Achilles Tendinopathy
Achilles tendinopathy is pain, stiffness and often thickening in the Achilles tendon — the large tendon connecting the calf muscles to the heel bone. It’s extremely common in runners and jumping athletes, but also affects recreational exercisers and those who’ve increased their walking or activity level.
The word “tendinopathy” replaces the older term “tendinitis” because we now know inflammation is rarely the primary problem — the tendon tissue itself undergoes structural changes that require specific loading to reverse.
Why It Happens
- Sudden increases in running distance, intensity or frequency
- Inadequate calf strength relative to training load
- Tight or weak calf complex
- Running on hills or changing from cushioned to minimal footwear
- Poor foot and ankle biomechanics
- Prior injury to the Achilles (scar tissue can predispose to recurrence)
Types
- Midportion: 2–7 cm above the heel — the most common type, responds very well to eccentric loading
- Insertional: At the point where the tendon attaches to the heel bone — slightly more complex to treat, compression aggravates it
Symptoms
- Pain and stiffness at the back of the ankle or heel, typically worst first thing in the morning
- Eases somewhat with gentle warm-up, worsens again with heavy or prolonged activity
- A thickened, tender nodule in the tendon in chronic cases
- Pain on rising onto the toes under load
Treatment
Progressive Tendon Loading — The Gold Standard
Eccentric and heavy slow resistance calf loading (such as the Alfredson protocol) is the most evidence-based treatment. We design and progress a specific exercise program based on your pain response and function.
Managing Compressive Load
Insertional tendinopathy is worsened by compressing the tendon against the heel bone (heel drops off a step, stretching). We’ll guide you on which exercises to avoid and when.
Manual Therapy and Dry Needling
Calf soft tissue release and dry needling improve muscle function and reduce pain to allow better loading.
Running Reintroduction
A structured return-to-run program that progressively reloads the tendon without provoking flares.
Footwear
Heel lift inserts can temporarily reduce Achilles load. We’ll advise on appropriate footwear for your training.
