Tendons & What Is Achilles Tendinopathy?

Tendons are the tissues that connect muscles to bones. The Achilles tendon is the tendon that connects the calf muscles to the heel bone. A normal tendon is white, elastic and made up of collagen and different tendon cells that are well organised into a matrix.

In an Achilles Tendinopathy, the tendon is unable to adapt to the stress or load being placed upon it. The collagen becomes disorganised and fragmented and the tendon cells begin to degenerate making it weak. If the source of the tendon injury persists the area of degeneration may worsen over time or can rupture.

What Causes Achilles Tendinopathy?

Achilles tendinopathy is caused by overloading/overuse or under-loading/underuse of the tendon. Many things can affect the load that is going through the tendon; therefore, it is important to be assessed by a physiotherapist to determine individual causes and risk factors.

General risk factors include:



  • Bio-mechanical issues such as poor core stability around hip and knee, weak calf muscles, leg length differences and flat feet
  • Increasing age
  • Corticosteroid use
  • Other medical conditions including diabetes, high blood pressure, obesity, inflammatory arthritis, hyper-mobility.

Training errors including:

  • Abrupt changes or increases in training
  • Excessive hill training
  • Training on hard or sloping surfaces
  • Increased repetitive loading
  • Poor shock absorption
  • Poor quality footwear

Symptoms of Tendinopathy:

  • Pain and stiffness over Achilles tendon which is worse in the morning
  • Pain with jumping, hopping and running
  • Pain with prolonged walking or walking up slopes/hills
  • Swelling or thickening of tendon
  • Reduced muscle strength through calf muscles
  • Tendon rupture

Treatment: How Can Physiotherapy Help? 

Your physiotherapist can help to determine the loading capacity required in order to effectively rehabilitate a tendinopathy. Prolonged under-loading or overloading can result in further progression of a tendinopathy, therefore it is important to determine an ideal loading and rehabilitation program for each person individually.

Some specific treatment strategies your physiotherapist may use include:

  • Advice on icing, pain-relief and load management strategies to allow the tendon to initially adapt to the acute stresses
  • Manual therapy techniques, soft tissue mobilisation and dry needling to reduce pain and release tension through calf muscles
  • Taping strategies to help offload tendon in the short term
  • Addressing biomechanical issues during activities such as walking, running and sport
  • Addressing other areas of muscle imbalance that may be contributing to overload
  • Specific strengthening exercises that safely load the tendon
  • Clinical movement therapy classes: Individually tailored exercise classes that will allow you to safely and adequately load through the Achilles tendon while addressing other biomechanical issues

To make an appointment with one of our Physiotherapists to find out more about how we can help you, call us on (08) 6389 2947 or click here to book online.