Achilles Tendinopathy by David Eakins from RU:ACTIVE

Achilles tendinopathy aka achilles tendinosis (AT) is a condition we often see in our clinic. It can affect triathletes, runners, track and field athletes, Cross Fitters and even sometimes sedentary individuals. It can be both challenging and rewarding to treat.

The common theme amongst most of those presenting with AT is usually a change in tendon loading which has exceeded the capacity of that individual’s tendon.

The Achilles tendon is a strong fibrous band of tissue which connects the calf muscles to your heel bone. It absorbs and releases energy as you walk, run and jump. The Achilles tendon normal remodels itself in order to adapt to the demands placed upon it. It’s when this process can’t keep up with the demand, Achilles tendinopathy may develop. This can present on an continuum of reactive tendon (acute) to the development of Chronic Achilles Tendinopathy, or somewhere in between.


  • Pain in the mid-portion or insertion of the Achilles tendon
  • They may be a swelling / nodule / thickening of the tendon
  • Often sore to touch
  • First steps in the morning painful and stiff
  • Pain usually improves with exercise, may disappear but return after
  • Does not improve after a period of prolonged rest

Common Causes/Risk factors

There are many factors which can contribute to developing AT but may include the following:


  • Increased training load and volume
  • Change in footwear (e.g. too quick progression to minimalist shoes)
  • change of running surface
  • sudden introduction of hill running or sprints
  • Poor recovery, poor sleep, poor nutrition


  • Altered biomechanics (possibly due to a previous or other injury)
  • Inadequate calf strength for load demands
  • Lack for general strength and conditioning for load demand


The primary treatment for Achilles tendinopathy is modification of tendon loading activities and progressive strength / capacity of the tendon over time. Most cases of AT can be managed well given the correct advise and adherence to rehabilitation exercises and load management. The strategy for each individual will be slightly different depending on their circumstance and stages of the condition.

Very broadly speaking AT can take anywhere from 6 weeks to 12months to resolve (and some will experience symptom for years). The good news is that during this time you may still be able to train and compete within certain parameters and continue to enjoy your training.

It is important to know that Achilles tendinopathy rarely resolves with rest alone (apart from possibly a reactive tendinopathy). If you start to develop pain in your Achilles tendon, please seek advice from your healthcare professional experienced in treating this condition. The correct advice early on may save you a lot of missed training in the future.

About David…..

David is an DHA registered Osteopath with 10yrs experience treating a wide range of musculoskeletal conditions from elite level athletes to people that just enjoy to train. He has a Master degree in Osteopathy and an MSc Sports Medicine, Exercise & Health from University College London.

Working closely with team of physiotherapists at RU Active Physiotherapy, he uses an integrated approach of combining manual therapy with exercise rehabilitation and advise to reduce patients pain, improve function and optimize their recovery.

eb789413 4b03 424a 90f9 c6e3b35ba9d21
Posted on 31st May 2021