Achilles Tendinopathy

The Achilles tendon connects the calf muscles to the heel bone and plays a critical role in walking, running, jumping, and push off activities. Achilles tendinopathy occurs when the tendon is exposed to repeated or excessive load beyond its current capacity, leading to pain and reduced function.

Despite the term tendinitis, Achilles tendinopathy is often not primarily an inflammatory condition. Symptoms are more commonly related to changes in tendon load tolerance, strength deficits, and altered movement mechanics that increase strain on the tendon over time.

• Pain or stiffness along the Achilles tendon
• Pain near the heel or higher up along the tendon
• Morning stiffness that improves with movement
• Pain during or after walking, running, or jumping
• Tenderness or thickening of the tendon
• Reduced push off strength
• Symptoms that worsen with increased training or activity

• Sudden increases in running, jumping, or walking volume
• Reduced calf strength or endurance
• Limited ankle mobility
• Poor load tolerance of the Achilles tendon
• Altered lower limb mechanics
• Inadequate recovery between training sessions
• Previous Achilles injury or ongoing calf tightness

Physiotherapy for Achilles tendinopathy focuses on improving the tendon’s ability to tolerate load rather than avoiding activity altogether. Because tendons adapt slowly, rehabilitation emphasizes progressive loading and strengthening over time.

Physiotherapy management may include:
• Progressive calf strengthening to improve tendon capacity
• Gradual loading of the Achilles tendon using structured exercise progressions
• Improving ankle mobility to reduce excessive tendon strain
• Movement retraining for walking, running, and jumping tasks
• Activity and load management to balance recovery and continued movement
• Education around training progression and symptom monitoring
• Manual therapy when indicated

Recovery timelines vary depending on symptom duration, activity demands, and adherence to a progressive loading plan. Many individuals experience meaningful improvement over weeks to months with consistent rehabilitation. Early intervention and appropriate loading reduce the risk of prolonged symptoms or tendon degeneration.