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What Is Achilles Tendinopathy?

Achilles tendinopathy is a load-related condition affecting the Achilles tendon — the thick tendon connecting the calf muscles to the heel bone.

It develops when repetitive load exceeds the tendon’s capacity to adapt.

There are two main types:

• Mid-portion Achilles tendinopathy (2–6 cm above the heel)

• Insertional Achilles tendinopathy (at the heel attachment)

Management differs slightly depending on location.

 

Common Symptoms of Achilles Tendon Pain

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You may have Achilles tendinopathy if you experience:

• Pain at the back of the heel

• Morning stiffness

• Pain during the first few minutes of running

• Tenderness when squeezing the tendon

• Pain with calf raises

• Swelling or thickening of the tendon

Symptoms are typically load-related and gradual in onset.

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What Causes Achilles Tendinopathy?

Modern tendon research shows this is primarily a load–capacity mismatch, not inflammation.

Common contributors include:

1. Sudden Training Increase

• Rapid mileage progression

• Increased hill running

• Speed session spikes

• Return after time off

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2. Calf Strength Deficits

Strong evidence supports the role of reduced calf capacity.

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3. Reduced Tendon Adaptation

Tendons require progressive loading to maintain health. Underloading and overloading can both contribute.

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4. Biomechanical & Load Factors

• Increased ankle stiffness

• Excessive hill exposure

• Sudden footwear change

• Increased plyometric load

 

Do I Need a Scan for Achilles Tendon Pain?

Usually no. Diagnosis is primarily clinical.

Ultrasound or MRI may show:

• Tendon thickening

• Degenerative changes

However, imaging findings do not always correlate with pain and severity.

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Evidence-Based Treatment for Achilles Tendinopathy

Current international guidelines strongly support progressive loading as first-line treatment.

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1. Heavy Slow Resistance (HSR)

Research shows heavy slow resistance training is effective for:

• Reducing pain

• Improving tendon capacity

• Long-term outcomes

Exercises typically include:

• Heel raises (progressively loaded)

• Bent-knee and straight-knee variations

• Single-leg progressions

• Heavy gym-based calf strengthening

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2. Load Management (Not Complete Rest)

We modify:

• Running volume

• Hill exposure

• Speed work

• Plyometrics

Complete rest is rarely recommended unless symptoms are severe.

A pain-monitoring model is used.

3.  Isometrics (Short-Term Relief)

Isometric loading may reduce pain temporarily and assist early-stage management.

 

⚠️ What Is NOT Strongly Supported by Evidence

• Passive-only treatment

• Massage alone

• Stretching alone

• Shockwave without loading

• Complete immobilisation (unless severe case)

Tendon adaptation requires progressive load.

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Can I Keep Running With Achilles Tendinopathy?

In many cases, yes. If:

• Pain is mild to moderate

• Symptoms settle within 24 hours

• Load is managed appropriately

Running can often continue in modified form.

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How Long Does Achilles Tendinopathy Take to Improve?

Tendon rehabilitation requires time.

Typical timelines:

• Early improvement: 4–6 weeks

• Significant improvement: 8–12 weeks

• Full tendon adaptation: 3–6 months

Consistency matters more than intensity.

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Insertional vs Mid-Portion Achilles Pain

Insertional Achilles tendinopathy may require:

• Avoiding excessive heel drop early

• Modified range strengthening

• Gradual load progression

Mid-portion tendinopathy typically tolerates full-range loading sooner.

Accurate diagnosis matters.

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Why Achilles Tendinopathy Becomes Persistent

Persistent symptoms are associated with:

• Inadequate loading progression

• Frequent flare-ups

• Fear of loading

• Underloading the tendon

• Inconsistent rehab

This is why structured programming is critical.

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Why Choose Omnia Physio for Achilles Rehab in Sydney?

At Omnia Physio, we specialise in endurance and performance athletes.

Your treatment includes:

• Detailed calf strength assessment

• Structured progressive loading plan

• Running load management strategy

• Return-to-performance programming

• Education based on modern tendon science

We don’t just calm pain — we rebuild tendon capacity.

 

Frequently Asked Questions

Is Achilles tendinopathy inflammation?

No. It is primarily a load-related tendon adaptation issue.

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Should I stretch my Achilles?

Stretching alone does not resolve tendon capacity deficits.

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Do I need a boot?

Rarely. Immobilisation may delay tendon adaptation.

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Is surgery common?

Surgery is uncommon and reserved for persistent cases after structured rehabilitation.

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Book Achilles Tendon Physiotherapy

If you’re experiencing Achilles tendon pain while running or training:

Omnia Physio – Potts Point, Sydney
Specialising in runners and endurance athletes.

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