Now, I don’t know you personally, but I know you just want a stronger Achilles tendon. If you’ve still got pain – read my previous article. If you don’t, here’s the disclaimer – you could have an Achilles that doesn’t play by the rules I’m going to lay down – so please, make yourself acquainted with a very experienced and highly qualified health practitioner who knows about tendons – vet them. Because… and this is important… there are medical reasons why some tendon issues appear and stick around – syndromes, arthritis’s, gouts, blood disorders, use of some antibiotics, even waist to hip ratio – if you’re carrying too much fat you should get tested for Type 2 diabetes and work on losing fat – it’s linked to more tendon problems, so… it’s not as simple as strong calves and good ankle mobility. Some of those medical things will need a straight shooting expert.
There are steps in this journey – skip them if you wish, but don’t miss them, meaning you better know you’ve got the capacity to do the step you’re missing. If you don’t, bear the brunt of the setbacks, because they are common when you skip steps. For example, if you don’t complete your Achilles rebuild all the way through strength to elastic loading, you’ll run closer to heel strike and that will inevitably overload your hamstring, take Chris Judd for example. I want you to understand how your life will change and what your future will look like as the long night of Achilles-winter comes in. There’s no skipping the night and the dawn can’t be rushed. We’re not going to go deep into the ecosystem of tendon physiology – for most of you that sort of detail is TBU – True But Useless – knowing it isn’t what gets you moving through the night of Achilles injuries. It’s up to us that do know it to guide you through it.
This is how they look – Stage 1 sees you de-load the tendon first, get strong to offset wastage, apply static then slow loads, progress the speed of isolated movements. Stage 2 will see you shift to whole body loads in “functional” positions. Stage 3 means you introduce speed of whole body loaded tasks, and then finally, stage 4 means adding elastic springy loads.
In the first part of stage 1, de-load your tendon and get control of the pain as per my previous article, and with a good sports doctor, until your pain is down at around 1/10 – where 10 is a nightmare and 0 is, well, no pain. But, even if your tendon is stubborn and the pain is taking longer than 2-3 weeks to come down that much, don’t rest your tendon longer than 3 weeks. This stage is also about re-loading your muscle to restore some strength and endurance. It’s also about restructuring the tendon in a short position. Stay away from stretching the tendon or loading it at length.
The main fibres are made from collagen, the restructuring of which is going to take at least 100 days, whether you’ve got pain or not. Collagen just gets replaced slowly.
The Achilles tendon is a bit like the grumpy dog you inherited. Give him time to settle after such an upsetting change, with occasional slow, low impulse movements. These slow, low impulse loads can be applied in a way like calf raises, more correctly heel raises, held for 30-60 seconds, for 3-4 reps, twice each day. The rationale here is to send significant signals to the whole area, maintaining stimulus in a non-elastic way. In the early days, springiness, elasticity – it’s no good – if you load the tendon in a lengthened position, expect to wake up the tendon cells – and when they wake up because of load at length, they vomit – nasty, water-attracting proteins – that cause swelling.
Impatient yet? Let me ease the pressure. If you can do 4 reps of 60 seconds isometric heel raises, on 60 seconds rest, and your tendon hasn’t reacted badly in 2 days, you can progress. Add 20kg, for 3-4 reps, twice each day. Same criteria – if there are no setbacks after 2 days, increase load towards 40kg, then 60kg. This can happen in a matter of days, all this progression. But, it could also take 2-3 months – remember the 100 day rule?
Let’s look ahead a little, towards the dawn - when you do eventually get running on the tendon, if you’re using your feet and Achilles tendons as springs, these type 2 fibres in the calf won’t be shortening as they contract – they’re going to reflexively hold (ie isometrically hold) their length under very high duress. However, since you can’t let the tendon elastically lengthen at this time, you’re going to have to stick to the non-isometric methods – up/downs - to stimulate these fibres. Once you’ve been checked the box of heel raising 60kg for 60 seconds for 4 reps, you’re going to need to shift away from the type 1 oxygen-breathing endurance-hardy cells to wake up the type 2 glycolytic muscle fibres that will be recruited in running for high intensity bursts at near maximal power.
I recommend something like 3-4 sets of 6-8 reps (taking 3-4 seconds each rep) at heel raises plus extra weight approaching or up to your own bodyweight, with a partial recovery of up to 30 seconds between sets.
Frans Bosch is a quietly spoken but exceptionally insightful and successful running coach, professor of biomechanics and motor control – I love his work, but I think he would disagree with this regime perhaps because it will generate lactic acid, which is NOT what the pennate fibres of the calf are designed for, which is isometric bursts – but we need this regime to shift the stimulus down from the 60 second isometric efforts in stage 1 whilst still maintaining a high work load – let’s do the math – 4 sets of 6 reps at 3 seconds/rep is 72 seconds time under tension – a nice progression on the 60 second isometric holds. Bosch is right that the the best stimulus is running itself, but when you’re not ready for running and you need a stimulus – this is it.
When you’ve proven your Achilles can handle the above loads, progress again to shorter holds– 1-2 seconds, higher loads, lower reps again, eg. 2-4 reps. To keep your time under tension (TUT) up, add more sets. For example, 4 reps x 2 seconds x 8 sets = 64 seconds TUT.
To account for the load change, a day on/off approach is wise.
Practically speaking, these latter stage exercises don’t have to be just heel raises – they could even look like weighted tyre drags, sled drags and in the absence of a sled, push a loaded wheelbarrow (eg. 20 to 30 kg) up a short hill. I’ve even packed a rucksack with a kettlebell and walked up short inclines. The incline and the weight of the wheelbarrow mean a 20kg load packs plenty of punch into the system, compared to a heel raise loaded with approaching-bodyweight.
Stage 3 is where speed is introduced, but you’ll have to earn the right first. See you in the next article.