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Achilles Tendinopathy

Achilles tendinopathy is a common cause of pain and stiffness at the back of the ankle. It often develops gradually and is especially common in runners, active adults, and people who have recently increased their walking, running, or training. 

Dr. Michael Hoiles has created this resource to help you understand Achilles tendinopathy, common symptoms, treatment options, recovery expectations, and how progressive exercise and chiropractic care may help you return to activity. 

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Quick Facts 

✔ The Achilles tendon connects the calf muscles to the heel bone. 

✔ Pain and stiffness are often worse first thing in the morning or after rest. 

✔ Sudden increases in running, jumping, or training are common triggers. 

✔ Progressive strengthening is one of the most important parts of rehabilitation. 

✔ Complete rest is usually not necessary, but activity may need to be temporarily modified. 

✔ Recovery is often gradual and can take several months. 

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Anatomy illustration of the Achilles tendon showing its connection between the calf muscles and heel bone and the common area affected by Achilles tendinopathy.

Achilles Tendon Anatomy 

The Achilles tendon is the large, strong tendon at the back of the ankle. It connects the calf muscles — primarily the gastrocnemius and soleus — to the heel bone (calcaneus). 

The Achilles plays an important role in: 

  • Walking and running 

  • Pushing off the ground 

  • Rising onto your toes 

  • Jumping and landing 

  • Climbing stairs 

Achilles tendinopathy can develop in the mid-portion of the tendon or closer to where the tendon attaches to the heel, known as insertional Achilles tendinopathy. 

Because the Achilles attaches to the heel bone, symptoms in this area can sometimes overlap with other causes of foot and heel pain.

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What Is Achilles Tendinopathy? 

Achilles tendinopathy occurs when the Achilles tendon becomes painful and its ability to tolerate load is reduced. 

Symptoms commonly develop gradually rather than from a single injury. The tendon may become painful when the demands placed on it exceed what it is currently able to tolerate. 

The term tendinopathy is generally preferred to “tendinitis,” as persistent Achilles pain is not simply an inflammatory problem. 

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Common Causes & Risk Factors 

Achilles tendinopathy is often associated with changes in how much load is being placed on the tendon. 

Common contributing factors include: 

  • Increasing running distance or intensity too quickly 

  • Adding more hills or speed training 

  • Returning to exercise after time off 

  • Repetitive jumping or running 

  • Reduced calf strength 

  • Limited ankle mobility 

  • Changes in footwear 

  • Sudden increases in walking or recreational activity 

Often, several factors contribute rather than one specific cause. 

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Common Symptoms:

  • Pain at the back of the ankle or heel 

  • Morning stiffness 

  • Pain during the first few steps after rest 

  • Tenderness along the Achilles tendon 

  • Thickening or swelling of the tendon 

  • Pain when running or jumping 

  • Pain when rising onto your toes 

  • Symptoms that improve as you warm up but return afterward 

Pain underneath the heel rather than primarily at the back of the ankle may sometimes be related to plantar fasciitis rather than the Achilles tendon.

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How Is Achilles Tendinopathy Diagnosed? 

Achilles tendinopathy can usually be diagnosed through your history and a physical examination. 

Assessment may include: 

  • Location of pain and tenderness 

  • Achilles tendon thickness or swelling 

  • Ankle range of motion 

  • Calf strength 

  • Single-leg heel raises 

  • Walking or running mechanics 

  • Recent changes in activity or training 

Imaging such as ultrasound or MRI is not routinely required but may be useful when the diagnosis is unclear or another injury is suspected. 

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What Helps Achilles Tendinopathy? 

Treatment typically focuses on managing tendon load and progressively rebuilding strength. 

This may include: 

  • Temporarily reducing aggravating activities 

  • Progressive calf and Achilles strengthening 

  • Gradually increasing walking or running 

  • Addressing ankle mobility when appropriate 

  • Modifying training volume or intensity 

  • Appropriate footwear 

  • Maintaining fitness through tolerated activities 

The goal is generally not to completely unload the tendon, but to gradually improve its ability to tolerate activity. Progressive strengthening is a central part of rehabilitation. 

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How Chiropractic Can Help 

Chiropractic care for Achilles tendinopathy may combine rehabilitation with treatment of contributing factors in the foot, ankle, and lower leg. 

Depending on the assessment, treatment may include: 

  • Progressive Achilles and calf strengthening 

  • Ankle mobility exercises 

  • Soft tissue treatment 

  • Joint mobilization when appropriate 

  • Advice on activity and training modification 

  • Running or movement assessment 

The primary goal is to help the tendon progressively tolerate the demands of everyday activity, exercise, and sport. 

 

Shockwave Therapy for Achilles Tendinopathy 

For persistent Achilles tendinopathy that has not responded adequately to exercise-based rehabilitation, shockwave therapy may be considered. 

Shockwave therapy delivers mechanical energy to the affected area and is generally used alongside a progressive strengthening program rather than as a replacement for rehabilitation. 

Whether shockwave therapy is appropriate depends on the location of the tendinopathy, how long symptoms have been present, and previous treatment. 

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Recovery Timeline 

Achilles tendinopathy often improves gradually. 

  • Mild or recent symptoms: Improvement may begin within several weeks. 

  • Persistent tendinopathy: Rehabilitation commonly takes several months. 

  • Long-standing symptoms: Returning to unrestricted running or sport may take six months or longer. 

Progress is rarely perfectly linear, and temporary flare-ups can occur as activity and exercise are increased. 

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Can I Still Exercise Achilles Tendinopathy? 

In many cases, yes. 

You may need to temporarily reduce activities that significantly aggravate the tendon, particularly running, jumping, hills, or high-volume training. 

Cycling, swimming, strength training, or other tolerated activities can often be used to maintain fitness while the Achilles gradually becomes stronger. 

Running and jumping can then be progressively reintroduced as symptoms and tendon capacity improve. 

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Exercises Commonly Recommended 

The exact exercises depend on your symptoms and stage of recovery. 

Early Stage 

  • Seated calf raises 

  • Double-leg calf raises 

  • Isometric calf holds 

  • Gentle ankle mobility 

Strengthening Stage 

  • Single-leg calf raises 

  • Bent-knee calf raises 

  • Weighted calf raises 

  • Step-ups or split squats 

Return to Activity 

  • Heavy calf raises 

  • Single-leg strengthening 

  • Hopping progressions 

  • Running progressions 

  • Sport-specific jumping or change-of-direction drills 

Exercise selection may differ between mid-portion and insertional Achilles tendinopathy, particularly when exercises place the ankle into deeper dorsiflexion. 

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Common Mistakes That Slow Recovery

  • Completely resting the tendon for too long 

  • Returning to running too quickly 

  • Increasing training volume suddenly 

  • Doing strengthening exercises inconsistently 

  • Progressing exercises too aggressively 

  • Ignoring morning stiffness or worsening symptoms 

  • Focusing only on stretching instead of rebuilding strength 

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When Should You Seek an Assessment? ​

  • Pain persists or continues to return 

  • Running or walking is becoming difficult 

  • Morning stiffness is increasing 

  • The tendon appears swollen or thickened 

  • Symptoms are limiting exercise or sport 

  • You are unsure how to safely progress your rehabilitation 

 

When Should I Worry? 

  • Sudden severe pain at the back of the ankle, particularly with a pop or snapping sensation, difficulty walking, or an inability to push off or rise onto your toes may indicate an Achilles tendon rupture. 

  • This requires prompt medical assessment. 

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Frequently Asked Questions 

Can Achilles tendinopathy heal on its own? 
Symptoms may settle with reduced activity, but progressive strengthening is often important for restoring the tendon's ability to tolerate activity. 

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Should I stretch my Achilles tendon? 
Stretching may be appropriate for some people, but it is not always necessary and may aggravate insertional Achilles symptoms. 

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Can I run with Achilles tendinopathy? 
Sometimes. Running may need to be reduced or temporarily stopped depending on symptom severity and how the tendon responds during and after activity. 

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Are calf raises good for Achilles tendinopathy? 
Yes. Progressive calf strengthening is commonly a central component of Achilles rehabilitation. 

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How long does Achilles tendinopathy take to heal? 
Recovery varies, but persistent cases commonly require several months of progressive rehabilitation. 

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Does shockwave therapy help Achilles tendinopathy? 
Shockwave therapy may be considered for persistent cases, usually alongside an appropriate exercise and loading program. 

 

What is the difference between Achilles tendinopathy and an Achilles rupture? 
Tendinopathy usually develops gradually, while a rupture typically involves sudden injury and a significant loss of Achilles function. 

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Summary 

✔ Achilles tendinopathy commonly causes pain and morning stiffness at the back of the ankle. 

✔ Sudden changes in running, jumping, or training can contribute to symptoms. 

✔ Progressive strengthening is an important part of rehabilitation. 

✔ Complete rest is usually unnecessary, although aggravating activities may need to be modified. 

✔ Recovery often takes several months and requires gradual progression. 

✔ Sudden severe pain or loss of Achilles function should be assessed promptly. 

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Ready to Get Back to Moving Comfortably? 

If Achilles pain is limiting your walking, running, workouts, or sports, an assessment can help determine what may be contributing to your symptoms and develop an appropriate rehabilitation plan. 

Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation, and practical advice to help people recover from injury, move better, and stay active. 

Book an appointment today to start your recovery and get back to doing what you enjoy. 

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