Achilles Tendinopathy

Achilles Tendinopathy

Article by J.Miller, Z.Russell

What is Achilles Tendinopathy?

Achilles tendinopathy, previously known as Achilles tendonitis, is a common overuse injury affecting joggers, jumpers, and individuals engaged in repetitive activities. This condition encompasses both inflammation (tendonitis) and a range of other pathologies affecting the Achilles tendon.

Causes of Achilles Tendon Pain

Tendons, the tough fibres connecting muscle to bone, often succumb to pain due to repetitive stress or natural ageing. Over time, small tears accumulate, leading to tendon injuries. These injuries can be sudden or gradual, with factors like over-training, abrupt increases in exercise intensity, and inadequate footwear contributing to the risk.

Differentiating Tendinopathy from Enthesopathy

While Achilles tendinopathy generally arises from repetitive strain, enthesopathy specifically involves the entheses, where tendons or ligaments attach to bone, and is characterised by inflammation, degeneration, or damage at these attachment points.

Read more: Achilles tendinopathy vs enthesopathy

Recognising and Diagnosing Achilles Tendinopathy


Symptoms include burning pain at the start of an activity, stiffness, particularly in the morning, and tenderness or swelling in the Achilles tendon. The pain might worsen after exercise and vary in intensity based on activity levels.

Diagnosis Steps

Diagnosing Achilles tendinopathy involves consulting a physiotherapist or sports doctor, evaluating your medical history and symptoms, and undergoing clinical tests. While diagnostic imaging is seldom necessary, it may be recommended in complex cases.

Achilles tendinopathy
Achilles Tendinopathy

Treatment and Rehabilitation of Achilles Tendinopathy

Modern Approaches to Treatment

Recent research has led to significant advancements in treating Achilles tendinopathy. A tailored treatment plan, based on the specific phase of your injury, is crucial. This may involve specific exercises, managing activity loads, and monitoring progress through pain provocation tests and functional assessments.

Exercise’s Role in Recovery

Exercise, particularly isometric exercises, plays a crucial role in managing tendinopathy, providing pain relief, and aiding recovery. Progression in treatment is carefully monitored, with a focus on gradually increasing exercise loads to stimulate tendon growth while avoiding overloading.

Eccentric strengthening exercises are also recommended but should be introduced gradually to avoid aggravating the condition.

Importance of Load Management

Effectively managing your activity load is vital for successful recovery. Your physiotherapist will guide you in adjusting your exercise program based on your symptoms and response to activity. This includes modifying activities to prevent exacerbation of symptoms and ensuring recovery.

Avoiding Certain Exercises

Avoid exercises that exacerbate Achilles tendon pain, such as running uphill or performing deep squats, unless advised by your physiotherapist.

Complementary Therapies

Massage, foam rollers, and stretches can help release tension in associated muscle groups.

Addressing Adjacent Joints and Biomechanics

Biomechanical issues in the lower limb can increase the risk of Achilles tendinopathy. Your physiotherapist will assess and address any deficiencies in ankle dorsiflexion, squat alignment, and gluteal control, among other factors.

Exploring Novel Therapies

Emerging therapies, such as injections of sclerosing agents or platelet-derived growth factors, show promise but are still experimental. Consult your physiotherapist or soprts doctor for advice on these treatments.

Prevention and Long-Term Management

Healing Timeline

The healing timeline varies based on the tendinopathy phase, ranging from days to months. Early and appropriate management is key to quick recovery.

Achilles Tendinopathy Phases
Achilles Tendinopathy Phases

Preventing Achilles Tendon Rupture

A complete rupture of the Achilles tendon, though rare, is a severe complication. Early intervention and preventive measures are crucial to avoid this outcome.

Conclusion: The Role of Your Physiotherapist

Physiotherapists play an integral role in the diagnosis, treatment, and prevention of Achilles tendinopathy. Consulting a physiotherapist early can lead to a more effective treatment plan, quicker recovery, and guidance on preventing future injuries. If you’re experiencing symptoms of Achilles tendinopathy, seeking professional advice is the first step towards recovery.

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General Information

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