# Achilles tendinopathy Achilles tendinopathy is pain and stiffness in the thick cord above the heel (the Achilles tendon), usually because training load rose faster than the tendon could adapt. It is often worst with the first steps of the morning, warms up as you move, then flares afterward. We find what the tendon can take, load it in gradual steps, and keep you running and hiking while it builds back up. ## Symptoms - Pain and stiffness above the heel with the first steps of the morning - A tendon that warms up during a run, then aches afterward - Tenderness when you pinch the tendon, or a thickened spot you can feel - Pain at the back of the heel bone, where the tendon joins it - Pain on hills, stairs and calf raises - Stiffness after sitting for a while - A tendon that looks thicker or puffier than the other side ## Assessment We start with what changed before the tendon got sore. Common triggers are more hills or trail, a faster pace, new shoes, a first week of boot-packing, or a new season. Then we examine the tendon. We find where it is tender, in the middle of the cord or lower down where it joins the heel bone, because the two need slightly different loading. We check how far the ankle bends, and test calf strength and endurance, usually by counting single-leg heel raises on each side. We watch you walk, hop and run. We also check it is the tendon, not the small fluid sac behind the heel bone (the bursa), the sole of the foot, or a sore bone. If something else is likely, we explain what we found. ## Treatment Tendons get stronger with the right load, so exercise is the main treatment. We begin with calf raises the tendon can manage, often on both legs on flat ground. Then we make them gradually heavier: one leg, slow and weighted, then springy work and hopping. Some pain during and after is allowed, as long as it is no more than a little worse and has settled by the next morning. Alongside the loading: - **A small heel raise:** early on, a heel raise or heel cup in the shoe takes some stretch off the tendon, especially where it joins the heel bone. See [splints and bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing). - **Running and hiking load:** managed, not stopped. We work out how much the tendon can take now, and adjust as it improves. - **Hands-on treatment:** for a tight calf, to ease pain while the exercises take effect. - **A running assessment:** physiotherapists certified by The Running Clinic film you on a treadmill in slow motion and look at your stride and shoes. See [running assessment](https://backinactionphysiotherapy.com/services/running-assessment). - **Shockwave therapy:** one option for pain that lingers. [Shockwave therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy) sends focused sound waves into the sore tendon, alongside the exercises, not instead of them. As the tendon takes more, the work moves into [strength and conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning), building toward what your sport or job asks. ## Getting back to sport The return to running and hiking goes in steps, judged by the tendon rather than the calendar. Runners usually start with short runs on flat ground, then add time, then pace, then hills. Hikers and boot-packers build climb and distance the same way, because steep climbs load the calf and the tendon hardest. You move to the next step when the current one leaves the tendon no stiffer the next morning. Our [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) sheet, a warm-up from our physiotherapists, is there to print and do before each run. Keep the calf raises going after the pain settles: a strong calf helps the tendon cope with the next season. ## When to come in Book an assessment if the tendon is stiff most mornings, if pain comes on earlier in each run or hike, or if the cord has thickened. Come in too before a big step up in training, such as a first season of ski touring, if the tendon has been sore before. Go to the emergency department right away, or call 911, if any of these happen: - you felt a sudden snap or pop at the back of the heel and cannot rise onto your toes on that leg - one calf is swollen, warm and painful - the tendon is hot, red and swollen, and you have a fever - your foot is numb, cold or pale ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Running Assessment](https://backinactionphysiotherapy.com/services/running-assessment) - [Shockwave Therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy) - [Strength and Conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Programs - [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) ## Frequently asked questions ### Can I keep running with a sore Achilles? Usually, yes. Tendons need some load to heal, so we rarely ask you to stop completely. Run less, on flatter ground, and at a pace that leaves the tendon no more than a little worse. If it is stiffer than usual the next morning, that run was too much. Pain that sharpens during a run, or makes you limp, means stop and book an assessment. ### Should I stretch my Achilles tendon? Carefully. Gentle calf stretches suit some people, but hard stretching into the sore spot can irritate the tendon, especially where it joins the heel bone. Dropping the heel below the edge of a step is a common culprit there. Loading exercises such as calf raises do more for the tendon than stretching does. We show you which version suits where your tendon is sore. ### Will shockwave therapy fix my Achilles? Not by itself. Shockwave is one part of a plan, and the loading exercises are what build the tendon back up. We consider it for pain that has lingered through a stretch of exercise. The pulses feel like firm, fast tapping, and the area can be sore for a day or so afterward. It is not suitable for everyone, so we check your health history first. ### How long does Achilles tendinopathy take to settle? No set date. Tendons adapt slowly, and one that has been sore for months tends to take longer than one caught early. We judge progress by two things: how the tendon feels the morning after a loading session, and how much it can take without flaring. Stopping the exercises as soon as the pain eases is the usual reason it comes back. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*