Achilles tendon pathologies are among the most common injuries in sports comprising running and repetitive jumping¹ ⁶. During running and jumping, the Achilles tendon is subjected to loads as high as six to 12 times the body weight and runners have a 30 times greater risk of developing a tendinopathy as they age² (p865).

What is a tendinopathy?

A tendinopathy indicates a disorder of the tendon that causes pain and affects the function of the tendon.

What causes an Achilles tendinopathy?

Achilles tendinopathy is primarily seen as an overuse injury. The Achilles tendon is prone to injury when it is exposed to unaccustomed high loads² (p865). A sudden increase in loading (due to increased volume, intensity or type of exercise), a change in running surface (like hill training) or a change in footwear are all factors that affect the tendon and that could contribute to an Achilles tendinopathy ². Relative tendon overload may occur in a single episode or over a period of time.

achilles tendinopathy pain area

What are the symptoms of Achilles tendinopathy?

Generally, people complain of pain and possible thickening in the tendon which limits activity¹ and they experience increased pain with increased load². Athletes presenting with a tendinopathy usually have pain during or after exercise, or more frequently the following morning upon rising. Athletes are sometimes able to run through the pain or the pain disappears when they warm up. The pain however typically returns after exercise or when they cool down⁵ ². Morning stiffness and pain in the Achilles region is a hallmark sign of Achilles tendinopathy.

Management of an Achilles tendinopathy

achilles tendinopathy exerciseExercise and rehabilitation are critical components of any tendon intervention³. Treatment of Achilles tendinopathy initially involves managing the patient’s load. This is done by firstly decreasing the load to control symptoms and then by increasing the load to improve tendon capacity through a progressive loading programme² (p877).

Extracorporeal Shockwave Therapy can also be used as an adjunct to rehabilitation in the management of Achilles tendinopathies. Your physiotherapist will be able to assist you with an effective and evidence-based rehabilitation programme to manage and treat your Achilles tendinopathy.

This article was updated by the team from Lamberti Physiotherapy’s Tygervalley branch in the Western Cape. Contact them for a tendinopathy assessment and treatment by completing this appointment form.


  1. Abat F, Alfredson H, Cucchiarini M, Marmotti A, Mouton C, Oliveira J.M, Pereira H, Peretti G.M, Romero-Rodriguez D, Spang C, Stephen J, van Bergen C.J.A & de Girolamo L 2017, Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part 1: biology, biomechanics, anatomy and an exercise-based approach, Journal of Experimental Orthopaedics 4:18
  2. Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K 2017, Brukner and Kahn’s Clinical Sports Medicine, 5th Edition,McGraw-Hill, Australia
  3. Cook J, Stasinopoulos D & BrismeéJM 2018, Instertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone-updated evidence of non-surgical management, Journal of Manual & Manipulative Therapy26(3):119-122
  4. McClinton S, Luedke L, Clewley D 2017, Nonsurgical Management of Midsubstance Achilles Tendinopathy, Clinics in Podiatric Medicine and Surgery Vol. 32, Issue 2, pg.137-160
  5. Rabusin C, Menz H, McClelland J, Evans A, Landorf K, Malliaras P, Docking S & Munteanu S 2019, Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy: study protocol f for a randomised trial, Journal of Foot and Ankle Research 12:20
  6. Silbernagel K & Crossley K 2015, A Proposed Return-to-Sport Program for Patients with Midportion Achilles Tendinopathy: Rationale and Implementation, Journal of Orthopaedic & Sports Physical Therapy Vol.45, No.11
  7. Cook J. Lower Limb Tendinopathy. Lower Limb Tendinopathy course; 2020 Mar 9-10; Cape Town, South Africa. P1-102.