Why Your Achilles Pain Isn’t Going Away (and What to Do About It)
Every step feels like someone’s tightening a vice on the back of your ankle. It starts as a dull ache in the morning, flares when you run, and lingers for days. You stretch, you rest, but somehow…it’s still there.
What is Achilles Tendinopathy?
Achilles tendinopathy is a common overuse injury affecting the Achilles tendon and is most seen in people partaking in running and jumping activities. It is the result of an imbalance between break down and healing, where there is more breakdown in the tendon occurring than healing. Many factors play into the tipping of the scales between breakdown and healing, such as; insufficient rest and recovery and aging, however, the most common driver is an increase in load or usage. Increased load/usage can come in the form of an increase in; intensity, volume or frequency of training.
It often develops gradually, starting with stiffness or mild pain, and can progress to persistent discomfort that limits walking, running, or sport.
How common is this?
Achilles tendinopathy is one of the most frequent running-related injuries, accounting for 5–12% of all running injuries and affecting 8–15% of runners annually (Wang., Y et al 2022). Among athletes, 24% of athletes will experience Achilles Tendinopathy at some point in their life (Zainuddin, F., et al 2022).
Without proper intervention, symptoms can linger for months and even years (Ingram., P, 2024). Even after recovery, recurrence rates of around 15% have been reported over five years (Silbernagel, 2011).
How do I fix this?
The good news? Achilles tendinopathy is highly treatable with an evidence-based approach. The key is progressive, targeted rehabilitation rather than rest alone.
- Get an Accurate Diagnosis
Not all heel pain is Achilles tendinopathy. A physiotherapist can assess whether the pain is from mid-portion tendinopathy, insertional tendinopathy, bursitis, or a tear — each requires slightly different management. - Modify Your Load, Don’t Stop Completely
Tendons love to load, but too much, too soon aggravates symptoms. Reduce high-impact activities (e.g., sprinting, hill running) while maintaining load through loading in the gym using isometrics or slow isotonic exercises. It is important to get this dose right, as different exercises place different load on the tendon, and this is where our physios can help! - Strengthen Your Calf and Achilles
Research shows progressive strengthening is the gold standard. Heavy, slow resistance exercises, like calf raises on flat ground or a step, help stimulate tendon adaptation.- Isometric holds can reduce pain in the early stages.
- Eccentric and concentric loading builds long-term resilience.
- Address Contributing Factors
Calf strength, strength of other muscles within the lower limb, footwear, running technique, calf flexibility, ankle mobility, and training load errors all play a role. - Plan a Gradual Return to Sport
Reintroduce plyometric and sport-specific drills once strength and tolerance improve. Jumping back into full training too early is the fastest way to relapse.
What does the other side of Achilles Tendinopathy look like?
With the right programming, you can expect:
Pain-free mornings – no more limping to the shower or downstairs to the coffee machine.
- Stronger calves and tendon – reducing your risk of future injury.
- Better performance – restored speed, power, and endurance.
- Confidence in your body – knowing you can train without fear of flare-ups.
Achilles tendinopathy doesn’t have to be the injury that sidelines your goals. In fact, with structured rehab, many people return stronger than before.
Takeaway
If you’ve been battling persistent Achilles pain, ignoring it won’t make it disappear. Come in to see our physio’s and see how a rehabilitation program can introduce progressive loading, and address the factors that aggravated your Achilles to begin with.
Remember: The Achilles is built for strength and endurance — treat it well, and it will carry you further than you think.
