ACHILLES Tendinopathy

This article will cover what an Achilles Tendinopathy is, how they happen and more importantly- how they are best managed.


What is an Achilles Tendinopathy?

  Achilles tendinopathies occur when the tendon is exposed to rapid increases in load and fails to adapt and recover. For example, in running, load increases include sudden increases in running distance, frequency, or changes in running surface. Basically, the tendon doesn’t recover properly between exposures to this load, becoming irritated, inflamed, and painful.

What is the difference between Achilles tendinopathy and Achilles tendinitis?

This could be a whole article in itself – discussing the difference between any type of tendinopathy and tendinitis. However, to put it simply, tendinitis is an outdated term that refers to inflammation of the tendon. It is a simple and inaccurate term.The reason tendinitis is inaccurate is that people can have inflammation of a tendon without experiencing pain. Inflammation can also be a natural response to exercise and load, not necessarily indicating injury or damage. On the other hand, the term tendinopathy is a more contemporary way of describing tendon pain. It means that there is not just inflammation, but various processes occurring in the tendon, making it a more accurate term.

While there is more to delve into regarding these terms, they are often used interchangeably in the literature. All you need to know is that tendinopathy refers to an irritated and annoyed tendon.

What is the Achilles Tendon?

The Achilles tendon runs from the bottom of the calf muscle and attaches to the heel bone. Its function is to act like a spring, absorbing load with each step and helping propel us forward. When the tendon is functioning properly, it’s a great efficient spring. But when it’s angry, it lets us know!

Achilles Tendinopathy Treatment

The initial part of any tendon treatment is load management, which involves reducing the loads the tendon is undergoing to allow it to calm down. The specifics of load management differ based on factors such as whether the person is new to running or has a fresh Achilles injury.

Tendons like doing work as it helps maintain their growth and integrity. However, if they’re exposed to too much load too quickly, they become angry. On the other hand, if they’re underexposed, they become weak and angry. So, load management needs to provide enough load exposure for the tendon to adapt and grow without overloading it. Finding the sweet spot of load tolerance is an art form and varies from person to person.

For individuals with a fresh Achilles tendinopathy, a more conservative approach is taken initially. We allow the tendon to completely calm down before gradually reloading it to the point where the individual wants to go. For those with a longer-term Achilles tendon issue (weeks to months), we are a bit less conservative but still aim to keep the load response or irritation to a minimum. In these cases, we know that pain is not a sign of further damage, so we can afford to keep loading the tendon to prevent it from weakening.

Can you continue to exercise if you have Achilles tendinopathy?

In a nutshell, yes, but it will differ from person to person. We know that there’s a low risk of significant injury or damage if you are experiencing pain in your Achilles. So, running or exercising while you have Achilles tendinopathy will essentially continue to aggravate that tendon. Please note that this is not medical advice, but it is always important to check in with a health professional to see how you can navigate your exercise through your pain. As a physio, I would often work with you to find a suitable exercise level and guide you through it as your symptoms allow.

Achilles Tendinopathy Exercises

 Another significant part of tendon rehab is strength and conditioning. Since the Achilles tendon acts like a spring, exercises focus on making it a better spring. The rehab often starts with low-intensity sustained effort isometric exercises, such as isometric calf raises. The idea is to find the halfway point of a calf raise and hold it there. We typically aim for a 40-second hold, matched with a 40-second rest, and repeated for 5 sets.

  As the tendon tolerates more exercise, we progress to actual calf raises, both double leg and then single leg. It is also important to focus on strength and conditioning of the whole lower limb to enhance running performance. Exercises such as Bulgarian Split Squats and Single Leg Deadlifts are two exercises that I love for any athletic pursuit!

  Plyometric work is another crucial but often overlooked aspect of tendon rehab. As we consider the Achilles tendon to be a spring, plyometric exercises help make it a better spring. These exercises can include jumping on the spot, box jumps, and single-leg bounding, improving running performance and reducing Achilles pain.

  It’s important to mention at this point, that these are just general guidelines around the exercises that I prescribe to most patients. However, it’s always important to check with a health professional before you start undertaking any type of exercise. When I prescribe exercise to patients, I do so based on their symptoms and their abilities, so I won’t be giving exact sets and repetitions for these because that obviously will differ from person to person.

How long do achilles Tendinopathy last for?

  This is a difficult question to answer as it varies depending on a few factors. It will depend on the individual, how long they’ve been running, and their physical fitness. It also depends on the duration since the onset of symptoms. If it’s a fresh Achilles tendinopathy, they tend to recover quite quickly if we catch it early and manage it properly. However, if it’s someone who has had this issue for weeks or months, the condition can hang around for a while. During that time, you can maintain a good level of function, but it may take longer for the symptoms to completely disappear. Other factors such as upcoming events can also influence how long the condition persists. If someone has an event coming up or is in the middle of a sports season, we tend to keep them active while understanding that the pain may be more prominent. However, during the preseason, we take a more conservative approach and allow the condition to calm down before the season starts.

 Another common question we receive regarding most injuries is what else can be done to make it feel better – should heat or ice be used? The answer is that if it’s not going to harm you, do whatever makes you feel good. There’s no golden rule for Achilles tendinopathy. If massage, icing, or foam rolling makes you feel better, go for it. But ultimately, consistent loading and getting stronger are the main factors that will help you recover.


To wrap this thing up, Achilles tendinopathy refers to tendon irritation caused by a sudden increase in load when the tendon has not properly recovered. Treatment involves managing your load and symptoms through strength and conditioning. So hopefully this article has provided some information for yourself and how physiotherapy can help manage Achilles tendinopathy.

Thanks for reading!