Achilles Tendonitis

I tore both my achilles tendons this summer after a long layoff
from soccer a hard field and poor cleats caused a major tear on the
left side and a lesser one on the right side.

Recommended therapy is a process called heel drops.

Depending on the severity of the injury you must monitor your pain
while performing this therapy.

Start with both feet on a step with heels hanging off the step. Weight should be on the balls of both feet to start. You want to drop down off of the step and decelerate quickly at the bottom of the movement. Don't bounce at the bottom but halt the lowering movement as fast as possible.
Then do a toe raise slowly. Start with both feet. Then progress to one foot at a time. Do sets of 15-20 daily for two weeks. Then progress to the single foot method.

I guess a doctor in the US, who wanted to have surgery, tried to shred his tendons by doing this procedure of heel drops off his staircase. After a couple of weeks of drops he found the pain going away and his tendons strengthening. Surgery was avoided and now the entire physical therapy world here in north america prescribes them.

Hope that helps.

Once you have done what Mozart has suggested you could add an exercise band to the exercise by simply placing it around the ankle and have it fixed behind you, and then continue with the single leg exercise's as previously described, you make progression by using a strong band (theraband). Take it easy. John Murphy

I've seen a couple sets of protocols for heel drops, including the heavy load eccentric training. I know that some people (including my PT, if I remember corrrectly) recommend against heel drops because of the stress. Yet the eccentric action makes sense to me.. Since I'm interested in running hills, it seems to me like doing these on a ramp rather than stairs would mimic the sport-specific motion more and perhaps not overstretch things - but perhaps might lose some benefits. It would be the same as a calf raise, but emphasizing the eccentric dropping.

When I do the heel drops on steps with shoes, they seem very similar to doing them on ramp (since my toes rock upward), but when in bare feet, the toes stay flatter on the step so the angle is very different on step vs ramp (ramp simulates hills better). Or is a step recommended because it's more convenient?

Just curious what your and others' thoughts on this might be. Thanks.

Research over the last few years has revealed that most conditions previously diagnosed as achilles tendonitis are in fact an achilles tendonosus. The difference is in the lack of any inflammatory markers when tissue samples are taken from the affected area. Researchers have found that within the tendon there are areas of degenerative mucoid tissue (DMT). In other words 'soft spots'. It is hypothesized that these areas develop due to excessive forces being applied unevenly throughout the tendon so that only one part of the tendon is taking the load. The main type of force is a combination of torsional and longitudinal load similar to wringing out a wet towel as the ends are stretched apart. If this occurs repeatedly the fibres of the towel weaken and fray or in the case of the tendon the fibres stretch, weaken and breakdown leading to DMT.
This can occur with an increase in training freqency, speed, load, or different training surface or shoes.
What can be done?
The tendon can be strengthened as already mentioned with graduated eccentric loading. Several different protocols may be used. If excessive torsion is also a factor then this too must be addressed. This may be due to overpronation of the foot. The most common solution is too wear orthotics in ALL shoes, not just when training. Lower limb biomechanics may also have to be adjusted if this is deemed a factor in overpronation of the foot and subsequent torsion of the achilles. A suitably trained chartered physiotherapist should be able to diagnose any lower limb biomechanical problem and prescribe corrective exercises.
Increased tone in calf musculature may also be a factor. Soft tissue massage or acupuncture can be of use if this is the case.
Lumbar problems may also cause increased tone in the calf. Again this requires assessment by a professional.
As you can see it is not always that simple. In many cases the soleus is found to be weak and long rather than tight. If this is the case stretching should be stopped.
Hope this has been of some help.
John