A Physical Therapist approach to treating achilles tendinopathy
If you’ve noticed pain, stiffness, or tightness in the back of your heel—especially after running or when you take your first steps in the morning—you may be experiencing Achilles tendinopathy (often called Achilles tendonitis). This common overuse injury affects runners, athletes, and active adults alike.
The good news? With the right approach, most people can recover fully without surgery. Here’s what current research says about the best way to treat Achilles tendinopathy.
What Is Achilles Tendinopathy?
The Achilles tendon connects your calf muscles to your heel bone. Over time, repetitive stress or sudden increases in activity can cause it to become irritated or weakened.
Unlike simple inflammation, Achilles tendinopathy involves changes in the tendon’s structure—so rest alone isn’t enough. The key is to help the tendon rebuild its strength through progressive, controlled loading.
1. Manage Load—Don’t Just Rest
It’s tempting to stop activity completely when your heel hurts, but complete rest can actually slow recovery. Instead, the goal is to reduce aggravating activities while keeping the tendon active.
Temporarily scale back running mileage or hill workouts.
Substitute with low-impact exercises like cycling, swimming, or walking.
Use a small heel lift or supportive shoe if pain persists with daily movement.
This keeps your tissues strong and prevents deconditioning while the tendon heals.
2. Follow a Progressive Strength Program
The most effective treatment for Achilles tendinopathy is a structured strengthening program. Research consistently shows that progressive loading exercises—like slow, heavy calf raises—help the tendon adapt and become stronger over time.
A physical therapist can guide you through the right progression, but the basics include:
Calf raises (straight and bent knee) to target both calf muscles.
Slow, controlled lowering (eccentric work) to load the tendon safely.
Gradual increases in weight or resistance as tolerated.
Tip: For insertional Achilles tendinopathy (where the pain is at the heel bone), avoid dropping your heel below a flat surface to reduce irritation.
3. Consider Helpful Adjunct Therapies
While exercise is the foundation, some patients benefit from additional treatments such as:
Manual therapy and soft-tissue techniques: To improve mobility and reduce surrounding tension.
Heel lifts or taping: For temporary symptom relief during daily activity.
NOTE: These adjuncts should support, not replace, a consistent strengthening program.
4. Be Patient and Consistent
Tendons adapt slowly—it can take 8 to 12 weeks (or more) to notice significant improvement. Consistency and progressive loading are key. Avoid rushing back into high-impact training before the tendon is ready.
5. Safely Return to Running or Sports
Once pain decreases and strength improves, begin a gradual return-to-running program:
Start with short walk/jog intervals.
Add rest days between runs.
Slowly reintroduce hills and speed work as symptoms allow.
A physical therapist can design a personalized plan to guide you through this process safely.
When to See a Physical Therapist
If your Achilles pain hasn’t improved after several weeks, or if it limits your ability to walk, run, or train, it’s time to see a sports physical therapist. They can perform a detailed assessment, tailor your exercise plan, and address biomechanical factors—like gait, strength, or footwear—that may be contributing to your symptoms.
Key Takeaway
The best way to treat Achilles tendinopathy is not rest—it’s progressive strength training, smart load management, and patience. With the right guidance, your tendon can heal and become stronger than before.
