Achilles Tendinopathy: Why It Hurts and What Helps
Achilles tendon pain is one of the most common injuries we see in runners, walkers, weekend warriors, and active adults. Whether your pain started gradually during training or appeared after ramping up your activity, the right diagnosis is essential for choosing the most effective treatment. At Burlington Sports Therapy, our chiropractors and physiotherapists regularly help patients recover from Achilles tendon injuries using evidence-based rehabilitation, progressive strengthening, and adjunctive treatments such as laser therapy and shockwave therapy when appropriate.
Achilles Tendonitis vs. Achilles Tendinopathy: Why the Difference Matters
Many people search online for Achilles tendonitis, but in reality, most persistent Achilles tendon problems are Achilles tendinopathy, not tendonitis. The suffix “-itis” means inflammation. While inflammation may be present in the early stages of an injury, research has shown that most Achilles pain lasting more than a few weeks involves changes in the tendon’s structure rather than ongoing inflammation. This is a distinction we make regularly with our patients, and it applies to tendon injuries throughout the body.
This distinction is important because it changes how we treat the condition. If the problem is true inflammation, rest and anti-inflammatory medications may help. However, with tendinopathy, the tendon needs carefully prescribed loading to stimulate healing and improve its ability to tolerate force again. Simply resting often provides temporary pain relief, but the pain usually returns once activity resumes because the tendon has not regained its strength.
Another important distinction to make is where in the tendon the pain is occurring. This makes a difference for what we recommend.
Mid-Portion Achilles Tendinopathy
This is the most common type of Achilles injury. Pain typically develops about 2 to 6 cm above the heel bone where the tendon has a relatively limited blood supply. Symptoms often include morning stiffness, pain when starting activity that improves as you warm up, tenderness in the middle of the tendon, and pain after running, jumping, or climbing stairs. Mid-portion Achilles tendinopathy generally responds well to progressive strengthening exercises.
Insertional Achilles Tendinopathy
Insertional Achilles pain occurs where the tendon attaches directly to the heel bone. This condition often behaves differently. Deep stretching of the calf can aggravate symptoms because it compresses the tendon against the heel. Treatment is modified by limiting excessive dorsiflexion early on while still progressively strengthening the calf muscles. This is one reason why an accurate assessment by a chiropractor or physiotherapist is so valuable. Two patients with “Achilles tendonitis” may require different rehabilitation programs depending on where the tendon is injured.
Strength Over Stretch
One of the biggest misconceptions is that tight calves are the primary cause of Achilles pain. While flexibility may play a role, research consistently shows that progressive strengthening is the most effective treatment for Achilles tendinopathy. The goal is to gradually increase the tendon’s ability to tolerate load. As we often tell our patients, you can’t go wrong with strong. A program that incorporates exercises like double and single leg heel raises, slow heavy calf strengthening, eccentric calf exercises, balance training, and plyometric progressions is suitable for those wishing to solve the problem properly.
What Are Eccentric Heel Raises?
Eccentric strengthening has become one of the most researched treatments for Achilles tendinopathy. During an eccentric heel raise, both feet lift onto the toes, but the injured side performs the slow lowering portion of the movement. This controlled loading stimulates tendon remodeling and helps improve strength and pain over time. Today, many physiotherapists combine eccentric exercises with heavy slow resistance training depending on the individual patient, activity level, and stage of recovery. The key is consistency. Tendons respond to progressive loading over weeks, not days.
When Do Laser Therapy and Shockwave Therapy Help?
Exercise remains the cornerstone of treatment, but additional therapies may help reduce pain and support recovery. Laser therapy, shockwave therapy, and active release are treatments that are commonly used at Burlington Sports Therapy.
Laser Therapy
Low-level laser therapy (also called cold laser therapy) has been used in sports medicine for decades. Research has demonstrated that when laser therapy is combined with an appropriate strengthening program, patients with Achilles tendinopathy may recover faster than exercise alone. One well-known study found that participants receiving laser therapy alongside eccentric exercises reached similar improvements in approximately four weeks compared with twelve weeks in the exercise-only group. Laser therapy is painless, non-invasive, and may be particularly helpful during the early stages of rehabilitation by helping reduce pain and allowing patients to tolerate their exercise program more comfortably.
Shockwave Therapy
Shockwave therapy is often recommended for chronic Achilles tendinopathy that has not improved despite several months of appropriate rehabilitation. Unlike laser therapy, shockwave delivers mechanical energy into the injured tendon to stimulate healing and reduce pain. Patients often notice gradual improvement over several weeks, especially when shockwave is combined with progressive strengthening exercises rather than used as a stand-alone treatment. Shockwave therapy is generally considered when symptoms have persisted for several months, or previous conservative treatments have not been successful.
Active Release Technique
Active release is a manual soft tissue therapy. It involves taking a muscle from a shortened position while the practitioner applies tension along the action line of the tissue being treated. It is a methodical way to target specific tissues and alter the pain sensation in the area. Historically, it has been known as an effective way of releasing tightness and adhesions in a muscle.
What About a Ruptured Achilles?
Most Achilles tendon problems build up gradually, but occasionally the tendon can tear. Rupture usually happens during a sudden, forced push-off (jumping or accelerating while running). People often describe hearing a loud “pop” or snapping noise, followed by an immediate inability to push off on the toes. There can be immediate bruising along with a visible lump or divot in the tendon. If you suspect a rupture, get assessed promptly. Imaging (diagnostic ultrasound or MRI) can help confirm the diagnosis, and the recovery plan (surgical or non-surgical) is different from the tendinopathy path outlined above.
How Long Does Recovery Take?
One of the most common questions patients ask is, “how long until my Achilles is better?” The answer depends on several factors, including how long symptoms have been present, the severity of tendon changes, activity demands, and consistency with rehabilitation. As a general guideline, mild cases may improve within 6 to 8 weeks, but more established tendinopathy often requires 3 to 6 months. Long-standing cases may take 6 to 12 months for full recovery. Although this timeline can sound discouraging, many patients begin noticing reduced pain and improved function much earlier when following a structured rehabilitation program.
Chiropractic and Physiotherapy for Achilles Injuries in Burlington
At Burlington Sports Therapy, every Achilles injury begins with a thorough assessment to determine exactly what structure is involved and why the injury developed. Treatment may include progressive strengthening programs, eccentric or heavy slow resistance exercise prescription, running and activity modification, manual therapy when appropriate, low-level laser therapy, shockwave therapy for chronic cases, and return-to-sport planning. Our goal is not simply to reduce pain but to restore tendon strength, improve function, and reduce the risk of future injury. For a broader overview of how we treat this condition, our Achilles tendinopathy condition page covers what to expect from an appointment.
Don’t Ignore Achilles Pain
Many people continue exercising despite Achilles pain, hoping it will disappear on its own. Unfortunately, tendons rarely recover completely without appropriate loading and rehabilitation. The earlier treatment begins, the easier recovery tends to be. If you’re experiencing Achilles pain, Achilles tendinopathy, Achilles tendonitis, or ongoing stiffness around the heel, our chiropractors and physiotherapists can help identify the cause and develop a treatment plan tailored to your goals. Give us a call or drop by the clinic.
References
- Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RAB, Bjordal JM. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. American Journal of Sports Medicine. 2008;36(5):881-887.
- World Association for Laser Therapy (WALT). Dose table for Low Level Laser Therapy. Revised April 2010.
- Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine. 2013;43(4):267-286.
- Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024. Journal of Orthopaedic & Sports Physical Therapy. 2024;54(12):CPG1-CPG32.
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