Sports Injuries care for

Achilles Tendinopathy

Very brief intro to Achilles tendinopathy

Your Achilles tendon is the thickest and strongest tendon in your body taking 7.3 times your body weight when hopping on 1 leg.

The Achilles tendon connects your calf muscle to the foot and ankle, is integral to the biomechanics of walking and running and Its proper function is essential for smooth and pain-free ambulation.

Achilles tendinopathy involves degeneration of the achilles tendon due to repetitive stress, leading to tissue changes, inflammation, and structural changes. It’s often caused by overuse, improper footwear, or sudden increase in physical activity/sport. This results in pain, stiffness, and reduced achilles tendon function, impacting mobility and requiring targeted rehabilitation for recovery.


Common signs and symptoms of Achilles tendinopathy

Achilles tendinopathy can range from mild discomfort to severe pain, affecting mobility in all forms; walking, standing from sitting, climbing, jumping and running. Common signs and symptoms can be a combination of:

  • Pain and stiffness
  • Swelling or thickening
  • Tenderness or warmth
  • Morning stiffness and discomfort
  • Symptoms easing with mild activity (walking)
  • Symptoms increasing with dynamic activity (running, jumping) 

Gradual onset of symptoms often characterises this condition, impacting daily activities such as walking as the condition worsens.

Pain relief for Achilles tendinopathy treatment

Pain relief for Achilles tendinopathy involves various approaches. Initial measures could include:

  • Activity modification
  • Isometric loading for pain modulation
  • Shockwave therapy
  • Heel raises
  • Heavy slow resistance training
  • Eccentric loading

Personalised treatment plans aim to alleviate pain, promote healing, and restore function.

It is important to avoid:

  • Stretching to increase range of motion
  • Complete rest
  • Walking without shoes
  • Walking in flat shoes
  • Steroid injections
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Ice or heat
  • Massage to the achilles tendon

Treatment of Achilles tendinopathy

With a structured rehabilitation programme the symptoms of an Achilles tendinopathy can fully settle. Depending on the severity and duration of the Achilles tendinopathy recovery time can range from 3-18 months.

The primary focus of treatment for Achilles tendinopathy should be a progressive loading programme of the achilles tendon going through the 4 stages of:

  • Isometric/static loading for pain relief
  • Heavy and slow loading through range
  • Dynamic loading through range
  • Activity and sport specific loading

In conjunction with a loading programme of the calf muscles other forms of treatment may include:

  • General strength and conditioning
  • Shockwave therapy
  • Platelet-rich plasma injections (PRP)

Exercises for Achilles tendinopathy treatment

For Achilles tendinopathy treatment, exercises should focus on gradually loading the achilles tendon while avoiding excessive strain. Lighter loads gradually advance to heavier ones and typically include:

  • Static hold heel raise
  • Double/single leg heel raise
  • Loading through full range movement
  • Eccentric heel raises
  • Kinetic chain above and below
  • Lower limb plyometrics > hopping, jumping
  • Sports specific movements

This gradual increase in exercise load bolsters achilles tendon strength without causing additional damage, and remodels its structure for improved resilience and healing to activity.

Calf exercises should be performed in both the bent knee position to bias the deep calf (soleus) muscles and straight knee position to bias the superficial calf (gastrocnemius) muscles.

Strengthening exercises of the lower limb, trunk and pelvis are also likely to be involved depending on the individual needs and stages of rehabilitation.


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How long does it take for Achilles tendinopathy to heal?

Healing time for Achilles tendinopathy ranges: mild cases may improve in 3 months with activity modification and strengthening exercises, while severe or chronic cases might take 6 months to settle. Patience, consistent adherence to treatment, and gradual progression of activities are key to successful achilles tendon recovery.

What is the best treatment for Achilles tendinopathy?

The best treatment of an Achilles tendinopathy is a heavy gradual loading programme. A loading programme involves a controlled increase in achilles tendon stress to stimulate tissue repair. It utilises the tendon’s ability to adapt and strengthen in response to gradual, controlled exercises. Initially, lighter loads are applied, gradually progressing to heavier ones, encouraging collagen synthesis and improved achilles tendon resilience. This programme aims to remodel the achilles tendon structure, enhancing its capacity to handle stress and promoting healing without causing further damage.

Is it OK to walk with Achilles tendinopathy?

In many cases, walking with Achilles tendinopathy is permissible, but it’s essential to manage the intensity and duration. Prolonged or intense walking might exacerbate symptoms. Moderation, proper footwear, and potential modifications like heel lifts or orthotics can help reduce strain on the achilles tendon while walking, aiding in recovery. However, if walking worsens pain or discomfort, it’s advisable to limit activity


What are the stages of Achilles tendinopathy?

Achilles tendinopathy progresses through Reactive Tendinopathy marked by inflammation, reactive on degeneration with structural breakdown and persistent stiffness, and finally, Degenerative Tendinopathy with chronic damage and relentless pain, each stage demanding specific treatment for optimal recovery.

What not to do with Achilles tendinopathy?

With Achilles tendinopathy treatment, you should avoid activities that exacerbate pain or strain the achilles tendon. Refrain from massage, compression of the tendon, high-impact exercises, excessive stretching to increase range of motion, or sudden increases in activity. Avoiding improper footwear and ignoring discomfort during physical activity is also advisable.

Should I have shockwave therapy for Achilles tendinopathy treatment?

Shockwave therapy is considered a potential treatment for Achilles tendinopathy if you have had it for more than 3 months. It can stimulate healing by promoting blood flow and tissue regeneration but it must be used in conjunction with a progressive loading programme for the achilles tendon.

Should I have a platelet-rich plasma (PRP) injection for Achilles tendinopathy?

PRP injections (Platelet-Rich Plasma) for Achilles tendinopathy remain a debated treatment option. Conservative treatment and loading over a 12 week period is recommended first. If there is little progress after 12 weeks, combining platelet-rich plasma (PRP) injections with other therapies such as progressive loading might offer a more comprehensive approach to manage Achilles tendinopathy. While some studies suggest potential benefits in promoting achilles tendon healing, evidence on its efficacy is mixed

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