Achilles tendinopathy is one of the most common injuries in athletes — particularly runners. It also affects sedentary individuals returning to activity. The good news: evidence-based treatments are highly effective when properly applied.
🩺 Achilles tendon pain?
Our specialized physiotherapists use scientifically validated protocols to treat your tendinopathy.
FAST BOOKING PHYSIOTendinitis vs Tendinopathy: What's the Difference?
The term "tendinitis" (tendon inflammation) is actually incorrect in most cases. Histological studies show that most chronically painful tendons don't present inflammation, but collagen degeneration (fiber disorganization, neovascularization). The correct term is tendinopathy.
The Achilles Tendon: The Body's Most Powerful Tendon
The Achilles tendon connects the calf muscles to the heel bone. It withstands forces of 6 to 8 times body weight during running and up to 12 times during jumping.
Main Causes of Achilles Tendinopathy
- Mechanical overload — Too-rapid increase in training volume or intensity
- Calf strength deficit — Inability to handle repetitive loads
- Ankle stiffness — Limited dorsiflexion (<35°)
- Surface or shoe changes — Sudden switch from road to trail, or high to low drop
- Metabolic factors — Diabetes, hypercholesterolemia, certain antibiotics (fluoroquinolones)
Evidence-Based Treatment: The 4-Phase Protocol
Phase 1: Pain Management (Weeks 1-2)
- Isometric exercises — 5 × 45 sec isometric calf contraction (proven analgesic effect)
- Load reduction — Don't stop completely, but reduce volume and intensity
- Acceptable pain rule — Pain ≤ 3/10 during exercise, no worsening next day
Phase 2: Eccentric Strengthening (Weeks 3-12)
The Alfredson protocol remains the reference for mid-portion tendinopathy: 3 × 15 eccentric reps with straight knee + 3 × 15 with bent knee, twice daily, 7 days a week for minimum 12 weeks.
Phase 3: Heavy Slow Resistance (Weeks 8-16)
The HSR protocol shows comparable results to eccentric training with better patient satisfaction.
Phase 4: Return to Sport (Weeks 12-24)
- Progressive plyometrics reintroduction — Light jumps → running → sprints
- Return criteria — Calf strength ≥90% of healthy side, no morning pain
- Running volume increase — 10% rule per week
Prevention: The 6 Pillars
1. Calf Strength
Goal: ability to do 25 single-leg heel raises. Train 2-3×/week.
2. Load Management
10% rule. No more than 10% weekly volume increase.
3. Ankle Mobility
Minimum 35° dorsiflexion. Daily mobility exercises if deficit.
4. Tendon Nutrition
Collagen (15-25g) + Vitamin C (200mg) 45 min before training.
5. Appropriate Footwear
Gradual transition between shoe types. Avoid sudden drop changes.
6. Sleep and Recovery
The tendon remodels primarily during sleep. Minimum 7-8h/night.
Frequently Asked Questions
How long to heal from Achilles tendinopathy?
On average 3-6 months with an appropriate protocol. Chronic cases (>6 months of symptoms) may require 6-12 months.
Can you keep running with Achilles tendinopathy?
Often yes, provided you respect the acceptable pain rule (≤3/10) and don't worsen symptoms the next day.
Are PRP injections effective?
Current evidence doesn't show PRP superiority over exercises alone for Achilles tendinopathy.
Should I wear a heel lift?
For insertional tendinopathy, yes — temporarily. For mid-portion, it's generally not necessary.
Are shockwave treatments recommended?
Extracorporeal shockwave therapy (ESWT) can be a useful supplement when exercises don't respond after 3 months.
📍 Achilles Tendinopathy Treatment in Gland
Our team combines manual physiotherapy, progressive loading exercises, and biomechanical monitoring.
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