Achilles Tendinopathy
Achilles pain responds extremely well to the right loading programme — and very poorly to rest alone. Getting the dose right is what changes it.
What is achilles tendinopathy?
Achilles tendinopathy is a change in the structure and tolerance of the tendon that connects your calf to your heel. It develops when the load placed on the tendon repeatedly outstrips its current capacity — usually a training increase, a change of shoes or surface, or a return after time off.
The tendon is not torn or degenerating beyond repair. It is under-prepared for what you're asking of it, and tendons adapt remarkably well when loaded progressively and consistently.
Pain is typically felt either in the mid-portion of the tendon or where it inserts into the heel bone. The two behave slightly differently in rehabilitation, which is why an accurate assessment matters.
Common symptoms
- Morning stiffness in the tendon or heel
- Pain at the start of a run that eases as you warm up
- Pain that returns hours later or the next morning
- Tenderness on pinching the tendon
- Thickening or a palpable nodule in the tendon
- Pain on hills, speed work or calf raises
- Reduced push-off power and calf endurance
What causes it
- A rapid increase in running volume, pace or hill work
- Return to training after a break or illness
- Reduced calf strength and endurance
- Sudden change of footwear, drop height or surface
- Restricted ankle mobility
- Poor recovery, sleep or nutrition around a training block
- Previous Achilles or calf injury
How physiotherapy helps
Assessment establishes where in the tendon the problem sits, how much load it currently tolerates and which links in the chain — calf strength, ankle mobility, running mechanics, training load — are driving it.
From there you get a progressive loading programme, adjusted by how the tendon responds over 24 hours rather than how it feels in the moment. Most runners keep running in some form throughout rehabilitation.
- Progressive calf and Achilles loading programme
- Isometric loading for pain relief in the early phase
- Manual therapy and dry needling to the calf complex
- Ankle and foot mobility work
- Running gait and cadence guidance
- Training load planning and return-to-running progression
- Footwear and heel-drop advice
When to seek treatment
- Achilles pain that has lasted more than two weeks
- Morning stiffness that keeps returning
- Pain that flares every time you increase your training
- Pain that has changed your running form
- A sudden sharp pain with a snap or inability to push off — seek urgent medical review
Frequently asked questions
Let's get you moving again
If this sounds like what you're dealing with, an assessment is the quickest way to understand it properly. Achilles Tendinopathy responds well to the right plan.