Insertional Achilles tendinopathy needs its own rehab plan: the standard advice to stretch the calf, drop the heels off a step or rest can make it worse. This Masterclass explains why, and shows how to program a 12-week return for your clients, and for yourself. It comes from personal experience, since I’ve been rehabbing my own insertional Achilles.
The core idea. At the insertion, the Achilles is compressed over the heel bone as the ankle dorsiflexes. Tension alone is well tolerated, but tension plus compression is what makes the tendon irritable. So what you limit early (loaded dorsiflexion, high-load energy storage and release) is exactly what you rebuild toward by the end of the plan.
What you’ll learn
- What causes Achilles tendinopathy, and why recovery matters as much as load
- Why complete rest doesn’t work, and how tendon responds to loading
- How compressive load changes exercise selection, stretching and soft tissue work
- How to use the pain-monitoring model: how much pain to allow, and how to read the next-day response and the tendon’s perceived exertion
- How to rehab the whole muscle-tendon unit: calf, peroneals, tibialis posterior, foot and hip
- A 12-week, three-phase periodization (tissue healing and movement restoration, accumulation, intensification), with mobilization, activation and integration exercises for each phase
- How to choose between concentric, isometric and eccentric work
- Why high tendon load needs about three full recovery days
Chapters
0:00 Welcome and overview
2:51 What causes Achilles tendinopathy
8:59 Tendon structure and the tendinopathy continuum
21:22 Load management and recovery
30:59 Why the insertion is different: compressive load
41:43 Pain-monitoring model
46:56 Rehab considerations: muscle-tendon unit, foot and hip
51:49 Load management: contraction types and high tendon load
59:49 12-week rehab periodization
1:00:17 Phase I: tissue healing and movement restoration
1:20:39 Phase II: accumulation
1:27:39 Phase III: intensification
1:34:07 Wrap-up
Who it’s for
Trainers and therapists working with Achilles clients. The same approach applies to other insertional tendinopathies: choose exercises that reduce compression, then progress back toward the position you limited.
References cited in the Masterclass
- Cook and Purdam, the tendon pathology continuum model
- Silbernagel, Achilles tendinopathy references, including the pain-monitoring scheme with Crossley
- Magnusson et al., The pathogenesis of tendinopathy: balancing the response to loading
- Thomee et al., the pain-monitoring model
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