Achilles tendinopathy can make walking, running and even the first few steps in the morning uncomfortable. It often develops gradually, but once symptoms appear, they can take time to settle.
The good news is that most people improve with the right Achilles tendinopathy treatment. Rehabilitation usually focuses on managing the load placed through the tendon, gradually rebuilding calf strength and progressing back towards walking, running or sport.
Shockwave therapy may also be considered in some persistent cases. However, it should not replace a structured rehabilitation programme, and current research does not support using it routinely for everyone with Achilles tendinopathy.
In this guide, we explain the main rehabilitation milestones, how long recovery may take and when focused shockwave therapy might form part of your treatment plan.
Quick answer: what is the best treatment for Achilles tendinopathy?
Progressive exercise is the main treatment for Achilles tendinopathy. Rehabilitation normally starts with manageable calf exercises before progressing to heavier strength work, faster movements, hopping and a gradual return to running or sport.
You may also need to temporarily adjust your training, footwear or daily activities to reduce aggravating load.
Shockwave therapy may be discussed if:
- the diagnosis has been confirmed
- symptoms have persisted despite an appropriate rehabilitation programme
- your progress has plateaued
- other causes of Achilles pain have been considered
- you understand that the evidence for its effectiveness is mixed
- it is used alongside rehabilitation rather than as a replacement for exercise
A physiotherapy assessment can help confirm the likely cause of your pain and establish the right starting point.
What is Achilles tendinopathy?
The Achilles tendon is the strong band of tissue connecting the calf muscles to the heel bone. It stores and releases energy when you walk, run, jump and rise onto your toes.
Achilles tendinopathy occurs when the tendon becomes painful and less able to tolerate the demands placed on it. It is commonly associated with a change in load rather than a single traumatic incident.
For example, symptoms may appear after:
- increasing running mileage
- adding more hills or speed sessions
- returning to exercise after a break
- changing sport or training surface
- completing repeated jumping activities
- reducing recovery time between sessions
- suddenly increasing walking or standing
- changing footwear
Achilles tendinopathy can also affect people who do not run or play sport.
Common symptoms include:
- pain or tenderness along the tendon
- stiffness during the first steps in the morning
- pain after sitting or resting
- discomfort when walking uphill or using stairs
- pain when running or jumping
- reduced calf strength
- swelling or thickening around the tendon
- symptoms that initially ease with movement but return afterwards
What is the difference between midportion and insertional Achilles tendinopathy?
There are two main types of Achilles tendinopathy.
Midportion Achilles tendinopathy
Midportion tendinopathy normally causes pain several centimetres above the heel bone. The painful or thickened area is usually in the main body of the tendon.
Insertional Achilles tendinopathy
Insertional tendinopathy affects the point where the Achilles tendon attaches to the heel bone. Pain is normally felt at the back of the heel and may be aggravated by shoes pressing against the area.
Knowing which type you have is important because some exercises are performed differently.
For example, repeatedly lowering the heel below the edge of a step can increase compression at the tendon’s attachment to the heel. This may aggravate insertional Achilles tendinopathy, particularly during the early stages of rehabilitation.
Is Achilles tendinopathy the same as an Achilles tear?
No. Achilles tendinopathy usually develops gradually, whereas an Achilles tear or rupture often happens suddenly.
Seek urgent medical assessment if:
- you felt or heard a sudden snap or pop
- it felt as though someone kicked you in the back of the leg
- you have sudden, severe pain
- you cannot push off the affected foot
- you cannot rise onto your toes
- walking has suddenly become very difficult
- there is significant bruising or swelling
These symptoms could indicate a partial or complete Achilles rupture rather than tendinopathy.
How long does Achilles tendinopathy take to recover?
There is no exact recovery time. Some people notice improvement within several weeks, but Achilles tendinopathy rehabilitation commonly takes several months.
Recovery can be influenced by:
- how long you have had symptoms
- whether the problem is midportion or insertional
- your current strength
- the demands of your work or sport
- how irritable the tendon is
- your training history
- how consistently you complete rehabilitation
- other health or lifestyle factors
- whether the diagnosis is correct
It is normal for progress to vary from week to week. A temporary flare-up does not necessarily mean you have damaged the tendon again, but it can be a sign that the recent increase in activity was too much.
Recovery should be guided by milestones and function rather than dates alone.
Achilles tendinopathy rehabilitation milestones
The following milestones show how rehabilitation may progress. They are not fixed weekly stages, and the correct starting point will depend on your symptoms and ability.
Milestone 1: Settle the most irritable symptoms
The first aim is to make everyday activity manageable.
This does not always require complete rest. In fact, avoiding all load for too long can reduce the tendon’s capacity further. Instead, you may need to temporarily reduce or modify the activities that cause the biggest reaction.
This might include:
- reducing running distance
- removing hills and speed work
- replacing some runs with cycling or swimming
- reducing jumping activities
- taking more recovery time between sessions
- avoiding long periods in unsupportive or very flat shoes
- adjusting activities that repeatedly aggravate the tendon
Early exercises may include seated calf raises, supported double-leg heel raises or calf holds. The aim is to introduce a manageable amount of load without causing a prolonged flare-up.
You may be ready to progress when:
- walking is becoming more comfortable
- morning stiffness is reducing
- symptoms are more predictable
- basic calf exercises are manageable
- there is no significant increase in symptoms the following day
Milestone 2: Rebuild basic calf strength
Once the tendon can tolerate early loading, the next goal is to strengthen the calf and Achilles.
Exercises may include:
- seated heel raises
- standing double-leg heel raises
- assisted single-leg heel raises
- heel raises with the knee straight
- heel raises with the knee bent
- slow lowering exercises
- balance exercises
Both the straight-knee and bent-knee positions can be useful because they place different demands on the calf muscles.
The exercises should become progressively more challenging. If you can easily complete the repetitions, the tendon may not be receiving enough stimulus to build strength.
Progression could involve:
- moving from two legs to one
- adding weight
- increasing the range of movement where appropriate
- changing the speed
- increasing the number of repetitions
- using gym equipment
If you have insertional Achilles tendinopathy, heel raises will often begin on a flat surface rather than with the heel dropping below a step.
You may be ready for the next stage when:
- you can complete controlled single-leg heel raises
- your affected side is becoming stronger
- walking and stairs are comfortable
- morning stiffness is stable or improving
- added resistance does not cause a lasting flare-up
Milestone 3: Develop heavier strength and endurance
Everyday heel raises are a useful starting point, but running and sport place much greater demands on the Achilles tendon.
Rehabilitation should therefore progress beyond light exercises.
Heavier strengthening may include:
- weighted standing calf raises
- weighted seated calf raises
- single-leg calf raises
- calf presses using gym equipment
- split-stance exercises
- step-ups and single-leg strength work
- exercises targeting the hips, knees and trunk
The aim is to improve both the tendon’s capacity and the strength of the surrounding muscles.
Strength and conditioning rehabilitation may help bridge the gap between basic treatment exercises and the demands of running, jumping or sport.
You may be ready to progress when:
- heavier calf exercises are well tolerated
- the affected leg is approaching the strength of the other side
- you can complete repeated heel raises with good control
- everyday activity causes minimal symptoms
- your symptoms settle back to their usual level by the next day
Milestone 4: Reintroduce faster movements
The Achilles tendon does not only need to tolerate slow strength exercises. It must also store and release energy quickly during running and jumping.
Later rehabilitation may therefore include:
- faster heel raises
- skipping
- small two-leg jumps
- hopping
- forward and sideways jumps
- landing exercises
- running drills
- changes of direction
These exercises should be introduced gradually. Starting explosive work before you have rebuilt enough strength may overload the tendon.
You may be ready to begin running when:
- you can walk briskly without a clear increase in pain
- you can complete repeated single-leg heel raises
- you can perform basic hopping without losing control
- there is no significant swelling
- symptoms are mild and stable
- your next-day response remains manageable
Milestone 5: Return to running or sport
Returning to running should normally begin below your previous distance and pace.
A walk-run programme may be useful. For example, you might alternate short periods of easy running with walking before gradually increasing the running intervals.
During this stage:
- begin on a flat, predictable surface
- keep the pace easy
- leave recovery time between runs
- increase one training variable at a time
- build duration before adding speed or hills
- monitor your response later that day and the next morning
- continue strength work alongside running
Fitness often returns faster than tendon capacity. You may feel aerobically capable of running further before the Achilles is ready for the extra load.
Freedom’s return-to-running plan explains how to build running back gradually after an injury.
Milestone 6: Return to full performance
Being able to jog does not necessarily mean you are ready for full sport.
The final stage should reflect the demands you need to tolerate. This could include:
- longer runs
- faster running
- hills
- sprinting
- repeated jumping
- acceleration and deceleration
- changes of direction
- sport-specific drills
- consecutive training days
The aim is not only to settle the current symptoms. It is to build enough capacity for your usual activity and reduce the likelihood of the same problem returning.
How much pain is acceptable during Achilles rehabilitation?
Some mild discomfort can occur during Achilles tendon exercises. Rehabilitation does not always need to be completely pain-free.
However, pain should remain manageable and should not continue increasing as you exercise. Your response later that day and the following morning is also important.
Signs that you may have progressed too quickly include:
- a clear increase in morning stiffness
- pain that remains elevated the following day
- new swelling
- reduced walking tolerance
- a new limp
- loss of strength or function
- symptoms becoming worse from one session to the next
If this happens, reduce the weight, repetitions, range or frequency. Return to the last level you could complete without a lasting flare-up.
A physiotherapist can help establish an appropriate pain-monitoring approach for your individual symptoms.
Do I need a scan for Achilles tendinopathy?
Achilles tendinopathy can often be diagnosed from your symptoms and a physical assessment. A scan is not always necessary.
Imaging may be considered when:
- the diagnosis is unclear
- a tear or another injury is suspected
- symptoms do not follow the expected pattern
- progress has stalled despite appropriate treatment
- the result would change your treatment plan
Changes on an ultrasound or MRI do not always match the level of pain. Imaging should therefore be considered alongside your symptoms and function rather than used in isolation.
Can footwear or orthotics help Achilles tendinopathy?
Footwear changes or heel lifts may temporarily reduce strain or compression in some people. However, they do not replace progressive rehabilitation.
An orthotic may be considered if an assessment identifies a specific reason it could help manage load through the foot and ankle.
Freedom Physio & Wellness provides orthotic assessments in Jersey for people who may benefit from additional support as part of a wider rehabilitation plan.
What is shockwave therapy for Achilles tendinopathy?
Shockwave therapy uses acoustic waves applied to the painful area through a handheld device. It is a non-invasive treatment, meaning it does not involve surgery or an injection.
Focused shockwave therapy delivers energy towards a targeted area of tissue. A course normally involves several treatment sessions, although the recommended protocol will depend on the condition, equipment and clinical assessment.
Freedom Physio & Wellness offers focused shockwave treatment in Jersey for several conditions, including Achilles tendinopathy.
When might shockwave therapy be considered?
Shockwave therapy may be discussed when:
- Achilles tendinopathy has been properly assessed
- symptoms have been present for a prolonged period
- an appropriate loading programme has been followed consistently
- rehabilitation progress has plateaued
- activity and training load have been addressed
- other causes of pain have been considered
- the expected benefits, limitations and risks have been explained
Shockwave should not normally be the first or only treatment. Progressive tendon loading remains central to Achilles tendinopathy rehabilitation.
It is also important to understand that current evidence for shockwave therapy in Achilles tendinopathy is mixed.
NICE states that shockwave therapy raises no major safety concerns but that evidence about its effectiveness for Achilles tendinopathy is limited and inconsistent. More recent systematic reviews have also questioned whether shockwave provides a meaningful additional benefit over exercise or a placebo treatment.
Therefore, shockwave should not be presented as a guaranteed way to heal the tendon or speed up recovery. It may be considered selectively following a clinical discussion, but it should not replace rehabilitation.
When may shockwave therapy not be appropriate?
Shockwave may not be suitable if:
- your pain has not been properly diagnosed
- you have a suspected Achilles tear or rupture
- you have only recently developed symptoms
- you have not yet tried an appropriate rehabilitation programme
- there is an infection or wound in the treatment area
- you have certain medical conditions affecting healing, bleeding or sensation
- treatment would be applied near vulnerable structures
- there are other clinical reasons identified during screening
Suitability must be determined by a qualified clinician. Tell your clinician about your medical conditions and medications before treatment begins.
Does shockwave therapy replace Achilles exercises?
No. Shockwave therapy does not replace progressive exercise.
Even if shockwave helps reduce pain, the tendon and calf still need enough strength and capacity to tolerate walking, running or sport.
A complete Achilles tendinopathy treatment plan may include:
- education about the condition
- changes to aggravating activities
- progressive calf strengthening
- wider lower-limb strength work
- a gradual return to running or sport
- footwear advice where relevant
- shockwave therapy in selected cases
- regular reassessment and progression
For more detail about the treatment itself, read Freedom’s guide to focused shockwave therapy for Achilles pain.
Could the AlterG treadmill support Achilles rehabilitation?
For suitable patients, reduced-body-weight running can provide a bridge between strength rehabilitation and normal outdoor running.
The AlterG Anti-Gravity Treadmill allows the amount of body weight used during walking or running to be reduced in controlled increments.
This may help some people:
- reintroduce a running movement with less load
- maintain cardiovascular fitness
- build confidence
- progress gradually towards full-body-weight running
- practise running while continuing Achilles rehabilitation
The AlterG is not suitable at every stage or for every Achilles condition. It should be introduced when the tendon has enough capacity for running and when reduced-body-weight exercise fits the wider rehabilitation plan.
When should I see a physio for Achilles pain?
Arrange an assessment if:
- your pain is affecting walking or everyday activity
- morning stiffness is getting worse
- symptoms return every time you run
- the tendon is swollen or thickened
- you are losing calf strength
- the problem has lasted for several weeks
- you are unsure which exercises are appropriate
- you have reached a plateau in your rehabilitation
- you want to return to running or sport safely
- you are considering shockwave therapy
A physio can determine whether your symptoms are consistent with Achilles tendinopathy, identify whether the pain is insertional or midportion and build a rehabilitation programme around your starting point and goals.
Book an appointment
If Achilles pain is affecting your walking, running or sport, Freedom Physio & Wellness can assess the problem and create a progressive treatment plan.
This may include physiotherapy, strength rehabilitation, return-to-running support and a discussion about whether focused shockwave therapy is appropriate to consider.
Contact Freedom Physio & Wellness to book an appointment in Jersey.
FAQ section
What is the fastest way to heal Achilles tendinopathy?
There is no reliable quick fix. The main treatment is a progressive exercise programme that rebuilds calf strength and the tendon’s ability to tolerate load. Managing aggravating activity, addressing recovery and progressing exercises consistently are usually more important than passive treatment alone.
Should I stretch Achilles tendinopathy?
Stretching may help some people, but it is not suitable in every case. Deep ankle stretches can increase compression at the back of the heel and may aggravate insertional Achilles tendinopathy. Ask a physio whether stretching is appropriate for your symptoms.
Can I walk with Achilles tendinopathy?
Walking is often possible if symptoms remain manageable and do not cause a prolonged reaction. You may need to temporarily reduce longer walks, steep hills or fast walking. If you are limping or pain is worsening, arrange an assessment.
Can I run with Achilles tendinopathy?
Some people can continue with modified running, but it depends on the severity of the symptoms and the tendon’s current capacity. Running should not cause sharp pain, a limp, increasing symptoms or a significant next-day reaction. A gradual return plan is usually safer than continuing normal training.
How long should I do Achilles tendon exercises?
Achilles rehabilitation normally takes several months rather than a few days or weeks. Exercises should be progressed as your strength and function improve. Even after symptoms settle, ongoing calf strengthening may help maintain the capacity needed for running and sport.
Are heel drops the best exercise for Achilles tendinopathy?
Heel drops can be useful, but they are not the only treatment. Rehabilitation may include isometric holds, seated calf raises, standing heel raises, heavy slow resistance and faster movements. Exercises performed below the level of a step may aggravate insertional Achilles tendinopathy.
Does shockwave therapy work for Achilles tendinopathy?
The evidence is mixed. Some people report improvement, but current research has not shown a consistent, clinically meaningful benefit for everyone with Achilles tendinopathy. Shockwave should not be considered a guaranteed treatment or a replacement for progressive rehabilitation.
When should shockwave therapy be considered?
It may be discussed when symptoms remain persistent despite an appropriate and consistently followed rehabilitation programme. The diagnosis should be confirmed, other causes considered and the uncertainty around effectiveness explained before treatment.
How many shockwave sessions are needed for Achilles tendinopathy?
The number and frequency of sessions depend on the clinical assessment, treatment protocol and equipment used. Your clinician should explain the proposed course, expected response, possible side effects and how it will fit alongside rehabilitation.
Can shockwave therapy make Achilles pain worse?
Temporary discomfort during treatment or a short-term increase in soreness can occur. More significant or lasting symptoms should be reported to the treating clinician. Shockwave should only be provided after appropriate screening and with informed consent.
