Achilles Tendinopathy

Sports & Remedial Massage - Myaree

Today, we’re diving into a common yet often misunderstood condition – Achilles Tendinopathy. Including Achilles tendinitis, this condition is an all-too-familiar adversary for active individuals or those frequently on their feet due to lifestyle or work demands.

Signs of Achilles Tendinopathy

Achilles Tendinopathy presents with localised pain in either the mid-portion of your Achilles tendon (mid-portion tendinopathy) or directly where the tendon inserts into the heel (insertional tendinopathy). This pain often strikes the hardest in the morning and when first starting an activity, but tends to “warm-up” or decrease as you keep moving. Such pain can make activities like walking, running, and jumping challenging.

What Can Cause Achilles Pain?

The culprits behind Achilles Tendinopathy can be varied. Abrupt changes in your physical activities, like dramatically increasing your running or jumping load or introducing new activities such as long hikes or hill sprints after a lull period, can instigate it. Even specific movements like fast take-offs or abrupt changes in direction may pose a risk. Additionally, research suggests those with higher body mass could be more susceptible to Achilles Tendinopathy, with the tendon bearing a heavier load.

What Shouldn’t You Do for Achilles Pain?

While it’s tempting to overlook the pain or brave through it, doing so can lead the condition to progress from an initial inflammatory stage (Achilles tendinitis) to a more chronic stage (Achilles tendinosis) marked by tendon fibers’ degeneration, persistent pain, and potential performance issues. Science is unambiguous here – cortisone injections, although providing temporary relief, can have long-term negative effects on your tendon health, transforming collagen into a brittle, less robust form. It’s equally important not to completely stop exercising, as tendon health necessitates load within a certain range. The key is finding an appropriate loading strategy to restore tendon capacity.

How Long Does Achilles Tendinopathy Take to Heal?

Recovery from Achilles Tendinopathy depends largely on the stage your tendon is in. If it’s the acute stage and appropriately treated, recovery can occur within 6-12 weeks. For tendinopathy persisting for over 6 weeks, the recovery might span 3-6 months. And for those who’ve had the pain for years, the healing process can extend beyond 6 months. Structural changes at this stage could be irreparable, making your tendon more susceptible to recurring episodes of tendinopathy. It’s important to remember that your recovery pace also hinges on your commitment to rehabilitation, including being willing to curtail training or regular activities for a while to let the tendon recuperate.

Adaptive Massage: From Rehab to Performance

Here’s where Adaptive Massage comes in! Our comprehensive Pain & Performance Therapy, a unique 5-step process, is designed to guide you from rehab to peak performance. We focus on adapting to your unique needs and empowering you with knowledge about your body and strategies for long-term prevention. Are you ready to join us on this journey? Let’s get started!

Introduction to Adaptive Massage’s Pain & Performance Therapy

Adaptive Massage’s Pain & Performance Therapy isn’t just about providing relief for the here and now; it’s about sustainable recovery and resilience for the future. We believe that you are unique, and so should be your recovery journey. The therapy is based on a distinct 5-step process: Assessment, Release & Reset, Reinforce & Activate, Reload & Integrate, and Maintenance. This comprehensive approach is designed to assist you all the way from rehab to performance, ensuring that your Achilles Tendinopathy doesn’t keep you off your feet for long.

So, let’s take a closer look at these steps to better understand how this therapy works in practice.

Step 1: Assessment

The journey to recovery starts with understanding your unique situation. This is achieved through a thorough assessment, laying the groundwork for the treatment plan ahead. It’s not just about pinpointing where the pain is; it’s also about understanding its nature, extent, and effects on your everyday life.

Key determinations during the assessment include whether the pain is localized in the mid-portion of your Achilles tendon (mid-portion tendinopathy), or directly where the tendon inserts into the heel (insertional tendinopathy). Is the pain acute, flaring up recently, or chronic, persisting over several weeks or more? This information is crucial in tailoring your treatment plan and sets the stage for the subsequent steps involving both massage and exercise therapy.

Remember, this is about creating a roadmap that leads you back to your active lifestyle while catering to your individual needs and circumstances. As we go along, this roadmap might need some tweaking depending on how your body responds. But worry not – flexibility and adaptation are at the heart of what we do at Adaptive Massage!

So, stay tuned, as we delve into each step of the Pain & Performance Therapy in the next sections, explaining how this approach can help you regain control over your Achilles Tendinopathy and reclaim your active life.

Step 2: Release & Reset

Once we’ve established a clear understanding of your condition through the assessment, we’re ready to kickstart your recovery with hands-on therapy. Though massage doesn’t provide a quick fix for Achilles Tendinopathy, it certainly plays a crucial role in symptom relief, enabling you to perform your exercises more comfortably. Furthermore, it assists in rectifying the compensations your body has made in response to pain.

In response to an injury, your body instinctively aims to protect the affected area, which often results in stiffness and changes in movement patterns to minimize strain. Therefore, our approach extends beyond focusing solely on the site of pain. By massaging adjacent regions like the foot, calf, hamstring, glutes, and lower back, we can offer significant relief and assist in regaining more natural movement patterns.

Now, here’s where our approach at Adaptive Massage stands out. Contrary to some practices, we do not massage the tendon directly or use techniques such as cross-fibre friction over the tendon. Research debunks the belief that we can ‘push out knots’ or ‘break down scar tissue’ in your Achilles through massage. Instead, what truly makes a difference in the alignment, strength, and health of your muscle and tendon cells and fibers is targeted exercise. That’s why the subsequent steps – Reinforce & Activate, and Reload & Integrate – are so important.

While avoiding direct tendon massage, we employ various manual therapy techniques like deep tissue massage, sports massage, and trigger point therapy on your foot, calf, hamstrings, glutes, and lower back. These techniques aim to alleviate pain, ease stiffness, and improve range of motion, setting you up for the exercise therapy to follow.

You can also supplement this with self-massage techniques and foam rolling at home. A tennis ball rolled under the foot can be an effective self-massage tool, and foam rolling can be beneficial for the calf, hamstrings, and glutes. However, it’s important to avoid the tendon when foam rolling.

One key point to remember in this phase is that stretching isn’t advised for Achilles tendinopathy. While it might seem counterintuitive, stretching can compress the tendon and potentially aggravate the condition further. Hence, it’s much more beneficial to focus on foam rolling and self myofascial release techniques that won’t put excessive compressive loads on your tendon.

[Video: Tennis ball foot]

[Video: Foam rolling calf, hamstring, glute]

[Video: Banded joint mobilization: ankle]

[Video: Massage foot, calf]

In Step 2: Release & Reset, our goal is to alleviate tension, reset your movement patterns, and prime your body for the next phase of your recovery journey. So, stay with me as we move into Step 3: Reinforce & Activate, where we’ll harness the power of exercise therapy!

Step 3: Reinforce, Reload & Integrate

As we venture into the third step of your rehabilitation journey, we’ll harness the power of exercise. Current research backs up the efficacy of exercise in the treatment of Achilles tendinopathy, but successful rehabilitation hinges on more than just sporadic exercise. It’s all about effective load management, the essential cornerstone of rehabilitation.

Load management is the key to rectifying the underlying issue of tendinopathy. It’s entirely possible to execute all the right exercises, yet not witness any improvement if you don’t change the activities causing the pain. The goal here is to find that sweet spot between too much and too little load.

In this initial stage of exercise rehabilitation, our focus is on decreasing pain with isometrics. These are exercises where your muscles contract, but your joints don’t move. With a highly reactive tendon, classic stretching exercises can be challenging due to pain. That’s where isometrics step in, their main purpose is to decrease pain.

Let’s take an example: A double leg bodyweight heel raise. This simple exercise could be your starting point. If you find it too easy, you could add weight or switch to a single-leg variation. Aim for 5 sets of 45 seconds, with a maximum of 2 minutes rest between each set. In the early phase, you should perform these exercises 2-3 times per day. 

The key for these exercises to be effective is intensity. They should be challenging! If you finish a 45-second double leg bodyweight heel raise and feel like you could have held for another 30 seconds, then it’s too easy. To increase the challenge, add weight or switch to a single-leg variation.

[Video: Heel raise variations]

In addition to isometric exercises, you should incorporate some range of motion exercises such as ankle rotations and point & flex exercises. It’s best to perform these unloaded, meaning no additional weight – for instance, while sitting down.

[Video: Ankle mobility]

But what about the exercises and activities to avoid? This is equally crucial in load management. Activities like excessive running, excessive stretching, plyometrics, and even your sport may need to be paused temporarily. Walking up hills or stairs could also aggravate your tendon. Remember, load management is about balance, not complete rest nor overuse.

As your pain decreases and the resilience of your tendon increases, we shift our focus to the next stage – strengthening and reinstating the elasticity in your step. 

At this juncture, our aim is to increase the load-bearing capacity of your tendon, which we’ll achieve through heavy slow resistance exercises. One such exercise is the seated heel raise with weight positioned directly over your shin. This exercise targets the soleus muscle effectively.

To target the gastrocnemius muscle, we’ll incorporate double to single-leg heel raises while holding a weight. For both exercises, a slow tempo is crucial – think 3 seconds up and 3 seconds down, with as much weight as you can tolerate while maintaining a good technique. Plan to do 4 sets of 15 repetitions every other day. On your off days, continue performing the isometrics from the previous phase.

[Video: Seated heel rasie]

[Video: Standing heel rasie]

Additionally, we’ll be integrating some balance and proprioception exercises. 

Besides the heavy slow resistance exercises, it’s important to boost your tendon’s ability to absorb and store loads. The Achilles tendon experiences the highest loads when used as a spring, utilizing the stretch-shortening cycle. Powerful movements such as running and repetitive jumping leverage the Achilles to store and then release energy, generating significant power.

Starting with box jumps is an excellent transitional step before moving onto full jumps and running. Stand on a small box about 15-20 cm high, step off and land on both feet in a mini squat position. Ensure that you don’t land with stiff joints and absorb the impact effectively. Start with 3 sets of 10 landings. Once this becomes comfortable, you can move to a higher box or try landing on a single leg.

[Video: Box step downs]

Next, we progress to some entry-level plyometrics, such as the double-leg hop. Simply perform repetitive small jumps just a few inches off the ground. Start with 30 to 50 reps before resting for a few minutes, aiming for 3 to 4 sets.

[Video: Double leg hop]

As always, load management is key. Monitor how your Achilles responds over the next 24 hours. If you feel good, we can progress to more challenging and demanding plyometrics. If not, we’ll need to stay at this stage for a bit longer. In Step 4: Reload & Integrate, the goal is to build up the tolerance and strength of your Achilles tendon to handle your usual levels of activity, gradually and safely reintegrating these loads back into your routine.

Step 4: Maintenance

Congratulations! You’ve made it through the most challenging parts of your Achilles tendinopathy rehabilitation. The final step of your journey is about maintaining the health of your Achilles tendon and ensuring that the progress you’ve made is here to stay. 

1. Regular Exercise Regimen

Keeping up with a regular exercise regimen is crucial. The exercises you’ve learned throughout the rehabilitation process are not meant to be abandoned once you’ve recovered. Instead, think of them as your new training companions. Continue to include them in your routine to keep your Achilles tendon strong and supple.

2. Listen to Your Body

It’s vital to continue listening to your body. If you experience mild discomfort in your Achilles tendon or surrounding areas, it may be a signal that you’re pushing too hard or not providing enough recovery time. Modulating your training in response to these signals can help you prevent further injury.

3. Regular Self-Massage and Foam Rolling

Don’t forget about the importance of regular self-massage and foam rolling. These techniques have provided symptom relief throughout your rehabilitation, and they remain essential tools for maintaining the health and functionality of your Achilles tendon. 

4. Regular Assessments

Lastly, consider regular assessments. They will help you keep track of your progress and catch any potential problems before they escalate. Even when you’re feeling good, regular checks can help ensure your Achilles tendon remains healthy. 

Remember, maintenance is an ongoing process. Even when you’ve achieved your rehabilitation goals, it’s important to keep the strength and health of your Achilles tendon in mind. By incorporating these elements into your routine, you can keep your Achilles tendon healthy and resilient, enabling you to continue doing the activities you love.


Congratulations on your journey through the Achilles tendinopathy rehabilitation process. It’s been a long journey from understanding the causes and recognising the symptoms, assessing your individual condition, releasing tension, activating and reloading your Achilles tendon, all the way to maintaining your recovery.

Remember, the road to recovery from Achilles tendinopathy can be a long one, with a time span ranging from weeks to months depending on the severity of your condition. It requires a lot of patience, consistency and dedication to work through each stage of the process.

Adaptive Massage’s Pain & Performance Therapy provides a comprehensive and individualised approach to manage and overcome Achilles tendinopathy. Remember, every journey begins with a single step. So, take that step today and start your journey from rehab to performance.

Always consult with a professional before beginning any new treatment or rehabilitation program. If you have any questions or concerns about your condition, don’t hesitate to reach out. We’re here to help you bridge the gap from rehab to performance. Let’s get started on your path to recovery today!

Key Takeaways

In wrapping up, here are the key points to remember on your journey to recover from Achilles tendinopathy and return to performance:

1. Understanding Achilles Tendinopathy: Tendinopathy typically occurs from performing a task you are not accustomed to (too much, too soon). The causes can be increasing running or jumping load too quickly, adding a new element to your training, or returning to sport after time off.

2. Assessment: Identifying whether your condition is acute or chronic is a critical part of the process. Determining the exact location and intensity of the pain is crucial for setting the stage for the treatment to follow.

3. Release & Reset: Massage can help with symptom relief and alleviate compensatory stiffness in the foot, calf, hamstrings, glutes, and lower back. But remember, no direct massage on the tendon itself!

4. Reinforce, Reload & Integrate: This combined step aims at reducing pain, introducing gentle, non-aggravating exercises, and then slowly building towards more demanding activities. The goal is also to build strength and reintegrate these loads in a progressive manner. Load management is key here – if you don’t adjust the activities causing the pain, the recovery process might be extended.

5. Maintenance: Once you’ve made it through the initial stages, maintenance is about preventing re-injury. Consistently perform your strengthening exercises, manage your load wisely and listen to your body.

Remember, recovery from Achilles tendinopathy isn’t a linear process and there will be ups and downs. Your dedication and persistence will pay off in the end. Don’t hesitate to reach out if you need guidance or support during your rehabilitation journey. Here’s to your successful recovery!

Book A Massage Today!

Thank you for taking the time to read this comprehensive guide on managing and recovering from Achilles tendinopathy. We hope that the information and steps provided empower you to take an active role in your recovery process. But remember, while self-care and home management are crucial, it’s equally important to consult with a professional to ensure that your rehabilitation process is both safe and effective.

If you are currently suffering from Achilles tendinopathy or any other form of tendon pain, we highly recommend getting in touch with a professional physical therapist. They can provide an accurate diagnosis, guide you through your personalized recovery plan, and support you every step of the way.

If you’re in need of expert care, don’t hesitate to reach out to us here at Adaptive Massage. Our Pain & Performance Therapy is designed to support you through your recovery journey and help you return to your favorite activities as quickly and safely as possible. 

Click the button below to schedule your first appointment, and let’s start your recovery journey today.

Looking forward to helping you regain your strength and return to the activities you love!