achilles tendonopathy

Achilles Tendonopathy: a cautionary note

Achilles Tendonopathy is a common injury, especially amongst distance runners. Firstly, I want to say that I would strongly suggest if you suspect that you have Achilles Tendonopathy, and it hasn’t settled within a few weeks, seek out a Physiotherapist to assess and diagnose your condition. The reason I want to start with this precaution, is that with this condition, depending on the specific area of pain, VERY different treatments will be recommended.

Often, the same rehabilitation recipe is given from a friend who has experienced a similar pain as it worked for them.

But with YOUR pain, it may produce different results.

Example. If you have an insertional Achilles Tendonopathy (pain felt at the base of your heal where it attaches to the calcaneus, bone), stretching WILL make it worse. Especially if it is, what we call, irritable.

active physio

Do I have Achilles Tendonopathy?

The Achilles Tendon is the largest tendon in the body. It attaches your calf muscles (Gastrocnemius and Soleus muscles) to your heal bone (calcaneus) at the back of your foot. It is largely responsible for the “spring” which is used in runners. Or propulsion.

The pain is usually well localised to the tendon itself. It can progress to being painful to the touch, on stretch or after cooling down after exercise.

Early morning stiffness is often present.

Slow to settle, quick to aggravate.

Possible causes for Achilles Tendonopathy

Shoes. Let’s start with the simple one. Literally, it could be caused due to direct pressure or rubbing on the Achilles because of poor fitting shoes. One option is to cut the heel notch, back part of the shoe, to allow more room for the Achilles and prevent friction. Secondly, you could strap the Achilles which will reduce some of the (skin) friction.

Increase in training load. Any increases in speed, distance, hills etc will place more pressure on your body. In particular, increased speed and hill work may target the Achilles Tendon area.

Training surface. If you change to a softer surface the ankle needs to adjust more and the Achilles may be placed under different strains. This in itself is not bad, but if done too quickly or in large training bouts, may suddenly flare up the Achilles.

Also look at daily life. Wearing heels. Prolonged standing. Excessive steps or driving. These may also contribute to developing an Achilles Tendonopathy.

achilles tendonopathy


The MAIN point to rehabilitation….CONSISTENCY. Like training for running. This condition is usually like marathon training than a 100 metre sprint. It will take time. But look out for the small improvements and seek help from a Physiotherapist for guidance and specific exercises for YOUR condition.

  • Identify if there have been any major changes in your training
  • Adjust training, so that you can train pain free or at least a 3/10 on the pain scale, which must settle by the next day
    • Run every other day
    • Reduce hill/ speed work
  • Cross train
  • Check that your shoes fit well
  • Ice – especially if there is a prominent swelling
  • Strap the Achilles to support it

Other areas to consider are the biomechanical chain – in otherwords – the problem may not BE your Achilles. It may be because you have weak hip stabilisers or poor strength in your quadriceps muscle. These areas need to be considered as well as a tight posterior sling (the back part of your leg and back).

Exercise Suggestions

Presently the suggestion is that isometric exercises (holding) should initially be used, then isotonic (contraction), then progress onto plyometrics (ballistics). There are many examples such as soleus squat, leg press etc. This, I think, can be covered in a future blog if interested!


Take a look at the strapping technique below to support the Achilles Tendon. What exercises have you found worked really well to either prevent or rehabilitate your Achilles Tendonopathy?