Understanding Achilles Tendon Injuries

by | Feb 20, 2024 | Injuries & rehabilitation

The legs of a person running on a track, risking Achilles tendon injuries.

Achilles tendon injuries can be painful and frustrating, often affecting physically active individuals. Whether you’re an athlete or simply enjoy an active lifestyle, understanding Achilles tendon injuries is crucial. This blog explores the causes, symptoms, physiotherapy management, lifestyle changes and pain relieving techniques.  

Anatomy of the Achilles Tendon

The Achilles tendon is a strong, fibrous band of tissue located at the back of the ankle. It connects the calf muscles (gastrocnemius and soleus) to the heel (calcaneus) and plays a crucial role in allowing you to point your toes, walk, run and jump by efficiently transferring the force generated in the calf muscle to the heel. It’s substantial weight-bearing function does however make it susceptible to injury.

Common Causes of Achilles Tendon Injuries

  • Overuse: Excessive running or jumping, combined with insufficient rest, places excessive strain on tendons.
  • Misuse: Poor posture, improper technique, or compensatory movements can contribute to tendon issues.
  • Disuse: Inconsistent loading, extended periods of rest, or sudden increases in exercise intensity can harm tendon health.
  • Medications: Certain medications like Accutane, antibiotics, or steroids may affect tendon health, making them more prone to injury.
  • General health: Conditions such as high blood pressure, high cholesterol, rheumatoid arthritis, and hormonal imbalances can increase the risk of tendon injuries.
  • Trauma: Direct physical injury can damage tendons.
  • Age and degeneration: Tendons become more vulnerable to injury as we age due to a decrease in blood supply.

Signs and Symptoms

  • Persistent discomfort or pain at the back of the heel, often aggravated with physical activity.
  • Morning stiffness or limited ankle flexibility.
  • Inflammation or sensitivity along the tendon.
  • Challenges performing tasks that involve pushing off from the foot.

Types of Achilles Tendon Injuries

  • Achilles tendinitis: inflammation of the Achilles tendon caused by excessive use or repetitive stress, and it can occur either at the point where the tendon attaches to the bone (insertional) or within the middle portion of the tendon.
  • Achilles tear: is a general term for damage to the Achilles tendon, which can range from partial tears to complete ruptures.
  • Achilles tendinopathy: chronic tendon degeneration and microtears in the Achilles tendon caused by long-term overuse. This is further be categorised into insertional tendinopathy or mid portion tendinopathy.
  • Achilles tenosynovitis: inflammation of the sheath surrounding the Achilles tendon

These conditions can occur independently or in conjunction with each other. For instance, you may have Achilles tendinopathy accompanied by microtears within the tendon.


Beginning with a review of the patient’s medical history and activities, a physiotherapist assesses  gait, range of motion, strength, flexibility and conducts specialized tests. They investigate factors like overuse or biomechanical issues, enabling them to precisely determine both the type of injury (tendinitis or tear) and its specific location within the Achilles tendon (insertional or midportion). This thorough evaluation forms the basis for an effective and customised treatment plan. Additionally, ultrasound or MRI may be employed to confirm the diagnosis and assess the extent of the injury.

Physiotherapy treatment 

Although rehab phases are specific to the injury healing timeline and the individual’s specific injury, this is the standard rehab framework: 

  1. Offload tendon and manage pain:
  2. Correct foot alignment
  3. Rest and avoid overuse
  4. Use technique to minimise compression of tendon
  5. Set the scene:
  6. Start to fix contributing factors
  7. Work on calve and ankle strength 
  8. Control of ankle movement 
  9. Facilitate tendon healing:
  10. Specific loading program
  11. Strengthen surrounding muscle
  12. Increase tendon load tolerance
  13. Functional strength to work towards everyday stuff
  14. Gradual increase in load 
  15. Get back to normal sport 
  16. Higher level training
  17. Sport specific rehabilitation 
  18. Return to sport 

The tendon then heals back to normal or even stronger.

If the tendon doesn’t have time to repair we call it disrepair and this causes changes to the collagen, blood vessels and the actual structure of the tendon. These can be called ‘degenerative changes’

Lifestyle changes 

Make the following adjustments to avoid aggravating the condition:

  • Steer clear from activities that place significant stress on the Achilles tendon, such as running, jumping or sudden stops.
  • Avoid repetitive and excessive movements that can aggravate the tendon 
  • Give your tendon adequate time to rest between activities and avoid pushing through pain or fatigue
  • Refrain from wearing heels, tight shoes or shoes that don’t provide proper arch support.
  • Avoid overstretching the the tendon as this can cause further damage.
  • Wear shoes with a slight heel to toe drop or considered getting heel raises in your shoes.

Pain relieving techniques  

To manage pain at home try the following techniques:

  • Gently massage the calve muscles to relief some tension 
  • Some individuals find relief from taping techniques to support the Achilles tendon
  • Isometric exercises can help reduce pain by promoting blood flow to the affected area without causing excessive strain on the tendon. (Hold for between 15-45 sec. Pain should be about a 2/10 and decrease as you hold it.)
  • In the initial stages of inflammation ice can be applied to calm the area and then later a hot pack can be used to improve blood flow and promote healing.


Achilles tendon injuries are not just painful; they can disrupt your daily life and activities. Our expert physiotherapists are here to guide you with a personalised treatment plan. Early intervention is crucial for a successful recovery and getting back to an active lifestyle. Don’t let pain hold you back; book your appointment at our practice today.

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