Achilles Tendinopathy

Tendinopathy is generally an overuse pathology leading to changes in the tendon matrix leading to pain and reduced capacity of the affected tendon and surrounding muscular.


This pathology occurs at 2 different points along the tendon:

  • Mid-portion Achilles tendinopathy, is 2-6cm from the heel in either a single side or over the belly itself, less common except more common in runners.
  • Insertional Achilles tendinopathy occurs at the heel bone, is less than 2 cm from the heel and most prevalent.

How does it occur?

Cook and Puram’s continuum model is what most practitioners follow today. It proposes tendons go through 3 stages or transitions of tendon changes.


Reactive tendinopathy

Results from acute overload of the tendon or just a quick increase or burst in workload or physical activity that the tendon is unaccustomed to. This is more common in the younger person or athlete. In this phase we reduce the overload activity and ensure sufficient rest between sessions. And start to try some isometric exercises.

Tendon disrepair

Greater disorganisation and breakdown of the tendon matrix, this can occur across a range of age groups and environments. Hard to know you’re here but tendon will be starting to thicken.

Degenerative tendinopathy

Tendon has become pathologic at this stage and hard to reverse BUT we know there is the ability to produce healthy tendon around this portion with correct loading.

So what’s the treatment?

  • Avoid aggravating and irritating activities that will compress the tendon or overload it. This can include things like adding in heel lifts, reducing running volume for a period, stop stretching it (please stop it doesn’t help!).
  • Isometrics: loading through the achilles tendon, generally done in the form of a calf raise hold or calf raise variation of some sort, dependant on patient and irritability of tendon. These also act as a sort of analgesic reducing pain throughout the day.
  • Isotonic exercise: Progression on from the isometric holds as tolerable by the patient. This helps to develop strength in the tendon and associated muscles. This will again progress into heavier loads to allow adaptation of the tendon matrix resulting in a happier tendon, we all want a happier tendon!
  • Plyometric exercise: the final stage to work on energy storage and release via the stretch shortening cycle. These will include hopping, jumping based exercises.
  • If it gets to the 3 month mark, shockwave therapy is an option for chronic tendinopathy to help reduce pain in the area, so patient can commence or continue to load the tendon.

Is Achilles tendinopathy something you’ve been dealing with? Come in for an assessment to find the best route forward!

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Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine43(6), 409–416.

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