Achilles Tendonitis
Treatment in Bicton
Achilles problems often start quietly: a little stiffness in the morning, an ache after sport, or a tendon that takes longer to warm up than it used to.
Catching those changes early, managing load and rebuilding tendon capacity can make a significant difference to recovery.
BOOK AN ACHILLES ASSESSMENT →Back Into Sport. Straight Into Trouble.
A recent Channel Ten news report caught my attention: "Achilles Tendon Injuries Skyrocket For Unusual Reason."
The unusual reason wasn't middle age, it was the rise of social sports with a low barrier to entry.
Pick up a racquet and you're playing. No pre-season, no conditioning, no gradual build-up the way you'd have with a club sport or a return to running.
It's a pattern I see reflected in clinic too: people who were fine for years, then go hard back into sports and something gives.
Tendonitis or Tendinopathy?
Most of the time, when someone comes in with the kind of pain that puts them at risk of a rupture, it's actually a tendinopathy, not tendonitis.
Tendonitis is painful, but far less serious.
Insertional vs Mid-Portion: Two Different Problems
We distinguish most commonly between two categories of tendinopathy.
Mid-Portion Achilles Tendinopathy
Affects the tendon itself, usually 2 to 6cm above the heel bone. This is the more common presentation, particularly in runners, and typically shows as a thickened, tender, sometimes visibly swollen section of tendon.
Insertional Achilles Tendinopathy
Affects the point where the tendon attaches to the heel bone. This type behaves differently in rehab and generally responds less well to the classic heel-drop-below-a-step exercise, which can aggravate it.
The location of the problem changes how we approach rehabilitation. An exercise that suits a mid-portion tendon may not be the right starting point for an insertional problem.
Early Signs
The earlier a tendinopathy is caught, the faster and more completely it tends to resolve.
Stiffness first thing in the morning or after sitting for a while.
Pain that eases once you've warmed up, then returns afterward or the next day.
A tender, thickened or slightly swollen spot on the tendon.
Discomfort that shows up specifically with hills, stairs or a jump in training load.
Acting on early signs can dramatically affect how long it takes to resolve. A tendon caught at the "stiff and achy" stage typically responds in weeks.
Signs That Need Urgent Assessment
Seek urgent medical attention through your GP, an urgent care clinic, or an emergency department rather than booking a routine assessment if you experience:
A sudden, audible pop or snap at the back of the ankle.
A sudden inability to push off, walk on your toes, or climb stairs on the affected side.
A feeling that you've been kicked or struck in the back of the leg despite nothing hitting you.
What Causes Achilles Tendinopathy?
Achilles tendinopathy is almost always a load management problem: the tendon is being asked to handle more than it's conditioned for.
This is why low-barrier social sports have become such a common trigger. Sudden bursts of sprinting, stopping and changing direction with no build-up phase is about the worst possible load pattern for an unconditioned Achilles.
Sudden Training Increase
A jump in running volume or intensity can exceed what the tendon is currently conditioned to tolerate.
Return to Sport
Returning after time off without gradually rebuilding tendon capacity.
Hills & Stairs
Hill or stair-heavy training can substantially increase demand on the Achilles.
Footwear
Worn or unsupportive footwear can be another contributor to the overall load placed on the tendon.
Calf Capacity
Calf strength or flexibility deficits can shift extra load onto the tendon.
Age & Load Tolerance
Tendons also become less tolerant of sudden load as we age, which can compound the problem when returning to fast-paced sport.
Settle the pain.
Rebuild the tendon.
Restore capacity.
Achilles tendinopathy responds to load, not rest.
Treatment is built around progressively restoring the amount and type of load your tendon can tolerate, while using other treatment options where they can help reduce symptoms or improve the way the surrounding tissues are moving.
The goal isn't simply to make the Achilles feel better for a few days. It's to progressively prepare it for the walking, running, training or sport you want to get back to.
Achilles Tendinopathy Treatment
Loading is the foundation. Other treatment can be added according to how the tendon is presenting and how well rehabilitation is progressing.
Progressive Loading
Achilles tendinopathy responds to load, not rest. Current evidence supports starting with isometric holds, particularly useful early on if the tendon is irritable, then progressing to slow, controlled strengthening (eccentric and concentric), and later to more dynamic, spring-like loading as the tendon tolerates it.
Focused Shockwave Therapy
Shockwave therapy is one of the better-evidenced treatments available for Achilles tendinopathy that hasn't responded to loading alone, for both insertional and mid-portion presentations.
Research suggests combining shockwave with a structured loading programme gets better results than either approach on its own.
Learn about Shockwave Therapy →Soft Tissue Therapy & Adhesion Release
Where restriction in the calf or surrounding tissue is limiting how well the tendon can load and glide.
A 2013 systematic review (Al-Abbad & Simon, Foot & Ankle International) found satisfactory evidence for shockwave therapy in both insertional and mid-portion chronic Achilles tendinopathy at a minimum three-month follow-up, with better results when combined with an eccentric loading programme than shockwave alone.
When Advanced Management Is Needed
Most Achilles tendinopathy responds well to the approach above. For complex or persistent cases we work alongside trusted local specialists.
Sam O'Neill
OnField Physiotherapy
Bicton
Ben Hodgetts
Melville Wellness Centre
Willagee
If your case needs surgical opinion, typically for a confirmed rupture or a chronic case that hasn't responded to conservative care, we'll help coordinate that referral too.
Reducing Your Risk Before It Starts
Build calf strength and tendon capacity gradually rather than jumping straight into higher-intensity training.
Increase running volume or hill work in small steps rather than big jumps.
Don't ignore stiffness that shows up after a change in training.
Frequently Asked Questions
Do I need a scan? +
Not usually. Achilles tendinopathy is typically diagnosed clinically. Imaging is more useful when the diagnosis is unclear.
Should I stop running completely? +
Usually not. Complete rest tends to decondition the tendon further. Most people do better modifying load (reducing volume, intensity, or hills) while working through a structured loading programme, rather than stopping entirely.
How long does this take to resolve? +
It depends heavily on how early it's caught and whether it's insertional or mid-portion. Early-stage cases can improve in a matter of weeks. Longstanding cases, especially insertional ones, can take several months of consistent loading.
Is shockwave therapy painful? +
It can be uncomfortable during treatment, particularly over a sensitive tendon, but it's brief and well tolerated by most people. Mild soreness for a day or two afterward is normal.
Don't ignore the “stiff and achy” stage.
If you've been explaining away stiffness or aching in your Achilles for weeks, that's exactly the window where treatment works fastest. Book an assessment and we'll find out exactly what's going on before it becomes a bigger problem.