Understanding achilles tendinopathy
The Achilles is the strongest tendon in the body and it thrives on load. Tendinopathy develops when the load applied outpaces the tendon's ability to adapt, leaving it thickened, painful and stiff, particularly first thing in the morning.
It appears either in the middle portion of the tendon or where it inserts into the heel bone. The two behave differently and need different rehabilitation, so the distinction is worth getting right.
Signs you might notice
- Morning stiffness in the tendon that eases with movement
- Pain at the start of exercise that warms up, then returns after
- Thickening or tenderness you can feel along the tendon
- Discomfort going up stairs or hills
- Reduced push off power on that side
Common contributing factors
- A sudden increase in running or hill work
- Calf weakness relative to the demand placed on it
- Reduced ankle mobility
- Change of footwear, especially heel drop
- Loading patterns that overwork one side
How we assess and treat it
We establish where in the tendon the problem sits and how it behaves under load, then test calf capacity properly rather than by eye. Gait analysis shows how you push off and whether one side is doing more work.
Rehabilitation is progressive and measurable. Tendons respond to the right dose of load applied consistently over time, and we will be clear with you about what that requires.
- Staged loading programme built to your current capacity
- Hands-on treatment and soft tissue work for symptom relief
- Calf and lower limb strengthening
- Running and gait retraining where relevant
- Footwear and training load advice
Common questions
Should I rest my Achilles completely?
Almost never. Tendons weaken with rest and the pain usually returns the moment you resume. Controlled loading is the treatment, not the risk.
Why does it hurt in the morning?
Tendons stiffen overnight. Morning stiffness that eases within half an hour is a classic tendinopathy sign, and tracking it is a useful way to measure progress.
How long is recovery?
Typically three months or more for a well established case. Anyone promising a rapid fix for a chronic tendon problem is overselling it.