Achilles tendinopathy is one of the most common overuse injuries among athletes, particularly those involved in running and jumping sports.
This study aims to present an integrated, evidence-based framework by examining both intrinsic (strength, ROM) and extrinsic (load, footwear) factors.
How can we prevent or reduce the incidence of Achilles tendinopathy?
Study: Achilles tendinopathy prevention: An evidence-based approach
What Did the Researchers Do?
Study Design
- Conducted a systematic literature review of 250 studies, narrowing it down to 34 high-quality ones.
- Used the PRISMA framework to evaluate risk factors and interventions.
- Subjects included in the review were active populations, including athletes and individuals engaged in repetitive lower-limb activities.
Core Components
The researchers synthesized data around five core components:
- Eccentric exercise
- Strength training
- Load management
- Range of motion (ROM)
- Footwear biomechanics
What Were the Results?
Eccentric Calf Training
- Effective at reducing pain and remodeling tendon structure.
- Alfredson protocols and variations improve tendon load capacity and collagen alignment.
Strength Deficits Are Key Risk Factors
- Weak plantar flexors, particularly the soleus, are associated with a higher risk of injury.
- A torque of less than 50 N.m is a potential red flag.
Optimal ROM Is a “Goldilocks” Zone
- Less than 20° dorsiflexion increases risk.
- Excessive ROM (especially AROM > 9°) can signal insufficient stiffness.
- Both extremes are problematic.
Footwear Greatly Affects Risk
- Raised-heel shoes reduce dorsiflexion and shift stress to the tendon.
- Minimalist footwear supports natural foot mechanics if transitioned to gradually.
- Wide toe boxes reduce forefoot pressure and bunion risk.
Load Management Matters
- Sudden spikes in volume or intensity elevate injury risk.
- Overtraining without recovery disrupts tendon adaptation and healing.
What Does This Mean?
- Achilles tendon injuries, like all injuries, aren’t about one issue ⮕ they’re about the interaction of strength, ROM, footwear, and training load.
- Eccentric training and progressive resistance ⮕ enhance tendon resilience.
- Footwear isn’t just about comfort ⮕ it’s about mechanics.
- Range of motion must be in an optimal window ⮕ not just “more is better.”
- Integrating all these pieces ⮕ provides a smarter, more athlete-specific approach to injury prevention.
Limitations
- Individual biomechanics weren’t deeply analyzed or personalized.
- Studies are limited to retrospective analysis and we need prospective data to really understand how and why some athletes develop tendiopathy and injury.
Coach's Takeaway
- Strengthen the soleus and load eccentrically.
- ROM screening should be part of your assessment.
- Monitor training loads and player response.
- Consider footwear and be cautious of raised heels.
- Prevention must be multi-factorial, not one-size-fits-all.
Hope this helps.
Ramsey
