Achilles Tendinopathy

May 3, 2017 | News

A Runner’s Achilles Heel

Did you know that runners are thirty times more likely to suffer from Achilles tendinopathy than their sedentary counterparts?  With the running season ramping up in Darwin so too are running injuries.  One of the most common injuries that runners present with is Achilles Tendinopathy


What does Achilles tendinopathy feel like?

Achilles pain in most commonly felt in the middle of the tendon but in some cases is felt at the insertion of the tendon into the back of the heel.  The pain is usually worse when the body is cold.  Most people experience increased pain and stiffness when first getting out of bed in the morning.  When running, the pain is normally worse at the beginning of the run, as the body warms up the pain tends to decrease.  Following exercise, or when the body cools down, then pain normally increases.


The pain usually comes on gradually over weeks or months rather than an acute, sudden onset.

If not Achilles tendinopathy, what else could it be?

Beware, not all Achilles pain is due to Achilles tendinopathy.  Other differential diagnoses include:

  • Retrocalcaneal bursitis
  • Achilles strain or tear
  • Referred pain from nerves or the lower back
  • Posterior impingement of the ankle
  • Calcaneal apophysitis (in children and adolescents)

Achilles tendinopathy is best diagnosed with a thorough clinical assessment with your Physiotherapist or Sports Physician.  In some cases, your therapist may refer for imaging to help to determine the cause of your symptoms.

What causes Achilles Tendinopathy?

Achilles tendinopathy can be caused by a number of issues, but one of the main factors that affects the tendon is rapid changes in loading.  Tendons are very sensitive to changes in volume of exercises, so when volume or activity is increased rapidly, the cells in the tendon don’t have enough time to adapt to the load and can be pathologically affected.

For example, if a person hasn’t run in months and then runs 10kms, the tendon may not be able to manage the rapid change in both the type of exercise and the volume, making the tendon more susceptible to developing a tendinopathy.  This is why it is best to gradually increase volume and types of activity.

Other factors that can predispose runner to Achilles tendinopathy include:

  • Calf weakness
  • Abnormal foot mechanics
  • Genetics
  • Type II Diabetes
  • Decreased calf flexibility
  •              Stiff Ankle

  •      Poor Running Biomechanics

How can I treat Achilles Tendinopathy?

Reduce Pain

The first step to managing Achilles tendinopathy is to manage to load.  If the amount and type of activity that a person is doing is beyond the capacity of the tendon then this should be modified to a level that the tendon can tolerate.

Isometric exercises can be used to help to relieve tendon pain.  An isometric exercise is a static, sustained contraction of the muscle.  For example, a static, sustained calf raise (lifting the heel up off the ground).  Recent research hypothesises that due to pain, the contraction of the muscle (in this case the calf) can be inhibited when a tendinopathy is present.  If the muscle isn’t contracting optimally then there is less shock absorption through the tendon placing more stress through the tendon.

In some cases, medications such as anti-inflammatories are taken to help to reduce symptoms (always consult your doctor prior to taking anti-inflammatories).

Improve Strength and Biomechanics

A strengthening program can then be undertaken to help to improve the strength of the calf. There have been many studies showing the efficacy of a specific eccentric strengthening (strengthening while the calf is elongating) exercises for the calf.

Biomechanical abnormalities such as calf or ankle stiffness, footwear and foot position should also be addressed.

Gradually Increase Function and Load

Focus can then move to improving the power of the muscle as well as gradually increasing training loads.


At Territory Sportsmedicine, we’re proud to be a sponsor of the City2Surf

If you’re experiencing Achilles Tendinopathy or any other running related injuries, please feel free to contact us.


Kujala, U. M., Sarna, S. Kaprio, J. (2005). Cumulative incidence of Achilles tendon rupture in male former elite athletes. Clinical Journal of Sports Medicine, 15(3), 133-135

Alfredson, H., Cook, J., Silbernagel, K., & Karlenson, J. (2012). Pain in the Achilles Region. In P. Brukner & K. Khan (Eds.), in Brukner & Khan’s Clinical Sports Medicine (4th ed.). North Ryde, Australia McGraw-Hill

Naugle, K. M. & Fillingim, R. B., & Riley, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. Pain, 13(12), 1139-1150