Achilles Tendinopathy Explained
A Simple Guide for Active and Everyday People
Achilles tendinopathy is one of the most common causes of pain at the back of the heel, and something we frequently treat at South Coast Rx Physiotherapy.
It affects runners, gym goers, field sport athletes, and also people who have recently increased their walking, training, or activity levels.
If you are experiencing pain or stiffness in your Achilles that worsens with walking, running, climbing stairs, or first thing in the morning, this guide will help you understand what is happening and how physiotherapy can help.
If you are searching for Achilles pain treatment in Fareham or Portsmouth, this article explains the condition, why it develops, and the most effective evidence based treatment options.
What Is Achilles Tendinopathy?
Achilles tendinopathy refers to pain and dysfunction in the Achilles tendon, which connects your calf muscles to your heel bone.
Despite often being described as “tendinitis”, research shows that this condition is usually not driven purely by inflammation. Instead, it reflects a tendon that has been overloaded beyond its current capacity.
In simple terms, the tendon is being asked to tolerate more load than it is currently conditioned for.
Achilles tendinopathy can occur in two main locations:
Mid portion Achilles pain, typically 2 to 6 cm above the heel
Insertional Achilles pain, located directly at the heel bone
An accurate diagnosis at our Fareham or Portsmouth physiotherapy clinics ensures the correct rehabilitation approach is applied.
Common Symptoms of Achilles Tendinopathy
People with Achilles tendinopathy often report:
Pain at the back of the heel
Morning stiffness that eases with movement
Pain during or after running or walking
Tenderness when squeezing the tendon
Reduced calf strength or power
Gradually worsening symptoms over time
Early assessment allows us to confirm the diagnosis and rule out more serious conditions such as partial tears or rupture.
What Causes Achilles Tendinopathy?
Achilles tendinopathy rarely develops because of one single event. It is usually the result of load exceeding tendon capacity over time.
Common contributing factors include:
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Sudden increases in training
Rapid changes in running distance, speed, hill work, or gym activity.
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Calf weakness
Reduced calf strength increases strain through the tendon.
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Poor load management
Returning to sport too quickly after time off.
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Reduced conditioning
Periods of inactivity lower tissue tolerance.
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Footwear or surface changes
New shoes or increased hard surface training can alter tendon load.
Understanding why the pain developed is essential. This is what we assess in detail during your appointment.
How Long Does Achilles Tendinopathy Take to Settle?
Recovery time depends on symptom duration and how well the tendon is rehabilitated.
As a general guide:
Early stage symptoms: 6 to 12 weeks
Longstanding symptoms: 3 to 6 months
Rest alone rarely resolves Achilles pain. Avoiding load often weakens the tendon further.
The key to recovery is progressive, targeted rehabilitation.
Why Graduated Loading Is the Most Effective Treatment
Research consistently shows that structured exercise based rehabilitation is the cornerstone of Achilles tendinopathy management.
Tendons need the right type of load to adapt and regain capacity.
Graduated loading works by:
Improving tendon load tolerance
Increasing calf strength and endurance
Reducing pain sensitivity
Restoring confidence in running and sport
At South Coast Rx Physiotherapy, your rehabilitation is structured in stages:
Early Stage
Pain education and load modification
Isometric calf strengthening
Reducing excessive tendon compression
Mid Stage
Progressive calf strengthening
Heavy slow resistance or controlled heel raises
Single leg loading progressions
Late Stage
Energy storage exercises such as hopping
Return to running drills
Sport specific progressions
Loading is progressed based on objective criteria, not guesswork.
What About Shockwave Therapy?
For persistent or stubborn Achilles tendinopathy, we may use Extracorporeal Shockwave Therapy, often referred to as shockwave therapy.
Shockwave therapy delivers controlled acoustic energy to the tendon.
Research suggests that shockwave therapy can:
Stimulate biological healing responses
Improve blood flow
Influence pain signalling pathways
Support tendon remodelling
Shockwave therapy is not a replacement for strengthening. It works best when combined with a structured loading programme.
At our Fareham and Portsmouth clinics, we commonly use shockwave therapy alongside progressive rehabilitation when symptoms have plateaued or remain resistant to exercise alone.
Why Combining Shockwave and Loading Works
Graduated loading builds long term tendon capacity.
Shockwave therapy may help reduce pain sensitivity and stimulate tissue level responses, allowing you to progress strengthening more effectively.
Together, they form a comprehensive, evidence informed treatment strategy for persistent Achilles pain.
What Does Achilles Rehabilitation Involve at SCRx?
Your rehabilitation programme is tailored to your lifestyle and goals.
This may include:
Objective calf strength testing
Load monitoring strategies
Progressive gym based strengthening
Return to running plans
Sport specific performance drills
We also provide Movement MOT and performance testing for athletes who want to ensure full recovery before returning to high demand activity.
Can Achilles Tendinopathy Be Prevented?
Recurrence is common if underlying strength and load management issues are not addressed.
Prevention strategies include:
Maintaining calf strength
Gradual increases in training volume
Monitoring weekly load changes
Incorporating strength training year round
Our Fareham and Portsmouth clinics also offer athletic testing to identify asymmetries and deficits that may increase injury risk.
When Should You See a Physiotherapist?
You should book an assessment if you:
Have Achilles pain lasting more than two weeks
Experience worsening morning stiffness
Struggle to progress running
Have pain that repeatedly returns
Are unsure whether your pain is Achilles related
Early treatment leads to faster recovery and better long term outcomes.
Book an Appointment at South Coast Rx Physiotherapy Fareham and Portsmouth
If Achilles pain is limiting your walking, running, or training, physiotherapy can help you return to activity safely and confidently.
Book online at www.scrx.co.uk
Our team in Fareham and Portsmouth is ready to help you move better and feel stronger.
References
Cook JL, Rio E, Purdam CR, Docking SI. (2016). Revisiting the continuum model of tendon pathology. British Journal of Sports Medicine.
Malliaras P, et al. (2013). Achilles and patellar tendinopathy loading programmes. British Journal of Sports Medicine.
Mani-Babu S, et al. (2015). The effectiveness of extracorporeal shockwave therapy in lower limb tendinopathy. American Journal of Sports Medicine.
Stania M, et al. (2023). Extracorporeal shockwave therapy for Achilles tendinopathy: systematic review and meta analysis.
National Institute for Health and Care Excellence. (2016). Extracorporeal shockwave therapy for refractory Achilles tendinopathy.
