. The thing to realize is that the eccentrics are NOT for strengthening your tendon/calves but for ‘rebuilding’ the tendon (i.e., straightening out the fibers). I’m not much for science/medicine but it worked for me!

      If it’s been 5 months for you already then definitely this is worth a try.
      Stay with it and let me know how you do or if you have any questions. Keep in mind – I’m not a doctor of physical therapist or any type of medical professional. As I wrote in the blog – I had this injury before and went to doctors and lots of physical therapy. It did heal up, but then just a few months later it was re-aggravated so I went to see the Sports Med doctor and he told me I should work on it on my own, that it is chronic and nothing he can do. So I went home and did some searching on the Internet and that’s when I found the Johnson paper, etc. The link to that paper is in the Resources page.

      Good luck!

      mark

  • Paige

    My doctor recommended a golf ball muscle roller to massage my tendinitis, worked very well and reduced the soreness, seriously check it out! http://www.zzathletics.com

  • imarunner

    I’ve been doing these drops for over 6 weeks now and have not had any improvement. The original article I read mentioned that they would cause mild/moderate pain. I have had no pain doing them either during or later. I worked up to 3 sets of 15 twice a day with an 8 lb backpack and 9 lb dumbbell. I can walk without pain but if I start to run it hurts in the first 1/4 mile, then goes away, then comes back after if I touch my heel. I don’t know if I should keep doing them or not.

    • mark2741

      Have you confirmed (via MRI with your doctor) that you have insertional achilles tendonosis/itis, versus the standard achilles tendonitis? Reason I ask is that the protocol for each type is very different. If it is insertional, then are you really stressing the muscle contraction at the top of the raise? That should cause some discomfort as it will be pulling at the tendon.

  • Jake Chow

    I appreciate your blog on this topic…..

    I increased my running mileage too quickly and paid the price with this malady. Shut things down 4 weeks ago, have been pain free for 3 weeks while doing the heel drop exercises

    Do you think it matters wearing a shoe or barefoot for the exercise?

    I hope to get back on schedule with light mileage after Labor Day

    Thanks again

    • mark2741

      Hi Jake,
      I always did them in running shoes so not sure if barefoot is okay but I don’t see why not.

      Good luck!
      Mark

      • Jake Chow

        Mark,

        Thanks for the prompt response…..

        On another note, how quickly did you resume physical activities?

        As I have said, I have shut things down now for 4 weeks and I am itching to get back on my running program

        Cheers,

        Jake

        • mark2741

          Hi Jake,

          It’s been a few years since so I don’t recall exactly, but I do recall getting back to activity once the pain was gone. Once I didn’t have pain, I continued to do the heel drops and also added static stretches of the calves, hamstrings, etc. BUT – I’m not a runner. I play squash and other sports, and will run an occasional 5k, but I don’t run for exercise.

          • Jake Chow

            Mark,

            Rebuilding mileage, continuing the heel drop exercises and stretching. Still pain free….

            Jake

          • mark2741

            Great to hear Jake! I recall the research paper where the eccentric heel drops were originally prescribed as a remedy claimed that the tendon fibers were straightened and essentially “rebuilt” by doing the heel drops. Hopefully that’s the case. In mine, I haven’t had any issues in a long time now, but I don’t play soccer anymore which is what caused it last. Squash multiple times per week has not been a problem.

          • Jake Chow

            This is turning into a fickle injury….pain came back on over a week ago – slowing things down again