Achilles Tendon Pain Physiotherapy
Achilles tendon pain usually reflects a mismatch between what the tendon can currently handle and what it is being asked to do. It responds to graded loading over months rather than to rest alone, and the plan is built around your training and your working day.
Individual rehabilitation plan — shaped by the assessment, reviewed as you progress
We assess your situation first, explain what the assessment shows, and agree a suitable rehabilitation direction with you. WhatsApp us to book, or ask first.
The Achilles tendon transmits large forces every time you push off, and pain here is generally a load-capacity problem rather than simple inflammation — which is why the older term tendinitis is gradually being replaced by tendinopathy. Pain in the middle of the tendon and pain right at its attachment to the heel bone behave differently and are managed differently. Symptoms alone cannot diagnose it; an in-person examination is what distinguishes these, and what excludes a partial or complete tendon tear.
The familiar pattern is stiffness and pain in the first steps of the morning, warming up during activity and then hurting again afterwards, with tenderness when you squeeze the tendon. It usually follows a change in training volume, surface, footwear or pace. Other possible causes deserve consideration: bursitis behind the heel, a bone stress reaction, a plantar heel problem, and in some cases nerve or inflammatory conditions can look similar, and more than one may be contributing.
- Morning stiffness and pain in the first steps
- Pain that warms up during a run and returns afterwards
- Tenderness when squeezing the tendon, sometimes with a thickened area
- Pain on stairs, hills, or pushing off to accelerate
- Calf tightness, and difficulty with single-leg heel raises
We look closely at what changed in the weeks before symptoms started, because tendon problems are usually a load story. We then locate the tender area precisely, test calf strength and endurance with heel raises, check ankle movement, and watch you walk, hop and push off. We also screen general health, since conditions and some medicines affect tendon tolerance and would change what we recommend.
- Your symptoms: location on the tendon, morning stiffness and warm-up pattern
- Daily activities and function: walking, stairs, standing hours and footwear
- Work or study demands, including time on your feet and terrain
- Sleep: whether the tendon aches at night and how the first steps feel
- Load and injury history: weekly training volume, surfaces, pace changes, previous episodes
- Movement: ankle dorsiflexion and big toe extension, compared side to side
- Strength and endurance of the calf, including single-leg heel raise capacity and balance
- Neurological and general screening: sensation, muscle power, general health and medicines that may affect tendons
Graded calf and tendon loading is the backbone, progressing from slow, controlled work towards spring-like loading if your goals require it. Depending on the assessment we may add a temporary heel raise, footwear changes, a training plan reset, and hands-on treatment or acupuncture where you consent and they may help you complete the exercise. Insertional and mid-tendon problems need different starting positions, so we do not use a fixed protocol; we adjust as you respond and your preferences shape the pace.
The most useful daily marker is morning stiffness: if it is no worse the day after a session, the load was about right. We usually reduce rather than stop running, because relative rest keeps tendon capacity while calming symptoms. You will get a flare-up plan, a rule for adjusting the next session, and a weekly plan for how much walking and running to do. Each visit reviews morning symptoms, heel raise capacity and activity tolerance before the load changes.
Gradual-onset Achilles pain suits a physiotherapy assessment and a loading plan. Arrange a prompt medical review if the area is red, hot and swollen with a fever, if pain came on after starting a new medicine known to affect tendons, if there is calf swelling with pain and warmth that does not fit the activity pattern, or if symptoms are worsening despite a sensible loading plan. A suspected tendon rupture is different and needs an emergency department the same day rather than any rehabilitation.
- A sudden snap or pop at the back of the ankle, often described as being kicked from behind
- Being unable to walk normally, to push off, or to stand on tiptoes on that leg
- A visible gap or dent in the tendon, or sudden loss of power in the calf
- Calf swelling with pain, warmth or discolouration that does not match your activity