26/02/2026
Achilles tendinopathies usually present with pain or stiffness in the Achilles tendon.
Symptoms are often worse with running, jumping or uphill walking. There can also be morning stiffness or pain with the first few steps of the day.
Sometimes we see tenderness or thickening of the tendon, or pain that ‘warms up’ with activity but worsens afterwards.
Research describes Achilles tendinopathy as a load-related tendon condition, where symptoms are closely linked to how much stress the tendon is exposed to.
Rather than a sudden injury, Achilles tendinopathy usually develops over time due to load mismatch - when the tendon is asked to tolerate more load than it can currently handle.
Common contributing factors include:
🔷 Sudden increases in running volume or intensity
🔷 Hills, speed work or plyometrics added too quickly
🔷 Reduced calf strength or endurance
🔷 Limited ankle mobility
🔷 Changes in footwear
🔷 Inadequate recovery between sessions
Evidence shows tendon structure adapts to load but only when loading is applied progressively and appropriately.
When presented with an Achilles tendinopathy, we assess calf strength, tendon load tolerance, ankle mobility, running or movement mechanics, and training history and recent load changes.
This aligns with modern tendon management principles that focus on function, capacity and load, rather than imaging alone.
Strong evidence supports exercise-based rehabilitation, particularly progressive calf loading, as the cornerstone of treatment. This may include:
🔹 Isometric exercises to manage pain early
🔹 Progressive strengthening (heavy slow resistance or eccentric loading)
🔹 Gradual return to running and sport
🔹 Load management and education
🔹 Addressing contributing factors such as footwear or training errors
Manual therapy may assist symptoms in the short term, but long-term improvement depends on building tendon capacity, not avoiding load.
