Achilles Tendinopathy: Causes, Symptoms, and Effective Treatments
What Is the Achilles Tendon?
The Achilles tendon is the largest and strongest tendon in the human body. It connects the calf muscles, both the gastrocnemius and soleus, to the heel bone, or calcaneus. This tendon is crucial in walking, running, jumping, and pushing off during movement. It aches like a spring, storing and releasing energy to help with propulsion.
Despite its strength, the Achilles tendon is prone to overuse injuries, especially in athletes and active individuals.
In this article, I’ll explain what Achille’s Tendinopathy is, how it’s diagnosed, what causes it, and most importantly, what you can do to treat it and stay active.
What Is Achilles Tendonitis or Tendinopathy?
Achilles tendinopathy is a chronic overuse type injury that results in pain, stiffness, and structural changes to the tendon. It typically occurs in one of two locations:
Mid-portion Achilles tendinopathy: Approx. 2 - 6 cm above the heel
Insertional Achilles tendinopathy: where the tendon inserts into the calcaneus
While “Achille’s tendinitis” refers to inflammation of the tendon, most cases today are diagnosed as Achilles tendinopathy. This is a more accurate term that reflects the condition's degenerative rather than purely inflammatory nature.
What Causes Achilles Tendinopathy?
A combination of load-related and biomechanical factors often causes Achilles tendinopathy. One of the most common causes is overuse of the tendon, usually due to a sudden increase in activity that loads the tendon, like starting to run 3 miles a day without properly building up to these runs weeks before. Here are a few more causes:
Sudden increase in running or jumping activity
As mentioned above.
Poor footwear or worn-out shoes
May lead to unwanted stress around the foot and ankle.
Inadequate warm-up or recovery
Very common. Like any muscle of the body, the Achilles tendon needs a proper warm-up.
Calf muscle tightness or weakness
May lead to faulty mechanics during activity.
Overpronation or poor ankle mobility
May lead to additional stress.
High training volume without adequate rest
Too much activity with little rest is a recipe for disaster.
Common Signs and Symptoms
Pain in the back of the ankle, especially with walking, running, or hopping
Morning stiffness or pain during the first few steps
Swelling or thickening of the tendon
Tenderness to touch
Decreased performance or calf strength
A “creaky” or nodular feel along the tendon in chronic cases
How Is It Diagnosed?
A physical therapist or healthcare provider typically diagnoses Achilles tendinopathy through:
Patient history: activity levels, recent changes in training, pain characteristics
Physical exam: palpation, heel raises, hop test, and Thompson test (to rule out rupture)
Ultrasound or MRI (if needed): may reveal tendon thickening, degeneration, or partial tears
Treatment Options for Achilles Tendinopathy
1. PHYSICAL THERAPY
Physical Therapy is the cornerstone of treatment. A structured loading program, like eccentric or heavy slow resistance training, helps restore tendon strength and function. It is the gold standard for long-term recovery.
2. Activity Modification
Reducing aggravating activities (like running, jumping, or uphill walking) while maintaining general movement and non-painful cross-training (like cycling or swimming) is essential.
3. Manual Therapy
Techniques like soft tissue mobilization, dry needling, or muscle scraping can help relieve symptoms. However, they should complement and not replace strengthening.
4. Orthotics / Footwear
Heel lifts, supportive shoes, or temporary orthotics may help offload the tendon during recovery.
5. Modalities
Shockwave therapy, laser, and other tools may reduce pain and support healing in some cases.
6. Injections
Corticosteroids: Although they may help with pain management, there is a high risk of weakening the tendon, and they are not typically first-line for treatment.
PRP (Platelet-Rich Plasma): Mixed evidence, may help in certain chronic cases
OUR TOP Exercises for Achilles Tendinopathy Rehab
There is no one exercise that is best or works for everyone, but over the course of my career, these are a few of my favorite exercises that I provide to my clients and have found to be most helpful.
PLANTAR FASCIA ROLLING
CALF FOAM ROLLING
EARLY STAGE: BAND PLANTARFLEXION
TIBIALIS RAISES
TIB BAR RAISES
ECCENTRIC CALF RAISE
SPLIT STANCE CAL RAISE
How Long Does Recovery Take?
Recovery can vary depending on the severity and duration of the issue. With consistent rehab and proper loading:
Mild to moderate cases: 6–12 weeks
Chronic or severe cases: 3–6 months or more
Conclusion
Achilles tendinopathy is common, but highly treatable with the right approach. The key is to gradually reload the tendon, respect pain thresholds, and stay consistent with rehab.
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