Achilles Tendinopathy: Understanding, Treating, and Preventing This Common Condition
Dr. Tyler Wright
Achilles tendinopathy is a condition that plagues athletes, active individuals, and even those with less physically demanding lifestyles. Understanding its causes, treatment strategies, and prevention techniques is essential for maintaining healthy, pain-free movement patterns. As a continuation of our exploration of ankle mobility and function, this post dives into what Achilles tendinopathy is, who is susceptible, why it develops, and how to effectively treat and prevent it.
What is Achilles Tendinopathy?
Achilles tendinopathy is a condition characterized by pain, stiffness, and impaired function in the Achilles tendon. It results from chronic overuse, microtrauma, and degenerative changes in the tendon structure. Unlike Achilles tendonitis (an acute inflammatory condition), tendinopathy is primarily degenerative, meaning inflammation is not the primary driver.
Common symptoms include:
- Morning stiffness that improves with movement
- Pain during or after activity
- Thickening or swelling of the Achilles tendon
- Tenderness when squeezing the tendon
Who is Susceptible?
Achilles tendinopathy commonly affects:
- Runners and endurance athletes who place repetitive strain on the tendon
- Athletes in explosive sports like basketball, soccer, or CrossFit that demand sudden changes in speed and direction
- Middle-aged individuals who are active but may have reduced tissue elasticity
- Those with biomechanical issues such as poor ankle mobility, calf weakness, or improper gait mechanics
- People with sudden training changes like increased mileage, intensity, or hill work
Why Does It Develop?
The primary causes of Achilles tendinopathy include:
- Overuse and overload: Repeated strain without proper recovery can cause micro-tears and degeneration.
- Poor biomechanics: Reduced ankle dorsiflexion, foot overpronation, or excessive calf tightness can all increase tendon stress.
- Inadequate recovery: Failure to allow sufficient rest between intense activities leads to tissue breakdown.
- Aging and reduced vascularity: The Achilles tendon naturally has limited blood supply, making recovery slower as we age.
Effective Treatment Strategies
Research supports a multifaceted approach to treating Achilles tendinopathy. Combining manual therapies with progressive loading exercises offers the best outcomes.
Manual Therapies for Pain and Healing
- Active Release Techniques (ART): ART targets adhesions and dysfunctional soft tissue patterns, improving mobility and reducing pain. Studies show improved outcomes in tendon healing when combined with loading protocols.
- Graston Technique (IASTM): Graston, a form of instrument-assisted soft tissue mobilization, has been shown to increase blood flow, promote collagen remodeling, and enhance healing in degenerative tendons.
- Focused Shockwave Therapy: This non-invasive treatment uses sound waves to stimulate cellular repair and improve blood flow. Research indicates that shockwave therapy is highly effective in cases where conservative treatments have failed, reducing pain and promoting tissue regeneration.
Rehab Exercises for Achilles Tendinopathy
Progressive loading is essential for tendon recovery. Key exercises include:
Eccentric Heel Drops (Proven in research to stimulate tendon remodeling)
- Stand on a step with heels hanging off the edge.
- Slowly lower your heels below the step level.
- Perform 3 sets of 15 reps twice daily.
Soleus Strengthening (Targets deeper calf muscles crucial for tendon stability)
- Perform slow, controlled bent-knee calf raises.
- Aim for 3 sets of 15 reps.
Isometric Holds (Great for reducing pain in reactive tendinopathy)
- Perform static calf raises and hold for 30-45 seconds.
- Repeat for 4-5 sets.
Heavy Slow Resistance Training (Effective for chronic Achilles tendinopathy)
- Gradually increase weight with exercises like seated calf raises or barbell deadlifts, focusing on controlled movement.
Preventing Achilles Tendinopathy
Prevention strategies focus on maintaining tissue resilience and optimal movement patterns:
- Ankle Mobility Work: Regularly perform ankle dorsiflexion drills and calf stretching to reduce tendon strain.
- Strength Training: Develop strong, balanced lower-leg muscles to absorb impact and reduce stress on the Achilles tendon.
- Progressive Load Management: Avoid sudden spikes in training volume or intensity. Increase mileage or resistance by no more than 10% per week.
- Proper Footwear: Choose supportive shoes that promote optimal gait mechanics and reduce excessive heel lift or pronation.
- Recovery Strategies: Adequate sleep, nutrition, and mobility-focused warm-ups improve tissue recovery and reduce injury risk.
Take Action for Stronger, Healthier Achilles Tendons
Achilles tendinopathy doesn’t have to sideline you from your active lifestyle. By integrating effective manual therapies like ART, Graston, and focused shockwave treatments with evidence-based rehab exercises, you can successfully reduce pain and improve function. Consistent ankle mobility drills, proper footwear, and intelligent training progression will further protect your Achilles tendon from future issues.
If you’re struggling with Achilles discomfort or want guidance on strengthening your tendons, we’re here to help. Book a consultation at Ascent Health & Performance to get started on a tailored treatment plan that meets your goals.
