Disclaimer: General educational purposes only. Always consult a qualified health professional. © 2026 Better Physiotherapy Bundoora.
Achilles tendinopathy is one of the most common running and sports injuries in Australia — affecting up to 9% of recreational runners and significantly higher rates in elite athletes. Stiffness in the morning, pain after prolonged running, and a tender, thickened tendon are the hallmarks. Physiotherapy is the gold standard treatment, but the right approach matters enormously.
What Is Achilles Tendinopathy?
The Achilles tendon connects the calf muscles to the heel bone and is the largest and strongest tendon in the body. Achilles tendinopathy is a degenerative change in the tendon tissue caused by cumulative overload that exceeds the tendon's capacity to recover. It is not an acute inflammatory process — which is why anti-inflammatory medication and rest alone are ineffective long-term treatments.
There are two types:
- Mid-portion Achilles tendinopathy — affects the middle of the tendon, 2–6 cm above the heel bone. This is the most common type and responds very well to progressive loading exercises.
- Insertional Achilles tendinopathy — affects where the tendon inserts into the heel bone. Requires slightly different management and is more complex to treat.
What Causes Achilles Tendinopathy?
- Sudden increase in running mileage, intensity, or frequency
- Returning to training after a period of inactivity
- Running uphill or on camber
- Switching to minimal footwear or barefoot running
- Weak calf muscles relative to training load
- Stiff ankle joint or limited dorsiflexion
Evidence-Based Physiotherapy Treatment
The evidence for Achilles tendinopathy treatment is clear. Progressive tendon loading is the cornerstone of treatment — not rest, not stretching, not anti-inflammatory medication.
- Isometric calf loading — sustained muscle contractions without movement that immediately reduce tendon pain and are used early in the acute phase
- Heavy slow resistance (HSR) training — single-leg heel raises performed slowly (3 seconds up, 3 seconds down) on a step, with progressive load. This stimulates tendon collagen repair and is the most effective medium-term treatment.
- Plyometric loading — progressive jumping and hopping exercises introduced in the later rehabilitation stages before return to running
- Running load management — structured modification of training volume and intensity to allow the tendon to adapt without further overload
- Shockwave therapy — for chronic, recalcitrant cases, acoustic shockwave therapy has excellent evidence and is significantly more effective than cortisone injection at 12 months
Frequently Asked Questions
Why is my Achilles painful in the morning and then warms up?
Morning stiffness that eases with activity is a hallmark of Achilles tendinopathy. The tendon is poorly vascularised and becomes stiff overnight; repetitive loading during the day temporarily reduces pain. This pattern does NOT mean it is getting better — it means the tendon is still pathological and needs treatment.
Should I stretch my Achilles?
Sustained static stretching of a symptomatic Achilles tendon is actually contraindicated — it compresses the tendon insertion and can worsen symptoms. Progressive loading exercises are far more effective than stretching. Your physiotherapist will prescribe the right approach.
What is the difference between Achilles tendinopathy and an Achilles tear?
Tendinopathy is a degenerative change within the tendon tissue — painful but structurally intact. A partial or complete Achilles tear involves structural disruption, is usually caused by a sudden forceful loading event, and may require surgical repair. Your physiotherapist can distinguish between the two with physical examination.
Can I use a heel raise for Achilles tendinopathy?
Yes — a temporary heel raise (placed in your shoe) reduces load on the Achilles and can provide pain relief in the acute phase. It is a short-term management tool, not a long-term solution. Your physiotherapist will advise on when to gradually wean off the raise.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora