Understanding Achilles Tendinopathy: Why It Happens and How to Fix It by Mark Corry APA Physiotherapist

If you’ve ever felt pain or tightness in the back of your ankle that just won’t go away, you might be dealing with midportion Achilles tendinopathy. It’s one of the most common causes of Achilles pain—especially in runners, walkers, and anyone who enjoys being active. A recent article in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT, 2024) highlights what we now know about this condition and how to treat it effectively.

What Is Midportion Achilles Tendinopathy?

Your Achilles tendon connects your calf muscles to your heel bone. In midportion Achilles tendinopathy, the middle part of the tendon becomes painful, thickened, or stiff. This area is particularly vulnerable because it experiences high loads during walking, running, and jumping. People often describe pain with activity, stiffness in the morning or after rest, and sometimes weakness in the calf.

Why It Happens

Achilles tendinopathy isn’t caused by one single event—it’s usually the result of too much load and not enough recovery. Sudden increases in running distance, changes in footwear, or returning to sport after a break can all trigger symptoms. The tendon responds to repeated stress by changing its structure, which makes it less able to handle load. Over time, this leads to pain, stiffness, and loss of muscle power.

What the Research Says

The JOSPT article highlights that people with Achilles tendinopathy often have:

• Reduced calf strength and muscle power

• Increased tendon stiffness

• Changes in how the tendon loads and stores energy
  These changes make it harder for the tendon to cope with everyday and sporting demands. The good news is that tendons can adapt again—with the right exercise and load management.

Key Steps for Recovery

1. Load Management
The goal isn’t to stop moving—it’s to find the right amount of movement. Total rest can actually make the tendon weaker. Instead, modify painful activities and gradually reintroduce them as symptoms settle.

2. Strength and Loading Exercises
Progressive calf strengthening is the mainstay of treatment. This usually starts with slow, heavy calf raises and progresses to more dynamic exercises as the tendon improves. A physiotherapist can help design a plan that matches your pain level and goals.

3. Address Stiffness and Mobility
Sometimes tightness in the ankle or hip can place extra stress on the Achilles. Mobility work in these areas can help improve movement efficiency and reduce overload on the tendon.

4. Patience and Progression
Tendons take time to adapt—often several months. Gradual loading, consistent exercise, and regular review make all the difference.

Myths vs Facts

• Myth: Rest will fix it.
  Fact: Complete rest can slow recovery. Controlled loading helps the tendon get stronger.

• Myth: Pain means damage.
  Fact: Mild pain during rehab is normal and safe, as long as it doesn’t worsen after exercise.

• Myth: Stretching alone is enough.
  Fact: Stretching can help mobility, but strengthening is what restores tendon health.

When to Seek Help

If pain has lasted longer than a few weeks, or you’re unsure how to start rehab, seeing a physiotherapist is the best step. They can assess your strength, movement, and training loads, then build a plan that restores both function and confidence.

The Takeaway

Achilles tendinopathy can be frustrating, but it’s highly treatable with the right approach. The latest evidence reinforces what physiotherapists already see every day—the tendon needs movement, not just rest. A structured, progressive program can restore strength, reduce pain, and get you back to the activities you love safely.

References:

Ruth L. Chimenti, Christopher Neville, Jeff Houck, Tyler Cuddeford, Dominic Carreira, and Robroy L. Martin (2024) Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision, Journal of Orthopaedic & Sports Physical Therapy 2024 54:12, CPG1-CPG32