Achilles Pain: Best Treatments for Achilles Tendinopathy
If you’ve ever felt a nagging pain at the back of your ankle — especially when walking, running, or getting out of bed in the morning — you may be experiencing Achilles tendinopathy. It’s one of the most common overuse injuries we treat at our physiotherapy clinics in Richmond and South Yarra, affecting both recreational exercisers and seasoned athletes.
In this blog I will walk you through the causes, symptoms, treatment options, recovery timeline, and safe return to sport, while answering the most common patient questions we hear every week at our clinic. We will touch on the most effective treatments and recovery timelines, which should help you make an informed decision on how to approach this condition and return to sports or running.
The Common Causes of Achilles Pain:
The Achilles tendon is the thick band of tissue connecting your calf muscles to your heel bone. It’s designed to absorb enormous loads, but like any structure, it has its limits. Achilles pain usually develops when the load placed on the tendon exceeds its ability to adapt and recover. You may recall increasing the workload through your running regime or in the gym, a few days or even a few weeks before you started experiencing symptoms.
The most frequent culprits include:
Sudden training increases: Ramping up running distance, intensity, or hill work too quickly.
Repetitive stress: Sports like basketball, soccer, and tennis that involve repeated jumping and sprinting.
Poor footwear or biomechanics: Flat shoes without support, or stiff calf/ankle mobility leading to extra strain.
Insertional compression: Pain at the tendon’s attachment on the heel bone can worsen when stretching into deep ankle dorsiflexion.
Age and tissue changes: Most cases occur in adults aged 30–60, when tendons naturally lose some elasticity.
Our patients usually ask
Why does my Achilles hurt when I walk?
The simple explanation is that even walking puts load through the tendon. If the tendon is irritated, each step can aggravate it — especially first thing in the morning or after sitting for long periods.
What can be mistaken for Achilles tendonitis?
Conditions like retrocalcaneal bursitis, posterior ankle impingement, or even a partial tendon tear can mimic Achilles tendinopathy. A physiotherapist can carefully examine and, if needed, refer for imaging to confirm. It is very important to get a clear diagnosis before you start any treatment, which is why we recommend not to self-diagnose.
Common Symptoms of Achilles Tendinopathy:
Some early signs to help you identify Achillies pain would include:
Morning stiffness in the ankle and heel that eases with a few minutes of movement.
Localised pain about 2–6 cm above the heel bone (midportion) or right at the tendon’s insertion on the heel.
Pain during or after activity, such as running, climbing stairs, or jumping.
Tenderness or thickening when you press the tendon, which may also feel bigger compared to the other foot.
Our patients usually ask:
What are some early signs of Achilles tendonitis?
The most reliable signs are (1) stiffness or pain in the morning and (2) pain and tenderness directly over the tendon when pressed or used.
Early identification of this condition leads to early intervention and better outcomes.
What exercises should you avoid with Achilles tendonitis?
Although we prefer to use an active recovery approach, in the early stages of the injury we recommend that you avoid explosive jumping, sprinting, or deep stretching into dorsiflexion — especially for insertional pain. These can compress or overload the tendon.
Best Treatments for Achilles Tendinopathy
The good news? With the right treatment plan, most people recover well. At our Richmond and South Yarra physiotherapy clinics, we use the latest evidence-based approaches to reduce pain and restore tendon strength.
Achillies Tendinopathy is a very common condition which means that it has been studied in detail and we have a variety of treatment options available.
1. Exercise Rehabilitation (the gold standard)
Structured loading is the backbone of recovery. This typically involves a 12-week progressive strengthening program:
Isometrics (holding calf raises) can settle pain in the early stages.
Eccentrics and heavy slow resistance training (lowering the heel slowly off a step, progressing to weighted calf raises) rebuild tendon capacity.
Energy-storage exercises (hops, bounds) are added later to prepare for sport.
One of the best non-invasive treatments for Achillies pain is Shockwave Therapy. It is highly effective for stubborn, long-standing cases and will provide pain relief and stimulate tendon healing. Studies have shown it to be extremely effective when combined with exercise rehabilitation.
3. Heel Lifts and Footwear
Short-term use of heel lifts or supportive shoes can reduce tendon strain and pain, particularly for insertional Achilles pain.
4. Hands-On Therapy
Manual therapy to the calf muscles, ankle joints, and surrounding tissues can improve mobility and reduce compensatory strain. While it doesn’t “fix” the tendon directly, it often makes exercise more comfortable.
5. Dry Needling
Some patients find short-term relief with dry needling of tight calf muscles. Research suggests it’s not a stand-alone solution, but it can be an adjunct.
6. Topical and Medication Options
Anti-inflammatory gels like Voltaren may give short-term pain relief, but they won’t address the root cause. Lasting improvement comes from progressive exercise.
7. Education & Load Management
A key part of physiotherapy is learning how to manage activity levels without overloading the tendon. This may mean temporarily adjusting running mileage, cross-training, or using the pain-monitoring model (allowing mild discomfort that settles within 24 hours).
Our Patients often ask:
How do you relieve Achilles tendonitis pain?
A mix of short-term strategies (ice, gentle isometrics, heel lifts) combined with long-term strengthening. Relief comes gradually as the tendon adapts.
What will a physio do for Achilles tendonitis?
Your physio will assess your tendon, guide you through a tailored exercise program, correct biomechanical issues, and use adjuncts like shockwave therapy if needed.
Should I massage Achilles tendonitis?
Massage can temporarily reduce discomfort in surrounding muscles, but it won’t repair the tendon itself. Use it as a supplement to a proper rehab plan.
Can Achilles tendonitis heal on its own?
Some mild cases improve with rest and reduced load, but without structured rehab, recurrence is common. A guided physiotherapy program greatly improves outcomes
The Recovery Timeline
Recovery isn’t instant — tendons adapt slowly. Here’s what most patients can expect:
First 4–6 weeks: Pain begins to settle with consistent load management and exercise.
8–12 weeks: Noticeable improvement in daily activities; strength starts to return.
3–6 months: Most people regain normal function and light sport participation.
6–12 months: Full tendon strength and resilience can take this long, particularly for athletes returning to explosive sports..
Returning to Sports and Running
One of the most common questions we hear is: “When can I run again?”
The answer isn’t based on time alone — it’s based on criteria:
Pain during and after activity is minimal (ideally ≤2/10).
You can perform 20–25 single-leg calf raises with good form and without next-day flare-up.
You can hop on the spot, then progress to running drills, without significant pain.
Tendon responds well the next morning (no marked stiffness or swelling).
From there, you’ll gradually progress from walk-jog intervals → steady running → hills/sprints → change-of-direction sports.
With guidance from our South Yarra and Richmond physiotherapists, most patients successfully return to their chosen activities, from weekend jogs to competitive sport.
Key Takeaways
Achilles tendinopathy is usually caused by overload and training errors, but age and biomechanics play a role too.
Symptoms include morning stiffness, pain during activity, and tenderness over the tendon.
The best treatment is a structured strengthening program, supported by adjuncts like shockwave therapy, hands-on care, and load management.
Recovery takes time — typically 3–6 months — but structured rehab sets you up for long-term success.
Return to sport is possible with criteria-based progressions, ensuring the tendon is ready for impact.
Looking for Help with Achilles Pain in Richmond or South Yarra?
If you’re struggling with Achilles tendon pain, our team of experienced physiotherapists can help you get back to moving comfortably. We’ve supported office workers, runners, weekend athletes, and professional sportspeople across Richmond and South Yarra with tailored rehab programs that combine the latest research with hands-on care.