Neuromuscular control for Achilles tendonitis rehab

Neuromuscular or motor control may play a role in both the cause as well as the successful treatment of Achilles tendonitis. In this article, we explain what motor control is and how you can regain full motor control in your calf-and-Achilles-tendon complex after you've injured your tendon. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. What is motor control?

2. How to retrain motor control in the calf muscle complex

3. How we can help

I've also discussed it in this video:

What is motor control?

A simple definition of motor control is how well your brain and nerves control your muscle contractions. Evidence is accumulating that a person who has a tendinopathy shows altered or decreased motor control in the affected limb (and sometimes even in the unaffected limb) compared with people with healthy tendons and that this can persist even once they return to sport.

What we don’t know is whether the decreased motor control is a part of the cause or whether it developed as a result of the injury.

Motor control deficits are not always visible to the naked eye, but for Achilles tendon patients one can often observe it when they struggle to slowly lower themselves down from standing on tiptoe with raised heels. Instead of a nice smooth movement, it often turns into a shake-shake-shake all the way to the floor. You don’t see this when they quickly drop to the floor at speed, because gravity pulls them down and the muscle doesn’t have to control anything.

How to retrain motor control in the calf muscle complex

The best approach to Achilles tendonitis rehab is still relative rest combined with a progressive strength training programme for your calf muscles and Achilles tendon.

The research shows that self-paced training, where you go up and down on your toes at whatever pace you like, doesn’t really work for improving motor control. A better way is to try and match the speed of the contraction to an outside stimulus, e.g. a metronome or a visual cue. In other words, it works best if you use a method that forces you to think about how you’re controlling the movement.

This is one of the reasons why we always get our patients to really slow their exercises down during the initial stages of rehab and focus on taking 3 seconds to lower all the way down from the heel lift; it forces the brain to really focus on the control.

Another method, advocated by Dr Seth O’Neill, is to purposefully stop the heel drop at specific points during the heel raise exercise and then change direction, as this also forces the brain to really think about how to best control the muscle contraction and movement.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter, and Instagram.

References

1. Rio, E., et al. (2016). "Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review." British Journal of Sports Medicine 50(4): 209-215.