Musculoskeletal · Patient education from the Pegasus Peak physiotherapy team.
Reviewed by the Pegasus Peak physiotherapy team — AHPRA-registered physiotherapists led by principal physiotherapist Kosta Logothetis. Last reviewed 2026-03-29.
Achilles tendinopathy explained, causes, symptoms, and proven exercise rehab. Learn how to fix Achilles pain with evidence-based physiotherapy.
Achilles tendinopathy refers to a clinical condition characterised by pain, stiffness, and impaired function of the Achilles tendon, most commonly arising from…
Achilles tendinopathy refers to a clinical condition characterised by pain, stiffness, and impaired function of the Achilles tendon, most commonly arising from repetitive mechanical loading rather than a single acute injury.
It is broadly classified into:
Importantly, this condition is not purely inflammatory, but instead reflects a failed healing response and maladaptation to load, resulting in structural and mechanical changes within the tendon (Cook & Purdam, 2009).
The Achilles tendon is the largest and strongest tendon in the human body, formed by the convergence of:
These muscles generate plantarflexion, essential for gait, running, and propulsion.
Achilles Tendon Diagram
Notable characteristics:
In tendinopathy, the tendon undergoes structural changes rather than acute inflammation, including:
This results in a tendon that is:
These changes are described in the tendon pathology continuum model, which includes:
The most significant contributor is a mismatch between applied load and tendon capacity.
Examples:
Patients commonly report:
A key clinical feature:
> Symptoms oftenimprove during activity but worsen afterward or the following day
Effective rehabilitation is centred onoptimising load, not eliminating it.
Goals:
Heavy slow resistance training has demonstrated comparable or superior outcomes to eccentric-only programs (Beyer et al., 2015).
This stage is critical for restoring sport-specific function.
While mobility is important:
Focus should remain on controlled loading rather than passive stretching.
A structured progression should consider:
Pain during activity is acceptable within tolerable limits, provided symptoms do not significantly worsen within 24 hours.
Achilles tendinopathy is not simply an overuse injury it is a load management problem, where the tendon’s capacity has been exceeded over time. Understanding this shifts the focus away from passive treatments and toward progressive, structured rehabilitation.
The most effective approach is not rest, but targeted loading. By gradually exposing the tendon to increasing demands through well-designed strengthening and return-to-activity programs, it can adapt, remodel, and regain its ability to tolerate force.
Recovery, however, requires consistency and patience. Tendons adapt more slowly than muscles, and rushing the process often leads to recurrence or chronic symptoms. A well-guided program particularly one that progresses from isometric loading to heavy resistance and eventually dynamic movements provides the best chance of long-term success.
Ultimately, the goal is not just to reduce pain, but to restore full function, performance, and resilience, allowing a safe and confident return to activity.
Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: A randomized controlled trial.The American Journal of Sports Medicine, 43(7), 1704–1711.
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.British Journal of Sports Medicine, 43(6), 409–416.
Magnusson, S. P., & Kjaer, M. (2019). The impact of loading, unloading, ageing and injury on the human tendon.The Journal of Physiology, 597(5), 1283–1298.
Questions about achilles tendinopathy: understanding the condition and its management? Our physiotherapists in Horningsea Park and Gregory Hills can assess and treat you — no referral needed.
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