Achilles Tendinopathy
The morning hobble to the kettle, the ache that warms up mid-run then punishes you after - Achilles tendinopathy is stubborn, but it responds well to the right loading, correctly dosed. Rest alone is not the answer.
Your care, at a glance
The questions worth asking any clinic — answered up front.
Who you'll see
Craig has treated running injuries for more than two decades, including with national athletics teams; Jonty lists muscle and tendon problems among his particular interests and pairs KangaTech with force-plate testing; Oliver brings a strength-and-conditioning approach tendon rehab depends on.
How we assess it
History and precise diagnosis (mid-portion vs insertional), objective calf strength and endurance testing against your other side, and video gait analysis for runners.
How we treat it
Progressive tendon loading from tolerable baseline through heavy slow strength work to energy-storage exercise, with training kept going within agreed pain limits — shockwave as an adjunct for stubborn cases.
When you progress
- Calf strength and endurance approaching symmetry on re-testing
- Morning stiffness and load response settling week on week
- Hopping and springy loading tolerated before speed work
- Graded running volume rebuilt before intensity
The evidence behind this approach
Structured tendon loading is the best-supported treatment for Achilles tendinopathy — from the classic eccentric protocol (Alfredson et al., AJSM 1998) to heavy slow resistance shown equally effective at one year (Beyer et al., AJSM 2015). And you usually don't have to stop training: continuing sport under a pain-monitoring model didn't compromise recovery in a randomised trial (Silbernagel et al., AJSM 2007).
Why it happens
Tendons are load-management organs: they adapt to what you ask of them, and they complain when the asking changes faster than they can adapt. Most Achilles tendinopathy follows a spike - a new running program, a return to netball after winter, more hills, less recovery - rather than a single injury moment.
Where it hurts matters. Pain in the middle of the tendon (mid-portion) and pain where the tendon attaches to the heel (insertional) behave differently and are loaded differently in rehab, which is one reason generic calf-raise handouts so often disappoint.
How we assess it
We take a careful history of your training and symptoms, locate the problem precisely, and rule out the conditions that mimic it. Then we measure: calf strength and endurance on both sides, often with KangaTech testing to quantify exactly how much capacity the injured side has lost - deficits that are commonly bigger than people expect.
For runners we can add slow-motion video analysis of your gait, because what happens above the tendon - cadence, stride, hip control - shapes what the tendon absorbs.
How we treat it
The engine of Achilles rehab is progressive tendon loading: starting at a level your tendon tolerates and building systematically - through heavy, slow strength work towards the springy, energy-storage loading that running demands. Total rest weakens the tendon further; smart loading rebuilds it.
We usually keep you active throughout, using a pain-monitoring approach - some tendon soreness within agreed limits is acceptable and even expected, provided it settles. For stubborn cases, shockwave therapy can be a useful adjunct alongside - never instead of - the loading program.
Why patience pays
Tendons adapt on a timescale of months, not weeks, and the single most common reason Achilles rehab fails is abandoning the program once pain eases - usually well before the strength deficit has closed. Because we re-test your calf capacity as you go, you can see the gap closing, and we can tell you honestly when the tendon is ready for speed, hills and sport again.
Getting back to what you love
Whether the goal is a pain-free morning walk, a return to parkrun or a marathon build, the plan is the same: measure the deficit, load it progressively, re-test, and return by criteria.
Book online through HotDoc at our Adelaide CBD or Edwardstown clinic - no referral needed, with HICAPS for on-the-spot private health claims.
Frequently asked questions
Should I stop running completely?
Usually not. Complete rest tends to weaken the tendon without fixing the problem. We typically modify your running - volume, surface, speed - to a level your tendon tolerates, and rebuild from there alongside the strength program.
How long does Achilles tendinopathy take to get better?
Tendons adapt slowly. Meaningful change usually takes 6-12 weeks of consistent loading, and full return to high-level running or sport often takes several months. Re-testing along the way shows you the progress you cannot always feel.
Is it okay to exercise with some pain?
Within limits, yes - we use a pain-monitoring approach where mild, settling symptoms during and after loading are acceptable. We agree on the limits with you up front, so you always know what is fine and what means backing off.
What about injections or surgery?
Evidence supports progressive loading as first-line care, and most people improve without injections or surgery. If your progress stalls despite well-dosed rehab, we discuss the options honestly and work with your GP or a specialist on next steps.