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  • Writer's pictureAndray Voronov

The Missing Link in Achilles Tendinopathy

achilles tendinitis pain rehab

Table of Contents:

1. Introduction:

Achilles tendinopathy (also known as achilles tendinitis) is a common injury that affects athletes and non-athletes alike. It is a condition that affects the Achilles tendon, which connects the calf muscles to the heel bone. Achilles tendinopathy can cause pain, swelling, and stiffness in the Achilles tendon, making it difficult to perform daily activities or sports.

Many people believe that stretching is the best way to prevent and treat Achilles tendinopathy. However, recent research has shown that strength training may be more effective than stretching for treating and preventing Achilles tendinopathy.

In this article, we will discuss what Achilles tendinopathy is, the causes of this condition, the benefits of strength training, and why you need strength training rather than stretching to prevent and treat Achilles tendinopathy.

2. What is Achilles Tendinopathy?

Achilles tendinopathy is a condition that affects the Achilles tendon, which connects the calf muscles to the heel bone. This condition is caused by degeneration or inflammation of the Achilles tendon, resulting in pain, swelling, and stiffness.

At this point you may be asking why I'm calling it achilles tendinopathy and not achilles tendinitis. An "tendinopathy" means that some sort of injury has occured to the tendon, whereas a tendinitis refers to inflammation. The key point here is that we now know that in a lot of cases of tendon related pain, there is often no inflammation.

Achilles tendinopathy can be classified into two types: non-insertional and insertional. Non-insertional Achilles tendinopathy affects the middle portion of the Achilles tendon, while insertional Achilles tendinopathy affects the lower part of the tendon where it attaches to the heel bone.

3. Causes of Achilles Tendinopathy:

There are several causes of Achilles tendinopathy, including:

  • Overuse: Achilles tendinopathy is often caused by overuse, which can occur when an individual participates in high-impact sports or activities that place a lot of stress on the Achilles tendon.

  • Age: As we age, the structure of our tendons changes, making them more susceptible to degeneration and injury.

  • Biomechanical factors: Individuals with poor foot mechanics and/or strength may be more prone to Achilles tendinopathy because of the increased stress placed on the Achilles tendon.

  • Tight muscles: Tight calf muscles can put added stress on the Achilles tendon, increasing the risk of injury.

4. Symptoms of Achilles Tendinopathy:

The symptoms of Achilles tendinopathy can vary depending on the severity of the injury. Common symptoms include:

  • Pain in the Achilles tendon during and after activity

  • Stiffness in the Achilles tendon

  • Swelling in the Achilles tendon

  • Tenderness to the touch

  • Limited range of motion in the ankle

If left untreated, Achilles tendinopathy can lead to a more serious injury, such as a ruptured Achilles tendon.

5. Traditional Treatment for Achilles Tendinopathy:

Traditionally, the treatment for Achilles tendinopathy has focused on stretching. However, as research in the area of tendon pain and injuries has improved over the years, we now understand that stretching may not be the answer to solving the issues here.

First of all, the most important factor in considering tendon injuries is that they are largely load related. This means that they occur for one of two reasons related to load.

  1. A submaximal load is applied to tendon for along period of time. This is what we would refer to as overuse. For example, walking up a flight of stairs may not normally be an issue, but if you had to walk up stairs repeatedly all day every day, eventually the achilles tendon is going to become painful.

  2. A sudden increase in load that exceeds the strength tolerance of the achilles tendon. For example, your gym installs a new basketball ring and you're keen to shoot some hoops, but it's been about 5 years since you've played. You play for around 20 minutes and afterwards you notice that your achilles is very tender. This is because the amount of running and jumping in those 20 minutes exceeded what you've done for the previous 5 years. (This is an oddly specific example, because it's what happened at the gym I go to)

6. Strength Training: An Effective Treatment for Achilles Tendinopathy

So, now we know that achilles tendinopathy is caused by weakness in the tendon, how do we strengthen it?

The golden rule of tendon rehab is this:

  • Isometric strength first to reduce pain

  • Eccentric exercises second to improve tendon healing

  • Concentric and eccentric exercises third to build strength

  • Plyometric exercies last to increase power

The reason for this is to gradually increase load tolerance of the tissue we're trying to rehab. If for example you jump straight to plyometric exercises, you risk worsening your condition, because you're asking a load intolerance tissue to perform a high load demanding task.

7.Why Strength Training is Better than Stretching for Achilles Tendinopathy

Generally speaking, we would want to avoid stretching a tendinopathy because as I mentioned above, weakness is the issue. It would be counterproductive to stretch and inhibit an already weakened tendon.


Q: What does achilles tendinopathy feel like?

A: A pain in the tendon behind the ankle, which gets worse after a lot of running or jumping activities.

Q: Why is it not called tendinitis?

A: Tendinitis refers to the presence of inflammation, which there often is not in the case of tendon injuries that have been lingering for a while.

Q: How long will it take to recover?

A: This depends on the individual. Everyone heals at difference rates and everyone will have varying levels of compliance to any rehabilitation program. Time frames may range from anywhere between 6-12 weeks.

Q: What risks are involved?

A: The major risk is that without adequate rehabilitation the tendinopathy may become chronic (long term) or at worst result in an achilles tear/rupture.

Q: Do I need surgery?

A: In most cases, no. Strength training and working with an allied professional who understands tendon rehabilitation may be adequate to get you back to sport.

Q: Can I get a cortisone injection to help?

A: Research has shown that cortisone injections directly into tendons may have dire long term effects, weakening the tendon and may result in an eventual rupture.

Q: Can osteopathy help?

A: definitely. Osteopaths are trained in the rehabilitation of musculoskeletal conditions such as tendinopathies. Your Narre Warren osteo at Gravity Osteopathy can utilise manual therapies such as massage and dry needling, in conjuction with a strengthening program to get you back to doing the things you love.

8. Conclusion

Achilles tendinopathy is a common condition that affects both athletes and non-athletes. It is often the result of a weakness in the achilles tendon, not tightness. Therefore, the way to rehabilitate this condition is by strengthening the achilles tendon. The strengthening process must be gradual, to ensure that the injury is not made worse by overloading the tendon too soon.

If you are suffering from achilles issues, book an appointment with your local Narre Warren Osteopath at Gravity Osteopathy today by clicking this booking link.

If you have more questions, feel free to get in contact with us here.

You can also email us at or give us a call on 0493 031 231

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