Achilles Tendonitis

Achilles tendonitis is a common and often frustrating overuse injury affecting the tendon that connects the calf muscles to the heel bone. It’s particularly common in runners and people who’ve recently increased their training volume or intensity, but it also develops in non-athletes from tight calves, unsupportive footwear, or the gradual, age-related changes tendons undergo over time.

The Achilles is the largest and strongest tendon in the body, transmitting substantial force with every step, push-off and jump. When load is applied faster than the tendon can adapt to it — through a sudden increase in running distance, a change of terrain, or simply years of cumulative wear — the tendon’s structure can begin to break down at a microscopic level, producing the pain and stiffness typical of tendonitis, more accurately described as tendinopathy, since true inflammation is only part of the picture.

What causes Achilles tendonitis

Most cases of Achilles tendinopathy relate to a mismatch between the load placed on the tendon and its current capacity to handle that load. A sudden increase in running distance, speed work, hill training, or a change from one type of footwear to another are all common triggers. Tight calf muscles increase strain through the tendon with every step, while biomechanical factors — such as how the foot rolls through each stride — can concentrate load unevenly along its length. Age plays a role too, since tendons naturally lose some elasticity over time, making them more vulnerable to this kind of overload injury.

Achilles tendinopathy is typically categorised by where along the tendon it occurs — either at the point where it inserts into the heel bone, or in the mid-portion a few centimetres above it — because this affects which loading exercises are appropriate and how quickly recovery tends to progress.

When to see a physiotherapist

Most Achilles tendon pain builds gradually and responds well to physiotherapy assessment and a structured loading programme. However, a sudden, sharp pain at the back of the heel — particularly one accompanied by an audible pop or snap, an inability to push off on the foot, or a sensation of being kicked in the back of the leg — can indicate a tendon rupture rather than tendinopathy, and needs urgent medical assessment rather than a routine physiotherapy appointment. Marked swelling, redness or warmth around the tendon, or fever, should also be assessed promptly to rule out infection. For the more common gradual-onset pain and stiffness, an earlier assessment still helps, since tendons that are loaded appropriately from the outset tend to recover more predictably than those left to become chronic.

Physiotherapy treatment for Achilles tendonitis

Once serious causes have been ruled out, treatment for Achilles tendinopathy centres on a structured, progressive loading programme — this is consistently the best-evidenced approach for tendon conditions, since tendons need appropriate load to remodel and strengthen, not rest. Andrew’s approach typically draws on:

• Exercise rehabilitation — a staged loading programme, usually progressing from isometric holds through to eccentric and then more dynamic, higher-load exercises as the tendon’s tolerance improves. This is the cornerstone of tendon treatment and matters more than any hands-on technique alone.
• Manual therapy to address calf tightness and restricted ankle movement, both of which increase strain through the tendon with each step.
• Shockwave therapy for tendons that haven’t responded fully to loading exercises alone, particularly in more persistent or chronic cases — it stimulates the tendon’s healing response and is a useful addition alongside, not instead of, the exercise programme.

Managing overall training load — how far, how fast and how often you’re running or training — sits alongside these treatments, since even a well-designed loading programme won’t help much if training volume keeps outpacing what the tendon can currently tolerate.

What to expect from treatment

Andrew will assess where along the tendon your pain is coming from, how irritable it currently is, and what’s likely driving it — whether that’s a training error, footwear, calf tightness or a combination — before building your loading programme accordingly. Unlike acute muscle injuries, tendons typically take longer to respond: many people notice some easing of morning stiffness and pain within a few weeks, but the structural changes that make the improvement durable — rather than a temporary lull before symptoms return — usually take several months of consistent, appropriately dosed loading.

Achilles tendonitis is one of Andrew’s particular clinical interests, and it’s a condition he sees often through his running assessments — if training load or running technique is part of what’s driving your symptoms, a full assessment of your gait and load can help ensure the problem doesn’t simply return once you’re back to full training.

Recovery timeline and preventing recurrence

Tendon conditions generally take longer to resolve than muscle strains, often 6 to 12 weeks for a good response to treatment, with more longstanding or chronic cases taking longer still. Continuing to run or train through this period is often possible in a modified form, since complete rest isn’t usually the best approach for tendons and can lead to deconditioning that makes the eventual return to full training harder. Once symptoms have settled, maintaining the calf strength built through the rehabilitation programme, managing training load sensibly, and addressing footwear or biomechanical contributors are what keep Achilles tendinopathy from becoming a recurring problem.