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• Icing with ice massage: Use a chunk of ice, and rub constantly on the tendon for15 minutes. Ice bags and gel ice don’t tend to provide a significant healing effect.
• Elevating the heel (about 1/4 inch) with a lift in all shoes is surprisingly helpful.
• Stretching when the tendon has been recently injured should be avoided. As the tendon heals into its later stages, stretching can be added but is still a risk. It is best performed with the guidance of a doctor or therapist.
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Strengthening may be introduced at the same time. Normally tendons don’t get stronger like muscles, but they can become adapted to higher loads through exercise.
• Focus on shoes and inserts first if there is a regular pattern of Achilles soreness. Overpronation or over supination are often causes and can be controlled by more stable shoes and off-the-shelf orthotics. Once the tendon has been injury-free for two months or more, it may be possible to move back to less stable shoes if one has used them successfully before the injury. After several tendon Yoga Injuries occur, a stable shoe with medical orthotics can be helpful.
• Physical therapy, ultrasound and other therapies are helpful. There is a special form of massage that can help with tendon pain and swelling, but it should not be overused for fear of irritating the tendon.
• Acupuncture can sometimes reduce the inflammation.
• Laser, electrical stimulation, and other modalities sometimes help.
• If the tendon is swollen, there is a bump on it, or you hear a noise when moving the ankle up and down, it must be rested.
• If the pain increases or persists more than a few weeks, see a doctor. Normally, X-rays do not show damage unless the pain is in the heel bone as well as the tendon. A good exam can lead to a diagnosis. If the doctor feels a defect or empty spot in the tendon, it is torn. Experienced doctors can determine whether the damage is to the paratenon (sheath) or to the tendon itself. The location of swelling or a bump can indicate how it was injured, and how difficult the healing process may be. Sometimes an MRI is necessary to see if there is permanent damage inside the tendon.
• When badly injured, a cast, or a “cast boot” can speed up the healing by immobilizing the foot.
• Never allow an injection into the tendon.
• In severe cases, surgery is sometimes necessary and the results are variable. Athletes have had success with surgical repair of ruptures, but this is debated. Tears do not need to be repaired unless they are fairly large, but a long break from sports is necessary to allow for healing. If the tendon itself is scarred and damaged internally, surgical repair can be effective. There is a chance, however, that the tendon will never be perfect again, but there may not be other options.