Achilles Tendinopathy
Most Achilles pain is a load problem. The tendon is reacting to how it is being asked to work, not failing.
Written by Alexander Khang, ISRM Level 5 Soft Tissue Therapist. 935 sessions delivered. 265+ five-star reviews.
What is Achilles Tendinopathy?
Achilles tendinopathy is degeneration of the Achilles tendon at the point where load exceeds the tendon's capacity to adapt. It is not inflammation in the classical sense; most chronic cases show no inflammatory cells on biopsy. The tendon tissue becomes disorganised. Pain is the tendon signalling that its load management is off.
Two presentations exist: mid-portion (2 to 6 cm above the heel) and insertional (at the heel bone). Treatment differs between them. The condition is common in runners, but also in desk workers who have a long period of inactivity followed by sudden loading.
Why it happens
The tendon cannot adapt fast enough to the load placed on it. This is almost always a training error, too much volume, too fast, without adequate recovery. In sedentary populations, the mechanism is deconditioning: the tendon loses capacity, then gets loaded suddenly.
Weak calf complex, poor ankle mobility, and hip control deficits all increase tendon load per stride. Stretching the tendon in this state makes it worse, not better.
"The tendon does not fail because it is weak. It fails because the load exceeded what it was prepared for."
How we treat Achilles Tendinopathy
Assessment
We find which part of the tendon is involved and what is overloading it. The answer changes the plan, so it comes first.
Tension Release
Hands-on soft tissue work, aimed at what the assessment found rather than only where it hurts.
Strength Rebuild
Building strength back so the tendon can take load again, planned around your training and reviewed as you go.
Relevant Clinical Articles
ACHILLES REHAB
Why your Achilles pain keeps coming back
Rest treats the symptom, not the cause. A clinical explanation of why Achilles pain returns, and what actually changes the load problem.
Read articleACHILLES REHAB
Eccentric loading for Achilles tendinopathy: what the evidence says
What the published research says about strength work for Achilles tendon pain, and why the details need an assessment first.
Read articleACHILLES REHAB
How to return to sport after an Achilles injury
What needs to be true before you go back to running after Achilles pain, and why a date on the calendar is the wrong test.
Read articleTreating this properly
This guide explains the problem. The programme treats it: a full assessment, then a course of hands-on treatment with the same practitioner.
See the Achilles Tendinopathy ProgrammeNot sure where to start?
Bring your history, your scan results, and your questions. The assessment is a clinical conversation, not a sales pitch.
Achilles Clinic
260 Pentonville Road
London, N1 9JY, United Kingdom
ISRM Level 5 Diploma in Soft Tissue Therapy