SCRx March Spotlight: Achilles Tendinopathy

What Is Achilles Tendinopathy? 

Achilles tendinopathy refers to pain and reduced function in the Achilles tendon, which connects your calf muscles to your heel bone. 

Although it’s often described as “tendinitis”, it’s usually not caused by inflammation alone. Instead, it reflects a tendon that has been overloaded beyond its current capacity. 

In simple terms: the tendon is being asked to tolerate more than it’s currently prepared for. 

It can present in two main areas: 

• Mid-portion pain (typically 2–6 cm above the heel) 

• Insertional pain (directly at the heel bone) 

Getting an accurate diagnosis is important, as this helps guide the right rehabilitation approach. 

Common Symptoms 

People with Achilles tendinopathy often report: 

• Pain at the back of the heel 

• Morning stiffness that eases with movement 

• Pain during or after walking or running 

• Tenderness when pressing on the tendon 

• Reduced calf strength or power 

• Symptoms that gradually worsen over time 

Early assessment can help confirm the diagnosis and rule out more serious issues, such as partial tears. 

Why Does It Develop? 

Achilles tendinopathy rarely comes from a single cause. It usually develops when the load placed on the tendon exceeds what it can tolerate over time. 

Common contributing factors include: 

• Sudden increases in activity 

  • Changes in running distance, speed, hills, or gym training. 

• Calf weakness 

  • Reduced strength increases the strain placed on the tendon. 

• Poor load management 

  • Returning to activity too quickly after time off. 

• Reduced conditioning 

  • Periods of inactivity lower the body’s tolerance to load. 

• Footwear or surface changes 

  • New shoes or more time on harder surfaces can increase stress on the tendon. 

Understanding these factors is a key part of effective treatment. 

How Long Does It Take to Settle? 

Recovery time varies depending on how long symptoms have been present and how well the tendon is rehabilitated. 

As a general guide: 

• Early-stage symptoms: around 6-12 weeks 

• Longstanding symptoms: around 3-6 months 

Rest alone rarely resolves Achilles pain. Avoiding load can actually reduce tendon strength further. 

The most effective approach is progressive, targeted rehabilitation.

What About Shockwave Therapy? 

For more persistent cases, SCRx may use shockwave therapy alongside rehabilitation. 

This treatment delivers controlled energy to the tendon and may help to: 

• Stimulate healing responses 

• Improve blood flow 

• Reduce pain sensitivity 

It’s not a standalone solution but can support progress when combined with a structured strengthening programme. 

Can It Be Prevented? 

Achilles tendinopathy can return if underlying strength and load issues aren’t addressed. 

To reduce your risk: 

• Maintain good calf strength 

• Increase activity levels gradually 

• Avoid sudden spikes in training 

• Include regular strength work in your routine 

When Should You Seek Advice? 

It may be worth speaking to a physiotherapist if you: 

• Have Achilles pain lasting more than a couple of weeks 

• Notice increasing morning stiffness 

• Struggle to return to running or activity 

• Experience recurring symptoms 

Early support can lead to quicker recovery and better long-term outcomes.