Achilles tendinopathy is one of the most common causes of pain at the back of the ankle. Whether you’re a runner, a keen walker or simply spend long hours on your feet, pain in the Achilles tendon can make every step uncomfortable and significantly affect your ability to stay active.
The good news is that most cases respond very well to the right rehabilitation programme. At Great Northern Physiotherapy, we’ll identify why your tendon has become overloaded and create a personalised, evidence-based treatment plan to reduce pain, rebuild strength and help you return to walking, running and sport with confidence.
Symptoms
The Achilles tendon connects your calf muscles to your heel bone and is the strongest tendon in the body. Despite its strength, repetitive overload can cause pain, stiffness and weakness.
Common symptoms include:
- Pain at the back of the heel or ankle
- Morning stiffness in the tendon
- Pain when walking or running
- Tenderness when squeezing the tendon
- Thickening of the tendon
- Mild swelling around the Achilles
- Reduced walking or running tolerance
- Pain during activities such as climbing stairs or pushing up onto your toes
Symptoms often improve slightly once you’ve warmed up, only to return after activity or later in the day.
Causes
Achilles tendinopathy develops when the tendon is exposed to more load than it can comfortably tolerate. Rather than being an inflammatory condition, it’s usually the result of gradual changes within the tendon caused by repetitive overload.
Common contributing factors include:
- Sudden increases in running or walking
- Changes in training intensity
- Returning to sport too quickly after injury
- Tight calf muscles
- Weakness in the calf or lower limb
- Poor running mechanics
- Inappropriate footwear
- Reduced recovery between exercise sessions
The tendon naturally adapts to exercise by becoming stronger. However, if training increases too quickly, the tendon may struggle to keep up, resulting in pain and reduced function.
Diagnosis
A detailed physiotherapy assessment is usually all that’s needed to diagnose Achilles tendinopathy.
During your appointment, we’ll discuss:
- When your symptoms started
- Your activity and training levels
- Running history
- Previous injuries
- Pain patterns throughout the day
- Your recovery goals
We’ll then assess:
- Achilles tendon tenderness
- Calf strength
- Ankle movement
- Walking and running mechanics
- Balance and single-leg control
- Functional movements
Most people don’t need imaging during the early stages.
However, diagnostic ultrasound can be helpful if symptoms are persistent, if another tendon injury is suspected, or to guide certain injection therapies.
Treatment Options
Comprehensive Physiotherapy Assessment
Our physiotherapists identify the specific factors contributing to your symptoms, allowing us to create a rehabilitation programme that’s tailored to your sport, lifestyle and goals.
Hands-on Physiotherapy
Manual therapy can help reduce pain, improve movement and prepare the tendon for progressive loading.
Treatment may include:
- Soft tissue massage
- Rockblading (instrument-assisted soft tissue technique)
- Movement re-education
Hands-on treatment is used alongside exercise to maximise long-term recovery.
Progressive Tendon Loading
Exercise is the gold standard treatment for Achilles tendinopathy.
Rather than resting the tendon completely, we use carefully progressed loading exercises that encourage the tendon to become stronger and more resilient.
Your programme may include:
- Isometric exercises
- Heavy calf strengthening
- Single-leg strengthening
- Plyometric exercises
- Balance training
- Running-specific rehabilitation
- Return-to-sport progression
Every loading programme is individually prescribed. Incorrect loading can delay recovery, so exercises should always be progressed under professional guidance.
Shockwave Therapy
Shockwave Therapy is an excellent option for long-standing Achilles tendinopathy.
This evidence-based treatment helps reduce pain while stimulating the body’s natural healing response within the tendon, making it an effective addition to a structured loading programme.
Injection Therapy
For selected cases, ultrasound-guided Hyaluronic Acid injections may be recommended.
Unlike steroid injections, hyaluronic acid acts as a lubricant and protective barrier around the tendon, helping reduce irritation while allowing rehabilitation to continue. Treatment recommendations are always based on your individual assessment.
Self-management
Successful recovery depends on gradually improving the tendon’s ability to tolerate load.
We often recommend:
- Completing your strengthening exercises consistently
- Reducing high-impact activities temporarily if pain is severe
- Gradually increasing walking or running distances
- Wearing supportive footwear
- Allowing adequate recovery between training sessions
- Avoiding sudden increases in exercise volume
- Maintaining lower limb strength
Complete rest is rarely the answer. Tendons become stronger through progressive loading, not prolonged inactivity.
Recovery Timelines
Tendons naturally have a relatively poor blood supply, meaning recovery can take time.
Typical recovery expectations include:
- Mild symptoms: 6–8 weeks
- Persistent tendinopathy: Around 12 weeks
- Long-standing cases: Several months depending on severity
Most people experience significant improvements within 12 weeks when following a structured rehabilitation programme. Early treatment often leads to faster recovery.
When to Seek Help
Arrange an assessment if:
- Achilles pain is affecting walking or running
- Tendon morning stiffness continues to worsen
- Your symptoms keep returning after exercise
- The tendon feels thickened or swollen
- Self-management hasn’t improved your symptoms
Seek urgent medical attention if:
- You feel a sudden “snap” or popping sensation in your Achilles
- You’re unable to push up onto your toes
- Walking becomes extremely difficult after an injury
- Significant swelling or bruising develops suddenly
These symptoms may indicate an Achilles tendon rupture and require urgent assessment.
Clinically Reviewed By
Phil Williams
Director and Consultant Physiotherapist
Get Back to Walking and Running Without Achilles Pain
Achilles tendinopathy can be frustrating, but with the right treatment, most people make an excellent recovery. By combining progressive strengthening with evidence-based physiotherapy, we can help you reduce pain, restore tendon health and return to the activities you enjoy.
Our experienced physiotherapists will guide your rehabilitation, helping you move with confidence and supporting your recovery every step of the way.
Book your initial assessment today and take the first step towards a stronger, pain-free Achilles tendon.
Achilles tendon FREQUENTLY ASKED QUESTIONS
Not usually. While reducing aggravating activities can help during painful flare-ups, progressive strengthening exercises are the most effective long-term treatment.
Morning stiffness is one of the classic signs of Achilles tendinopathy. While you sleep, the tendon remains in a shortened position as your foot naturally points downwards. During this time, fluid can build up around the tendon and blood flow is reduced. When you first stand up, the tendon is suddenly stretched, which can cause stiffness and pain. As you start walking, the tendon warms up, circulation improves, and the discomfort usually eases.
Yes. Even long-standing Achilles tendinopathy often responds very well to a structured loading programme combined with expert physiotherapy.
Yes. Research supports Shockwave Therapy as an effective treatment for persistent Achilles tendinopathy, particularly when combined with progressive strengthening exercises.
In most cases, yes. A carefully managed rehabilitation programme helps rebuild tendon strength and allows a gradual, safe return to running and sport.
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