Been rehabbing the hell out of my achilles... still feels like crap after 6 weeks. What now?

Buy shoes with elevated heals which take stress off the Achilles.

Are you sure wrote:

I'm not, I'm saying there is significantly less load with stretching. So how could that possible be harmful for an injury when you are advocating a treatment that far greater stress through the tendon? Any reasonable answer for that?

And if someone is far to irritable to tolerate eccentrics, but you want to put some type of low level tensile stress through a tendon how would you do that? Plus, you certainly are stretching the musculotendious unit at end range dorsiflexion with eccentrics... Unless you define stretching in some other way.

What exactly do you mean by "if someone is far to (sic) irritable to tolerate eccentrics"?

For the insertional achilles issue, which calls for the eccentric heel drops on a FLAT surface, there is not much stretching or dorsiflexing going on. That is why you don't want to do them off a step - the limited range of motion is important to avoid aggravating the injury.

You might not be picturing this right - you're standing straight up, vertically. On a flat surface (the floor). Your ankle is only bent at 90 degrees at the max. That is the furthest the eccentrics "stretch". Any kind of stretch you're suggesting with "stretches is going to be way beyond this 90 degrees, and that's part of the problem.

As for the "low level tensile stress" you ask about - the tensile stress is the absolute key to fixing the injury. It will not heal correctly on its own with rest alone. The collagen fibers are scrambled post-injury, and they will heel in this scrambled fashion if not re-aligned. The tensile stress of the weighted eccentrics causes the fibers to realign so they can heal properly. The eccentric load effect is the only thing we know that produces this effect.

That is why achilles (and hamstring) injuries are so frustrating - most runners just rest them, not realizing what they need to do to actually fix the injury, so the injured fibers heal (in a bad pattern) and the pain subsides, but they've healed in a weakened (scrambled, mis-aligned) pattern, and as soon as the runner starts up again with any volume or intensity they suffer a re-injury. Round & round the cycle goes. Usually takes about 6 weeks of daily eccentric exercises to completely fix it. Each time you do the eccentrics, a few more of the fibers get lined up properly.

I mean that is you have someone with 8/10 pain and it's either an acute and reactive tendinopathy you're not going to want to throw them into an eccentric program right away. That's likely to flare them up, sometimes your treatment should be to unload them initially (not completely, hence stretching or whatever you'd like) and then gradually reload the tendon and introduce eccentrics after their symptoms have calmed down.

I understand the eccentrics to neutral, but first, we were talking about eccentrics in general which are primarily through the full ROM as majority of Achilles tendinopathy cases are mid portion. Even down to neutral, I still think you're putting greater forces through a tendon with an eccentric performed on one leg than a stretch where you're bearing weight through both feet. But that isn't as important, it was just to stress that stretching should be fine for someone with any stage of Achilles tendinopathy because it's not as stressful as other treatments. And to your comment on comparing the eccentrics to stretching previously... There is a peer reviewed journal article comparing them both, so they must have been letsrunners as well. No sig differences in outcomes either.

Tensile stretch is a huge part of treating a tendinopathy, I've never said otherwise. I actually have been advocating the use of grades stress throughout all my posts. Not sure where you get this magic 6 week mark though? I'm not aware of any literature stating that and actually all the studies I've read have been conducted for 12wks so we can't confidently quote any other timelines. I'd like to see any literature if you have it though.

walk breaks wrote:

LISTEN TO THE GUY ABOVE ME.

I have dealt with this for four years. I swore off eccentrics because I thought they didn't do anything, after trying them unweighted for twice a day, for 16 weeks.

Since I have tried everything, recently I decided to give it a go again and started doing WEIGHTED eccentrics.

Thank you for posting this. Same experience here so I decided to give this a try. but i was very cautious because lots of eccentrics on a step with no weight were causing more pain.

So the first time, i just did flat level eccentrics near a desk and used the desk to add resistance when i was dropping my heel. After not having any backlash with these for a few days, i did the same thing on a step but would not lower to the point where i could feel the pulling in my achilles. I just used my arms to make it harder to drop the heel just below the step. I could feel the achilles but it wasn't painful.

I was felling optimistic so i took it to a sled press machine yesterday. I think i'm gaining ground cause it didn't cause further pain and i'm feeling it less walking around. plan to run tonight and see if i don't limp after.

I found that eccentric heel DROPS worked for me, IDK about you though, all the best man!