Achilles Tendinopathy: Causes, Symptoms, and Physiotherapy Treatment for Lasting Relief

The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles (gastrocnemius and soleus) to the heel bone. It is essential for almost every lower limb movement — walking, running, jumping, climbing stairs, and even simply standing on tiptoes. Despite its strength, the Achilles tendon is prone to injury, particularly when it is overloaded or not given sufficient recovery.

Achilles tendinopathy is one of the most common overuse injuries in the lower limb, affecting athletes, runners, and even people with sedentary lifestyles who suddenly increase their activity levels. It can cause persistent pain, stiffness, and limitations in everyday life.

In this comprehensive guide, we’ll explain what Achilles tendinopathy is, what causes it, its symptoms, and how physiotherapy can help you manage, recover, and prevent it from returning.

What Is Achilles Tendinopathy?

The Achilles tendon plays a key role in transmitting force from the calf muscles to the foot, allowing us to push off the ground. When the tendon is overloaded, microscopic tears occur, leading to structural changes. Unlike the outdated concept of “tendinitis” (which implied acute inflammation), tendinopathy involves tendon degeneration and thickening rather than just swelling.

There are two main types:

• Mid-portion Achilles tendinopathy: Occurs in the middle of the tendon, about 2–6 cm above the heel. This is the most common form, particularly in runners and active individuals.

• Insertional Achilles tendinopathy: Occurs at the point where the tendon attaches to the heel bone. This type is often aggravated by uphill running, jumping, or wearing stiff footwear.

Both conditions can range from mild discomfort to severe pain that limits walking and daily activity.

Causes and Risk Factors

Achilles tendinopathy is rarely caused by one single factor. Instead, it develops from a combination of overuse, poor recovery, and biomechanical issues.

Training and Activity-Related Causes

• Sudden increases in training load – for example, running longer distances or at faster speeds without gradual progression.

• High-impact sports – such as basketball, tennis, football, or athletics, where jumping and sprinting are common.

• Insufficient recovery time – not allowing enough rest between sessions places ongoing stress on the tendon.

  
  

Biomechanical Factors

• Overpronation (flat feet) – increases strain on the Achilles tendon.

• Tight calf muscles – limit ankle flexibility and overload the tendon.

• Weak hip and glute muscles – poor lower limb control can change how the foot strikes the ground, increasing tendon stress.

  
  

Footwear and Surface Choices

• Wearing old, unsupportive, or inappropriate shoes for your activity.

• Running on hard or uneven surfaces.

• Transitioning too quickly to minimalist footwear without proper adaptation.

  
  

Age and Lifestyle

• Most common in adults aged 30–60 years, when tendon elasticity naturally declines.

• Long hours standing or walking for work may increase risk.

  
  

Medical and Systemic Risk Factors

• Obesity, diabetes, and high cholesterol may compromise tendon health.

• Previous history of Achilles injury makes recurrence more likely.

Symptoms of Achilles Tendinopathy

The symptoms of Achilles tendinopathy often develop gradually and worsen if left untreated. Common signs include:

• Morning stiffness – pain and tightness when taking the first steps out of bed.

• Pain during activity – particularly running, jumping, climbing stairs, or walking uphill.

• Tenderness – soreness when pressing on the affected area of the tendon.

• Visible thickening or swelling – the tendon may feel enlarged or lumpy.

• “Warm-up effect” – discomfort may ease slightly during activity, but worsen after exercise or the next day.

• Reduced calf strength – difficulty performing heel raises or pushing off the ground.

  
  

If ignored, pain may progress from being activity-related to becoming constant, interfering with everyday tasks such as walking to the shops or standing for long periods.

Initial Self-Management Strategies

If you notice signs of Achilles tendinopathy, there are several things you can do to reduce symptoms in the early stages:

• Relative rest: Avoid high-impact activities such as sprinting and jumping, but keep moving with low-impact exercise such as cycling or swimming.

• Ice therapy: Applying ice for 10–15 minutes after activity may help reduce discomfort.

• Footwear adjustments: Supportive shoes with slight heel elevation can reduce tendon strain. Avoid barefoot walking on hard floors.

• Load modification: Instead of complete rest, gradually reduce activity levels and avoid sudden spikes in training.

• Gentle stretching and mobility: Light calf stretches may relieve stiffness, but avoid aggressive stretching which can aggravate symptoms.

  
  

These steps may provide short-term relief, but professional physiotherapy is essential for full recovery and preventing recurrence.

When to See a Physiotherapist

It’s important to seek professional help if:

• Pain persists for more than a week or two despite rest.

• The pain is interfering with walking, work, or daily life.

• There is visible swelling or thickening of the tendon.

• Symptoms return whenever you resume activity.

• You’re unsure whether your pain is due to Achilles tendinopathy or another condition, such as plantar fasciitis or bursitis.

Physiotherapy Treatment for Achilles Tendinopathy

At Revamp Physiotherapy in Carina, Brisbane, we use evidence-based treatment to address both the symptoms and the underlying causes of Achilles tendinopathy.

1. Comprehensive Assessment

We begin with a detailed assessment of:

• Your walking and running technique.

• Calf muscle strength and ankle flexibility.

• Hip and glute strength.

• Foot posture and footwear.

• Training habits and lifestyle factors.

  
  

2. Exercise-Based Rehabilitation

The cornerstone of treatment is a structured exercise program designed to gradually load and strengthen the tendon. This typically includes:

• Isometric exercises – holding calf raises in early stages to reduce pain.

• Eccentric calf raises – slowly lowering the heel off a step to strengthen tendon fibres.

• Progressive loading – gradually adding resistance or weights to build tendon tolerance.

• Plyometric training – once pain-free, adding explosive movements such as hopping and jumping to prepare for return to sport.

  
  

3. Manual Therapy

Hands-on treatment may include soft tissue release, joint mobilisation, or dry needling to reduce stiffness and improve function.

4. Load Management

We guide you in adjusting training loads safely, ensuring you build tendon strength without risk of re-injury.

5. Footwear and Orthotics Advice

We may recommend supportive footwear, orthotics, or temporary heel lifts to reduce tendon strain during recovery.

6. Education

Understanding tendon healing is essential. We’ll teach you how to pace activity, prevent flare-ups, and maintain tendon health long-term.

Recovery Timeline

Recovery depends on the severity and duration of the injury:

• Mild or early-stage tendinopathy: 6–12 weeks of consistent rehabilitation.

• Chronic cases: 3–6 months of progressive physiotherapy.

It’s important to remember that tendons adapt slowly. Patience, consistency, and adherence to your rehab plan are key to long-term success.

Preventing Achilles Tendinopathy

Once you’ve recovered, prevention strategies are vital to avoid recurrence. Key tips include:

• Warm up properly before sport or running.

• Gradually increase training — follow the “10% rule” (increase load by no more than 10% per week).

• Maintain calf strength and flexibility through regular stretching and strengthening exercises.

• Replace worn-out shoes and choose footwear appropriate for your activity.

• Strengthen supporting muscles, especially the glutes and hips, for better biomechanics.

• Listen to your body — don’t push through persistent tendon pain.

Why Choose Revamp Physiotherapy in Carina, Brisbane?

At Revamp Physiotherapy, we pride ourselves on providing expert care for tendon injuries such as Achilles tendinopathy. Our physiotherapists combine advanced clinical knowledge with a personalised approach to help you recover and return to the activities you love.

We don’t just treat the pain — we address the underlying causes to ensure long-term success and reduce the risk of recurrence. Whether you’re an elite athlete, a weekend runner, or simply dealing with daily heel pain, we’re here to help.

Achilles tendinopathy can be frustrating and persistent, but with the right management, it is highly treatable. Early diagnosis, structured physiotherapy, and consistent rehabilitation are the keys to recovery.

If you’re struggling with Achilles pain, don’t ignore it or hope it will go away. Book an appointment with Revamp Physiotherapy Carina today and take the first step towards a stronger, pain-free future.