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Achilles Tendinopathy (Symptoms, Causes & Treatment)

Updated: Mar 22, 2022

Achilles Tendinopathy

(Aliases: Achilles tendonitis, Achilles tendinitis, Achilles tendon pain, Achilles tendinosis, Achilles tendinopathy)


The Achilles tendon connects the calf muscle to the heel. It is the thickest tendon in the entire body and is easily identifiable as the thick rope-like structure behind the heel.

Achilles tendinopathy often occurs from overloading the tendon, which creates an imbalance in the body’s natural synthesis process (the building new tissues and breaking down of old or damaged tissues). This imbalance causes the tendon structure to adapt, becoming less efficient at dealing with load.

It used to be believed that Achilles Tendonitis was an inflammation of the tendon (“itis” meaning inflammation). However, latest research shows that it is an adaptation of the tissue structure to protect the tendon against excessive load by thickening.

It is especially common in runners where there is lots of repetition. Load refers to the training intensity e.g. distance, speed/pace, resistance (hill, terrain, weight). Pain initially felt during or after exercise, and usually worse first thing in the morning when getting out of bed.

As the injury progresses, symptoms can become more frequent and may start occurring without training. Identifying the injury early, including phase of tendinopathy (as below), and receiving appropriate treatment will prevent the injury progressing, and enable you to adapt your training in order to manage and rehabilitate the condition.

Phases of Tendinopathy

What else could it be?

It is important to have an injury assessment to rule out other possibilities. For example:

· Plantar Fasciitis,

· Retrocalcaneal Bursitis,

· Plantaris muscle pain or injury,

· Calcaneal stress fracture,

· Sever’s Disease,

· Posterior Tibial Tendon Dysfunction (PTTD),

· Ankle osteoarthritis.


· Pain and stiffness of the Achilles (initially during or rafter a run),

· Loss of strength in the affected area,

· Pain increase when performing exercise using/loading the Achilles tendon,

o Walking up or down stairs,

o Walking on tip toes,

o Squatting,

o Running,

· More pain and stiffness overnight or first thing in the morning,

· Achilles inflammation (swelling and heat) and/or thickening,

· Achilles tenderness (if squeeze between 2-6cm above the heel bone).


Understanding the cause of an injury is important to be able to effectively treat the pain and rehabilitate the injury to prevent reoccurrences. Possible causes include:

· Overtraining,

o Too much, too soon / sudden change in activity level,

o Excessive intensity or load (insufficient rest/recovery – the body needs time to adapt),

· Change of training surface (trail, road, hill),

· Wearing incorrect footwear,

· Biomechanics (inefficient movement),

· Tight or weak muscles (increasing stress or load on other muscles or tendons),

· Stiff joints (ankles or within the foot).


There are a range of treatment options or combinations for Achilles tendinopathy:

· Massage therapy – stimulating tendon fibre heeling and repair,

· Strength training programme (inc eccentric and isometric exercises),

· Movement re-education to off-load tendon stress (gait analysis to determine),

· Managing training load,

· Kinesiotaping,

· Acupuncture / dry needling,

· Orthotics / insoles,

· Ultrasound – stimulating tendon fibre heeling and repair.

Couple of exercises to help:

· Stretch calf muscles (Soleus & Gastrocnemius) to offload Achilles tendon stress. Here.

· Heel raises (eccentric), legs straight and knees bent (double leg, single leg). Here.

· Low impact exercises e.g. cycling and swimming (providing not experiencing pain whilst doing)


It is important to have the injury assessed to find the cause of the injury, as well as the stage or severity of the injury, to enable us to develop a treatment and rehabilitation plan that is appropriate to you and your requirements.

The above information provides you with generic information about the condition. An individualised assessment and treatment plan will ensure that other factors specific to are taken into account.

Injury assessment and treatments can be booked by:

Phone - 01352 746 500


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