Ankle & foot Sports Injury Physiotherapy
Achilles Tendinopathy
- Pain and stiffness at the back of the heel, worst in the morning
- Pain at the start of activity that may ease as you warm up
- Thickening of the tendon
- Pain going up on tiptoes
Quick answer
Achilles tendinopathy is overload of the tendon at the back of the heel, causing pain and stiffness that are worst on the first steps in the morning. It responds to progressive loading — particularly heavy, slow calf strengthening — over three to six months. Rest alone makes it worse.
Typical recovery
3–6 months
A typical range, not a promise — how long it takes depends on how long it has been going on, and on what you do between appointments.
The Achilles is the strongest tendon in the body and takes several times body weight with every running step. When the load applied exceeds what it has adapted to, it becomes painful and thickened.
The characteristic pattern
Pain and stiffness at the back of the heel that is worst on the first few steps in the morning and after sitting. Pain at the start of exercise that may ease as you warm up and then return worse afterwards. The tendon may feel thickened or nodular.
Two locations, treated slightly differently: mid-portion, two to six centimetres above the heel bone, and insertional, right at the bone. Insertional cases do not tolerate stretching or deep heel drops, because those compress the tendon against the bone.
Why rest is the wrong treatment
Tendons adapt to load and de-adapt without it. Resting a painful Achilles reduces pain for as long as you rest and leaves the tendon less capable than before, which is why it returns as soon as running resumes.
The treatment is progressive loading — uncomfortable at first, and it works.
How physiotherapy helps
- Isometric calf loading early, which reduces pain and begins building capacity
- Heavy, slow calf strengthening — both straight-knee and bent-knee, because they load different muscles
- For insertional cases, avoiding stretch and deep heel-drop positions in the early phase
- Reviewing training load, footwear and running mechanics
- Graded return to running, progressed by tolerance over 24 hours rather than pain during the run
How long it takes
Three to six months for most people. Longer if it has been present for a year or more. Some pain during loading is acceptable, provided it settles within 24 hours and is not increasing week on week.
Medically reviewed by Nasir Mughees, BPT, MPT, Orthopaedic Physiotherapy · Last reviewed September 2026