Achilles Tendinopathy- what is it and how to treat it

One of the most common injuries in runners is that of the Achilles Tendon. In fact, according to an article by Maffulli et al, 2004, the rate of Achilles Tendon injuries in runners is 10 times that in age matched controls. Achilles problems in cyclists also exist, and although less researched, can often be brought on by poor foot position in the pedal or an increase in uphill training.

Tendinopathy and not Tendinitis:

Like most running injuries, Achilles Tendon problems often arise from repetitive microtrauma to the tissue without enough time for recovery. The tendon fails to adapt to the excessive changes in load and tendon cells are unable to repair fiber damage. In a normal Achilles Tendon there is a good organization of cells and collagen that make up the tendon. However in a tendinopathy, there is a disorganization and degeneration of tissue making the tendon weaker.  Interestingly there is often an absence of inflammatory cells in these conditions which is why the term tendinopathy has replaced tendinitis in many tendon conditions.

What causes Achilles Tendiopathy:

Tendon injuries may be a caused by intrinsic or extrinsic factors alone or together.

Extrinsic factors are external factors which can cause excessive loading of the tendon. These include, poor training technique, changes in training patterns, previous injury, poor footwear and environmental factors such as training on hard slippery or slanting surfaces.

Increased foot pronation and leg length discrepancy are 2 intrinsic factors that have been associated with Achilles Tendinopathy. Poor muscle flexibility around the calf and weak proximal control can also contribute to Achilles Tendinopathy.

Signs and symptoms of Achilles Tendinopathy:

1)      Pain at the beginning and end of training sessions with decreased pain in-between.

2)      Pain during activities which load the tendon like stairs and on stretching the tendon

3)      Pain often in the in the morning which settles after some movement

4)      Localized swelling, thickening or small nodules around your tendon which may be painful to palpate.

If not treated properly, pain may worsen and start interfering with many activities of daily living.

Diagnosis of Achilles Tendinopathy:

Most doctors and physiotherapists would be able to diagnose the problem just by your signs and symptoms, however an Ultrasound scan is the best test for diagnosing Achilles Tendinopathy

Prevention of Achilles Tendiopathy

As always prevention is better than cure. Many running injuries are caused by people doing too much too soon. Pacing yourself is essential to preventing repetitive strain injuries. Runners shouldn’t increase their weekly mileage more than 10% a week. In addition, rest days are extremely important to allow the body to recover from hard training days. Change of speed, surface and training patterns should also be done slowly and with care.

Unfortunately Intrinsic factors are harder to recognise on ones-self and may only be picked up by a professional once the injury has taken place already.

Treatment of Achilles Tendinopathy:

Medications:  Due to the fact that there is an absence of inflammatory cells in an Achilles Tendinopathy, there is no rational basis for their use. Although NSAIDs may provide some pain relief, they do not result in sustained improvement in the healing process (Longo et al, 2009)

Physiotherapy:Physiotherapists are often successful in the treatment of Achilles Tendinopathy. A good physiotherapist will not only treat the symptoms but also help identify and manage both the intrinsic and extrinsic reasons for the injury. Treatment may consist of soft tissue massage and stretching to loosen the soft tissue around the area and taping to offload the tendon.

Stretches for the 2 muscles of the Achilles Tendon: (Pic 1-Gastrocs and Pic 2-Soleus)



Eccentric type exercise has been shown to help Achilles Tendinopathy. These exercises involve lengthening of the muscle in response to external resistance. Eccentric exercises are shown to help reverse the effects of tendinopathy by facilitating tendon tissue remodelling. It has been shown that eccentric exercises can improve symptoms in about 60% of patients (Longo et al 2009)

Eccentric Exercises (Left Leg in this example:)

Start on stair. Lift both heels. Lift right leg. Lower body weight on Left

Surgery: In 24% to 45.5% of patients with Achilles Tendinopathy, conservative management is unsuccessful, and surgery is recommended after exhausting conservative methods of management, often tried for at least 6 months (Longo et al, 2009)


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