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Our user asked: "Four weeks ago I was given a sheet by the orthopaedic showing pictures of eccentric (heel raising and lowering with both straight leg and knee bent)for Achilles tendonitis. He gave me no instructions about how exactly these were to be done. So I just went by the pictures and only lowered my heels from the step without starting out on my toes. I then showed the pictures to a PT who told me that I needed to go up on the toes on ONE leg and then down. I have checked on the internet where it was demonstrated that you should use BOTH legs to go up on the toes and then come down on one leg. Have I damaged my tendons by doing these the wrong way? Also, should I be having some burning around the edge of my heels?"
Ask a PT Response: "No - you have not damaged your tendons by doing the toe raises the "wrong way." Going up on the toes on one leg will be more challenging than going up on the toes on two legs since you will have to raise your entire body weight using only one leg. Going up on the toes is the concentric (muscle contracts and shortens) portion of the exercise. The orthopaedic's intention with the exercise was to work on the eccentric (muscle contracts and lengthens) portion of the exercise, which is the heel lowering portion from the heel raised position. Therefore, I would not worry as to whether you go up on the toes on one leg vs. two legs - I would focus on lowering down on one leg slowly and controlled.
If you did the exercises without raising your heels first (you instead just lowered your heels from the step) that is okay - your tendons are not damaged. You just did not work on eccentrics as much with your calf muscles. By changing your technique and elevating your heels first before lowering them, you will be working your calf muscles more eccentrically (just as the orthopaedic intended).
Your calf muscles (gastrocnemius and soleus) attach to the edges of your heels (calcaneus). Since these muscles are working to raise and lower your heels, it may be normal to feel those muscles "burn" or working during the exercise. You may also experience delayed onset muscle soreness 1-3 days after doing your exercises, especially if you are just beginning the exercise program or increasing the intensity. If this doesn't match your "burning" sensation, you should discuss the sensation with your care provider at your next appointment."
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