Achilles or ankle
Achilles Tendinopathy
Quick answer
Achilles tendinopathy is a load-related tendon pain condition affecting either the mid-portion of the tendon or its insertion at the heel. Management centres on graded calf and tendon loading and correcting training errors, with shockwave therapy considered as an adjunct in selected persistent cases.
Common symptoms
- Morning stiffness in the tendon
- Pain that warms up then returns after activity
- Local tenderness or thickening
- Pain with hopping, running or hill work
Potential causes and contributing factors
- Rapid increases in running volume, speed or hills
- Insufficient calf strength for the load
- Footwear or surface change
- Long lay-offs followed by rapid return
Who commonly experiences it
Runners, racquet and field sport players, gym-goers adding plyometrics, and middle-aged adults returning to sport.
How it is assessed at Back2Health
- Location: mid-portion versus insertional
- Symptom behaviour over 24 hours
- Calf strength and endurance testing
- Hopping and loading tolerance
- Training-load history
Where shockwave may fit
Shockwave is studied in both mid-portion and insertional presentations and may be considered when tendon pain persists despite a well-executed loading programme.
Where it may not fit
Insertional and mid-portion presentations are not treated with one identical protocol, and suspected partial tears, systemic inflammatory conditions or recent significant trauma need review first.
Rehabilitation and alternative treatment
Whether or not shockwave is used, the rehabilitation plan does the long-term work. Alternatives and adjuncts may include physiotherapy alone, manual therapy where indicated, load management, footwear or equipment changes, and referral for imaging or a medical opinion.
- Isometric and heavy slow calf loading
- Progressive tendon loading through range
- Plyometric and running progressions
- Training-load planning
- Footwear and heel-drop considerations
When medical referral may be needed
A sudden pop, marked weakness or an inability to push off requires urgent medical assessment to exclude a tendon rupture.
Seek urgent care for major trauma, sudden inability to bear weight, suspected fracture, severe swelling or redness, fever, unexplained weight loss, progressive weakness, or loss of bladder or bowel control.
Achilles Tendinopathy — questions patients ask
Complete rest usually reduces tendon capacity. Most plans reduce aggravating load while introducing controlled tendon loading.
Medical disclaimer. Information on this website is provided for general education and does not replace an individual clinical diagnosis or medical advice. Shockwave therapy is not suitable for every person or every condition. A qualified clinician must assess suitability.
Written by the Back2Health physiotherapy and rehabilitation team · Clinically reviewed by the Back2Health clinical team · Last reviewed 3 August 2026
Find out whether shockwave is right for your condition
Start with a clinical assessment. The Back2Health team will evaluate the source of your symptoms, explain whether shockwave is appropriate and build a rehabilitation plan around your goals.