Whether you’re sporty or sendentry, male or female pain in the Achilles tendon is common problem.

If you’re suffering with a problem with your Achilles tendon then it’s likely to be tender to touch and may feel stiff, particularly in the morning. Pain during the type of exercise that involves direct impact, such as running and walking, is also common.

What is an Achilles tendinopathy? 

Your Achilles tendons are the biggest, strongest tendons in your body. They attaches your calf muscles to your heel bones, helping you to lift your heel and propel forward when walking or running.

Your Achilles tendons adapts rapidly to cope with the demands of your activites. However, pain can develop if you exceed it’s capacity to adapt and an imbalance develops between the ‘wear and repair’ processes in the tendon. We call this process tendinopathy and as physios we think about this process in two different stages, which acts as a guide to the best treatment:

  1. Reactive stage

This is the very early stages of a tendinopathy. During this stage there may be some thickening of the Achilles tendon, stiffness and pain. This stage is completely reversible and the tendon will return to a normal, pain free state again if managed appropriately.

The best advice is to reduce all activities that cause pain to a level where you can do them comfortably. Unfortunatley, for some activities you might need to stop altogether for a short period. This is to allow your symptoms to settle. During this phase, ice and taping can be helpful and your GP may recommend a course of anti-inflammatories.

Once your symptoms have settled it’s vital to build up any previously painful activites in a very structured way and a physiotherapist can help with this.

  1. Degenerative stage: 

This stage is the next step on from the reactive phase. It’s associated with persistent pain and normally more in the middle-aged population. It can happen if the reactive stage is not managed appropriately and excessive pressure has been placed upon the Achilles tendon repeatedly.

In this stage your Achilles tendon will be thickened more with nodular sections and there are physical changes in the structure of the tendon which would be seen on an ultrasound scan. These changes are not reversible but appropriate treatment to strengthen the tendon mean that it can function is a pain free way again.

What are the risk factors of developing Achilles tendinopathy? 

Excessive and sudden increases in exercise are often the cause of developing tendinopathy however there are some other risk factors linked to this issue such as  your age, your body weight, being diabetic, tightness or weakness in the calves or less optimal movement pattern causing increased pressure on the Achilles tendon.

A physiotherapist would be able to advise you of all the underlying factors that may have contributed to your symtpoms and this would be taken into account in recommending an appropriate treatment programme.

What are the best exercises for strengthening the Achilles tendon:

Isometric ‘press and hold’ exercises are recommended to relieve pain for all patients suffering from Achilles tendon pain, whether in the reactive or degenerative phases of this condition.

Depending on the severity of your symptoms, you can practice these exercises either with both legs (slightly easier) or on one leg.Isometric exercise for the achilles tendinopathy

Hold each lift for 45 seconds and repeat 5 times.

Take a break of 15 seconds in between each repetition.

Repeat up to 4 times per day.

The benefits of Shockwave therapy for Achilles tendon pain

Shockwave therapy is recommended if you are in the degenerative stage of tendinopathy. It’s a mechanical treatment applied to the tendon which kick starts the healing process again and relieves pain.


Please don’t hesitate to get in touch if you have any further questions.

The Physiofit team!