Achilles Tendon Pain
Achilles Tendinopathy
Protection → Controlled Motion → Return to Function
What Achilles Tendinopathy Is
Achilles tendinopathy is overload and breakdown of the big tendon at the back of your ankle, common in runners and with sudden increases in activity. It causes pain and stiffness in the tendon — worst in the morning and at the start of activity, sometimes with a thickened, tender spot. Like all tendinopathies, the treatment is progressive loading — especially calf strengthening — not rest.
- Primary — Load-related tendinopathy — pain and stiffness in the Achilles, worst in the morning and at the start of activity, from running or a spike in load. Most common, and this protocol is for it.
- Secondary — Rupture or other — a sudden 'pop' with a gap in the tendon and weak push-off (possible rupture — get seen now), or pain right where the tendon meets the heel bone (insertional, loaded slightly differently).
Involved tissues: The Achilles tendon at the back of the ankle, connecting the calf muscles to the heel — overloaded either mid-tendon or where it inserts on the heel.
Two pillars for Achilles tendinopathy: first, manage the load — temporarily reduce the running and impact volume that's overloading it; second, load the tendon progressively — isometrics, then heavy-slow calf raises and eccentrics, because progressive calf loading is the proven treatment and rest just leaves the tendon weak. Dial back the running, load the calf.
Load the calf, don't just rest
The Achilles is one of the best-studied tendons in rehab, and the message is clear: progressive loading — heavy-slow calf raises and eccentric work — is the treatment, and it beats rest. Resting settles it briefly but leaves the tendon weak, so it flares as soon as you run again. So we manage the running/impact volume in the short term while progressively loading the calf-tendon unit: isometrics early (they ease pain), then heavy-slow calf raises and eccentric lowering that rebuild the tendon. Mild tendon discomfort during loading that settles is acceptable — this tendon needs load. One note: for pain right at the heel (insertional), keep the loading out of deep dorsiflexion — don't drop the heel below the step. Dial back the running, load the calf, reintroduce impact last.
⚠️ Screen Before You Start — Get Assessed First If You Have:
- ●A sudden 'pop' with weakness and difficulty pushing off (possible rupture — get seen now)
- ●A palpable gap in the tendon, or inability to rise onto the toes
- ●Redness, warmth, and swelling with fever
- ●Numbness, tingling, or a cold or pale foot
- ●Severe pain unrelieved by rest, or after a fall
This is education, not a diagnosis, and doesn't replace hands-on care.
🌡️ Finding your stage
Take your movement temperature. Pain with daily activity and morning stiffness = Protection. Pain only with running or heavier calf loading = Controlled Motion. Pain only with high running/jumping demand = Return to Function. Brief loading discomfort that settles is okay; a lasting flare means back off. Re-check every session.
Phase 1 · Acute
Protection Phase
🌡️ Morning stiffness · pain with daily activity
Goal: Calm the tendon, manage the running/impact volume, and start isometric loading.
Manual treatment: Pain-relief modalities and pain-free motion.
Frequency: Daily · short sessions.
A. Calm & Manage Load
SoftWave Therapy
Video coming soon- Dose
- As scheduled
- How
- Applied to the tendon to calm symptoms and stimulate healing.
- Watch for
- The anchor of the early phase.
Load Management & Footwear
Video coming soon- Dose
- Ongoing
- How
- Reduce running/impact volume (not full rest), and a small heel lift can ease the tendon early.
- Watch for
- Dial the load back, don't stop entirely. For heel-insertional pain, don't drop the heel below level.
B. Isometric Loading
Calf Isometrics
Video coming soon- Dose
- 5 × 30–45 sec
- How
- Sustained heel-raise holds (double- or single-leg) at a pain-free effort.
- Watch for
- Isometrics ease tendon pain and start loading it.
Manage the running/impact volume without full rest. Isometrics ease tendon pain — use them. For heel-insertional pain, avoid dropping the heel below level.
✅ Ready for the next phase when:
Morning and daily pain settling, isometrics comfortable.
Tracking Your Progress
The weekly stability check: am I better, the same, or worse than last week?
Better
Stay the course; progress the load as pain shrinks to only high demand.
Same
Change the load, tempo, or volume; make sure you're doing heavy-slow/eccentric work.
Worse
Drop back a phase and reduce load; re-check you've managed the running volume.
The Rules That Govern This Protocol
- 1Manage the running and impact volume while you rebuild.
- 2Load the tendon progressively — isometrics, then heavy-slow calf raises and eccentrics.
- 3Reintroduce running and impact gradually.
- 4No lasting increase in pain after a session (brief settling discomfort is okay).
Movement You Love Is Therapy. This protocol is general education based on course rehabilitation materials and standard principles. It is not medical advice, diagnosis, or treatment, and does not create a provider–patient relationship. If pain is severe, worsening, or unexplained, see a licensed provider.