Achilles Tendinopathy

What is Achilles Tendinopathy?

Achilles tendinopathy is irritation or degeneration of the Achilles tendon, which connects the calf muscles to the heel bone. It’s common in runners, jumpers, and athletes who increase training volume quickly.

Common Symptoms

• Pain and stiffness in the back of the heel or lower calf

• Pain that improves as activity warms up, then worsens after a period

• Swelling or thickening of the tendon

• Morning stiffness

Physical Therapist Diagnosis

A PT palpates the tendon for tenderness or thickening, assesses calf flexibility and strength, and evaluates running gait and mechanics.

Why it Happens

Overuse, sudden training increases in volume and/or intensity, poor calf strength, and limited ankle mobility all contribute to excessive tendon loading. Certain medications can play a role as well. 

Why it Doesn’t Always Heal on Its Own

Tendons require progressive loading to remodel. Rest alone often provides temporary relief but doesn’t restore tendon health and integrity.

Ideal Physical Therapy Treatment

Rehab emphasizes tendon loading, calf strength, and mechanics. Dry needling may help reduce calf muscle tightness contributing to tendon stress.

Key strategies include:

• Manual therapy and stretching for calf and ankle mobility

• Dry needling for gastrocnemius and soleus tension

• Eccentric and isometric loading for tendon healing

• Hip and core strengthening to reduce compensations

• Running gait retraining to reduce overload

• Supervised return-to-activity

Expected Outcomes

With consistent rehab, most athletes return to pain-free activity within 8–12 weeks.

Key Takeaway

Achilles tendinopathy responds best to structured loading and strengthening — not just rest.