Achilles Tendinopathy: Causes, Treatments & Self-Care Tips

Why the Pain Keeps Coming Back

Tendinopathy is a perfect storm of overuse, weakness, and poor recovery. Common triggers include:

When the tendon is overloaded repeatedly, its fibers break down faster than they repair. Over time, the structure weakens, the area becomes painful, and your nervous system starts to “guard” the region—making even light activity feel sore.
Breaking that cycle means improving both the tendon’s capacity and your movement mechanics.

What Science Says Works

1. Progressive Loading (Exercise Therapy)

Study after study shows that gradual, heavy loading of the calf–Achilles unit is the number-one treatment.
Eccentric exercises (slowly lowering your heel from a raised position) strengthen the tendon and encourage collagen repair.
Heavy-slow resistance training works just as well for people who prefer fewer reps with more weight.
For insertional pain, we modify exercises to avoid dropping the heel below the step, which compresses the tendon against bone.

In a 2021 British Journal of Sports Medicine review of 29 trials, exercise therapy outperformed all passive treatments for long-term recovery.

2. Shockwave Therapy (ESWT)

Extracorporeal shockwave therapy uses acoustic pulses to stimulate tissue repair and blood flow. A landmark American Journal of Sports Medicine study by Rompe et al. found patients who added shockwave to their exercise program improved faster and reported less pain after 12 weeks than exercise alone.

Study after study shows that gradual, heavy loading of the calf–Achilles unit is the number-one treatment.
Eccentric exercises (slowly lowering your heel from a raised position) strengthen the tendon and encourage collagen repair.
Heavy-slow resistance training works just as well for people who prefer fewer reps with more weight.
For insertional pain, we modify exercises to avoid dropping the heel below the step, which compresses the tendon against bone.

Later reviews confirmed:

At Unpain Clinic, we use both radial and focused shockwave—adjusting energy levels and pulse counts to each patient’s tolerance.

3. Manual Therapy & Soft-Tissue Work

Massage, myofascial release, and instrument-assisted techniques help reduce calf tightness, improve blood flow, and make loading exercises more comfortable. Combining manual therapy with exercise has shown better short-term pain relief than exercise alone in some reviews.

4. Extracorporeal Magnetotransduction Therapy (EMTT) & Neuromodulation

These advanced technologies use electromagnetic pulses to influence cellular metabolism and pain signaling. While research is emerging, our clinicians find EMTT helpful for reducing inflammation and improving circulation, especially in chronic cases.

5. A Whole-Body Approach

Focusing only on the sore spot misses the bigger picture. We evaluate how your hips, knees, and core contribute to overloading the Achilles. Often, weak glutes or limited ankle motion are the hidden culprits. Correcting them prevents recurrence once the tendon heals.

How We Treat Achilles Pain at Unpain Clinic

Our approach blends science with individualized care:
1. Assessment first – We test mobility, strength, gait, and posture to pinpoint why your Achilles hurts.

2.Targeted therapies – Based on findings, your plan may include:

3. Load management – We teach you how much activity is safe and when to rest.

4.Footwear & movement coaching – Small gait or shoe changes can make a big difference.

A typical treatment plan lasts 6–8 weeks, with reassessment every few sessions. Most patients notice meaningful pain reduction within the first month.

A Real-Life Example

A 42-year-old recreational runner came to Unpain Clinic after nine months of right-heel pain. She’d tried rest, stretching, and new shoes—no change.
Our assessment found:

We used four sessions of focused shockwave, soft-tissue release, and a customized loading plan. By week 6, she jogged pain-free for 3 km. At 12 weeks, she was back to 10 km runs and rated her morning pain 1/10 instead of 7/10.
Her success wasn’t luck—it was structure, progression, and consistency.

Home Strategies Between Sessions

Here’s what you can safely do to help your tendon heal:

1. Isometric Calf Holds
Stand on your toes (both feet), shift weight to the sore leg, and hold 45 seconds. Repeat 4–5 times. Great for reducing pain sensitivity.

2. Heel-Drop Loading
Rise with both feet, lower slowly (3–5 seconds) on the sore side. Three sets of 15, once or twice a day. Add backpack weight as tolerated.
For insertional pain, stop at flat ground—don’t drop below the step.

3. Gentle Stretching
Stretch your calves with the knee straight (gastroc) and bent (soleus), holding 30 seconds each, 2–3 times daily. Mild tension is fine; sharp pain is not.

4. Manage Your Load
Follow the “10 % rule”: increase weekly activity volume by no more than 10 %. Replace high-impact runs with cycling or swimming during flares.

5. Footwear Check
Use cushioned shoes with a slight heel lift. Avoid very flat or stiff shoes early on. Orthotic inserts can temporarily reduce strain.

6. Ice After Activity
Apply 10–15 minutes for comfort. It won’t fix the tendon, but it eases post-exercise soreness.

7. Track Progress
Note pain levels each morning and after workouts. Improvement looks like less morning stiffness, greater tolerance to activity, and stronger single-leg calf raises.