Achilles tendinopathy (overload syndrome)

Achilles tendinopathy (overload syndrome)

Achilles tendinopathy (overload syndrome) 400 300 Aida

We often hear the term Achilles tendon and Achilles tendinopathy. Some of you may know the story of how Paris disabled the great Achilles, but may not know much about the equally named syndrome. The overload syndrome or Achilles tendinopathy. Or it is maybe the other way around?

The term “Achilles tendon” comes from Greek mythology. However, today the term defines the Achilles tendon or cord that connects the calf muscles with the heel.

Achilles tendinopathy and rehabilitation

What is Achilles tendinopathy?

It sounds frightening but it may be healed. Tendinopathy is pain and swelling of the Achilles tendon, sometimes accompanied by lower functionality.

“The inflammation process of the connective tissue is the basis of the overload process of the Achilles tendon.”

Why are athletes and manual labourers especially affected?

Achilles tendinopathy most often occurs in athletes who mainly perform running and jumping movements. Sports that are considered to be most risky for this kind of injury are tennis, basketball, football, handball, volleyball, etc.

However, we must not disregard manual labourers who can suffer from overload syndrome due to repetitive movements with additional external forces.

Excessive influence of external forces can lead to tendinopathy of the Achilles tendon. Those forces are:

  • stretching forces (three-headed calf muscle; Latin: triceps surae),
  • compression forces (ground reaction force) and
  • torsion forces (walking on uneven ground).

Interesting facts about Achilles tendinopathy

Achilles tendinopathy is degenerative type of injury. What does this mean?

First of all, it is important to know that healing of tendons takes much longer than healing of soft tissues (i.e. muscles). Because this healing process takes so long, and due to our natural impatience to get well fast and return to do sports, the injury cannot heal properly and, consequently, a relatively minor injury can become chronic.

CLINICAL PICTURE – inflamed Achilles tendon

  • inflammation changes are located 2–6 cm above the heel bone (Latin: calcaneus).
  • pain linked to activity – decreases during activity and increases after activity
  • morning pain and stiffness in the upper jump joint occurs
  • a “grinding” sensation along the tendon can occur
  • tendon hurts when touched and when the calf muscles are being stretched
  • swelling is localized

Achilles tendon injury rehab

Which examinations are suitable to make an Achilles tendinopathy diagnosis?

First indication through clinical tests:

  • stretching the muscle-tendon unit
  • isometric contraction
  • palpation (touching)
  • magnetic resonance (MR)
  • ultrasound (US) (more accurate due to better spatial distribution)

Unsuitable sports footwear as one of the risk factors

Are you an impatient athlete? I used to be.

One of the external factors that can cause Achilles tendinopathy is definitely starting to train again too soon after a longer break. A too strong wish to start training again and a physically not prepared enough body are an ideal combination to cause an injury.

A sudden increase in training intensity as well as frequency of activity can lead to tendon overload – even if we deem an athlete to be physically well prepared. Any change causes some kind of stress to our body that, therefore, needs gradual adaptation.

However, let’s not overlook sports footwear. If it is not adapted to the activity, foot or even posture, it can irritate the Achilles tendon. The sole should be lined and the shoe should be flexible and have a simple form. It is also recommended to avoid running on hard surfaces.

Pain in the back of the heel

Not only mistakes during training sessions but also internal factors are among the main reasons for the occurrence of overload syndrome of the Achilles tendon.

Those include:

  • anatomical deviation of the lower extremity,
  • instability of the foot joint,
  • disproportion between gland muscle tension and flexibility,
  • degeneration of fat tissue below the heel bone,
  • age and age-related diseases (i.e.: rheumatoid arthritis).

Achilles tendinopathy – treatment

During the first phase, when a swelling is present, we can do the most ourselves – rest and cool.

“Rest does not improve the tolerance of the Achilles tendon.”

Rest is not the condition for the improvement of the injury. The pain soothes but as soon as you become active again, the Achilles tendon will hurt again, since rest does not improve the tolerance of the Achilles tendon.

Physiotherapy goals: foremost to sooth the pain, control the inflammation, speed up the healing process, fully rehabilitate the injury and, finally, to educate the patient in order to avoid possible future injuries.

Physiotherapy – Achilles tendinopathy

We physiotherapists also perform conservative physiotherapy. A physiotherapist may choose among several possible therapies:

  • therapeutic ultrasound,
  • laser,
  • electrotherapy to soothe pain,
  • transverse friction massage (cross fibre friction massage),
  • extracorporeal shock wave therapy (ESWT) – most recommended,
  • vacuum therapy,
  • Tecar therapy,
  • use of orthoses.

Manual techniques for achilles tendon rehab

Sometimes doctors choose to use corticosteroid injections that temporarily soothe the pain, however, it has been proven that they only help during the first 6 weeks, afterwards, they may even worsen the situation.

Why would they worsen the situation? Corticosteroids atrophy the muscle, which – from a long-term perspective – is very bad.

Other methods to speed up healing are: platelet-rich plasma injections, application of transdermal patches, stem cell or gene therapy.

How long does it approximately take for an Achilles tendon injury to heal?

With therapy and regular exercises healing takes approximately 6 months.

May I even exercise?


It has been proven that the right exercises are the most efficient rehabilitation method. In order to reach a higher stress tolerance, the Achilles tendon needs gradual exercise execution.

Achilles tendinopathy is rarely improved in for a long term only by using a passive approach (massage, injections, ultrasound, extracorporeal shock wave therapy). These techniques have to be combined with active exercises.

Exercises are, therefore, recommended, since specific activities enhance the tensile stiffness of the tendon.


  • Step on the edge of a stair with both
  • Lift yourself up on your toes with both
  • Lift the healthy foot off the ground and slowly lower yourself with the injured foot until you reach the HORIZONTAL position.

Don’t forget that a positive reaction of the body to the exercises is extremely slow. Therefore, we need persistence and patience.

Would you like to fully recover as soon as possible? Each injury needs a structured programme in order to recover completely. Therefore, I have developed a set of exercises and a guided programme for this issue.

Start today.


Overload is a key factor together with other external and internal factors for Achilles tendinopathy to appear.

During the acute phase, it is advisable to visit a doctor who will most likely first prescribe you rest and medication.

With the right exercises and other physiotherapy equipment physical therapy will, as an extremely important part of the healing, help speed up the rehabilitation. Only a specialist in physical and rehabilitation medicine, who works with this kind of problems, can give the best advice on which treatment combination in the most suitable for a specific case.

Once again – movement is the top priority. Choose professional programme and consistently work towards the goal.