What is Achilles tendinopathy?
Achilles tendinopathy is a load-related condition involving pain, impaired function and changes within the tendon. Symptoms often develop when the demands placed on the tendon exceed its current capacity to tolerate and adapt to load. It typically causes pain and stiffness at the back of the heel or lower calf, often worst first thing in the morning or at the start of activity.
Is Achilles tendinopathy the same as Achilles tendonitis?
The terms are often used interchangeably, but "tendinopathy" is now preferred. "Tendonitis" implies that inflammation is the main problem, whereas Achilles tendinopathy involves a wider mix of pain, reduced function and changes in the tendon's structure. This is one reason anti-inflammatory strategies on their own rarely resolve it.
How do I know if I have midportion or insertional Achilles tendinopathy?
Location is the main clue. Midportion tendinopathy affects the main body of the tendon, typically 2–6 cm above the heel bone, and there is often a tender or thickened area you can feel. Insertional tendinopathy affects the point where the tendon attaches to the back of the heel, and is often aggravated by positions that bend the foot up towards the shin, such as walking uphill or dropping the heel off a step. The two can coexist, and other conditions can cause similar pain, so a clinical assessment is the best way to be sure.
Do I need an ultrasound or MRI?
Usually not. Achilles tendinopathy is normally diagnosed clinically, based on the location and behaviour of your symptoms, examination findings and functional limitations. Ultrasound or MRI may be useful when the diagnosis is uncertain, symptoms are not following the expected course, a partial tear or other pathology is suspected, or imaging would change management. Tendon thickening and other structural changes can also be found in people without pain, so scan findings always need to be interpreted alongside the clinical picture.
Should I stop running with Achilles tendinopathy?
Not necessarily. Complete rest is not usually needed. In many cases, running can be modified, for example by reducing distance, speed or hills, and progressively reintroduced alongside calf strengthening. In a randomised controlled trial, people who continued running and jumping using a pain-monitoring model alongside rehabilitation did no worse than those who initially rested from those activities. What matters is how your symptoms respond during the run and over the following 24 hours.
Is it OK to feel pain during Achilles exercises?
Some discomfort can be acceptable during rehabilitation, provided the overall response remains manageable. Pain during exercise does not automatically mean that you are damaging the tendon. Rather than following a fixed pain number, monitor your symptoms during the session and over the next 24 hours. A clear and sustained increase in pain or morning stiffness suggests the recent load needs adjusting.
What is the best exercise for Achilles tendinopathy?
There isn't a single best one. Heel drops (eccentric training) and heavy slow resistance calf training have produced similar outcomes in midportion tendinopathy, and a 2023 systematic review did not identify one loading protocol as clearly superior. The more important principle is progressive loading: gradually increasing the type, magnitude and speed of load on the calf and tendon until it can tolerate what your running or sport demands.
Should I stretch my calf if I have Achilles tendinopathy?
It depends on the type. For insertional tendinopathy, calf stretching into deep dorsiflexion compresses the tendon against the heel bone and may aggravate symptoms. A 2025 randomised clinical trial in sport-active adults with chronic insertional tendinopathy found better outcomes with a programme that avoided calf stretching, limited dorsiflexion and used heel lifts. For midportion tendinopathy, stretching is less likely to be a problem, but it is not a substitute for progressive strengthening.
Do heel lifts help Achilles tendinopathy?
They can help some people, particularly those with insertional tendinopathy, by reducing how far the ankle bends upwards and therefore how much the tendon is compressed. Heel lifts were part of the lower-compression programme in the 2025 insertional tendinopathy trial. They are usually best seen as a way of reducing symptoms while you rebuild capacity, rather than a treatment on their own.
How long does Achilles tendinopathy take to recover?
Recovery is usually measured in months rather than weeks, and it varies considerably between people depending on how long symptoms have been present, the type of tendinopathy, and the demands you are returning to. Symptoms often improve before calf strength and endurance have fully recovered, which is why we use objective testing, rather than the absence of pain alone, to guide a return to running or sport.
Could my Achilles pain be a tear?
A sudden "pop" or snapping sensation, a feeling of being kicked in the back of the heel, immediate loss of push-off strength, difficulty walking normally, or significant swelling or bruising after an acute injury can indicate an Achilles tendon rupture. This needs prompt medical assessment rather than a tendinopathy programme. Rapidly worsening symptoms, or symptoms that do not behave like typical tendinopathy, should also be assessed.
When should I see a physiotherapist about Achilles pain?
It's worth getting assessed if pain has persisted for more than a couple of weeks despite reducing aggravating activity, if it is getting worse, if it is affecting how you walk or run, or if you are unsure whether it is midportion or insertional. It's also worth being seen if previous exercise programmes haven't helped, since the choice and range of exercises may need adjusting to your type of tendinopathy. Get in touch with us today to discuss your Achilles pain.
For a fuller explanation, read Achilles Tendinopathy: Midportion vs Insertional, Symptoms & Rehab.
References
- Chimenti RL, Neville C, Houck J, et al. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG44. doi:10.2519/jospt.2024.0302.
- Docking SI, Ooi CC, Connell D. Tendinopathy: is imaging telling us the entire story? J Orthop Sports Phys Ther. 2015;45(11):842–852. doi:10.2519/jospt.2015.5880.
- Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897–906. doi:10.1177/0363546506298279.
- Beyer R, Kongsgaard M, Hougs Kjær B, et al. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704–1711. doi:10.1177/0363546515584760.
- Maetz R, Dubé MO, Tougas A, Prudhomme F, Dubois B, Roy JS. Systematic review and meta-analyses of randomized controlled trials comparing exercise loading protocols with passive treatment modalities or other loading protocols for the management of midportion Achilles tendinopathy. Orthop J Sports Med. 2023;11(5):23259671231171178. doi:10.1177/23259671231171178.
- Pringels L, Capelleman R, Van den Abeele A, et al. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial. Br J Sports Med. 2025;59(9):640–650. doi:10.1136/bjsports-2024-109138.
- Cook JL, Purdam CR. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163–168. doi:10.1136/bjsports-2011-090414.