Achilles Tendonitis:
Symptoms, Pain Management and Recovery

Achilles Tendonitis and other pain associated with the Achilles tendon are the most frequently reported overuse type injury. The gastrocnemius and the soleus muscle make up the calf complex at the back of the lower leg and together create the Achilles tendon that attaches to the back of the heel bone, the calcaneus.

Issues often arise with the sudden increase of repetitive activities. The frequency of these activities puts a stress on the Achilles tendon, stemming from the tendons inability to properly recover between activity time, resulting in Achilles tendon pain. 

Injuries to the Achilles occur most often between those that are 30-50 years old, and men seem to develop issues more often than women. Injuries to the Achilles tendon are often related to chronic issues that stem from degenerative changes to the tendon typically in the mid region of the Achilles tendon.

What Are The Common Symptoms of Achilles Tendonitis?

• Point tenderness along the Achilles, typically in the mid region or at the insertion point

• Pain and stiffness during activities that increase the demand on the Achilles tendon

• Pain and stiffness may temporarily decrease as Achilles tendon “warms up” but then return as activities continue

• Typical onset of symptoms is gradual, but can experience a more sudden onset after an increased or new level or activity

• Pain may also be present after being stationary for a longer period of time or in the morning as you take your first few steps

What Causes Achilles Tendonitis?

• Decreased ankle dorsiflexion range of motion, bending the ankle up

• Decreased plantar flexion strength, pointing the foot downward

• Increased pronation or flattening of the arch of the foot

• Elevated BMI

• Training errors or overuse/under recovery type issues

How Can Physical Therapy Help My Achilles Tendonitis?

Your physical therapist will determine the extent of injury to the achilles tendon and will create a treatment path that will reduce pain and increase strength to the area to prevent reinjury. 

Progression of movement is quality based- as you demonstrate greater competency and capacity to do the movements they need to be progressively more challenging.

A physical therapist may recommend different interventions depending on where you are in the recovery process and the extent of the injury including: 

• Eccentric (slow lowering) loading to the Achilles tendon/calf complex

• Short term use of orthotics

• Manual therapy to mobilize stiffness in the ankle/foot complex and other related tissues

• Strengthening for specific weakness of the ankle/foot complex as noted during examination

• Progressive return to activities with graded exposure

• Specific exercises to hips, core, and lower extremities as indicated based upon examination findings

Every individual and every Achilles tendon issue is very unique. The treatment suggestions listed above include several options to try and see how they may improve your situation. 

In addition, a thorough evaluation by a physical therapist can help identify specific features about your condition and how to best manage them. Understanding as much as possible about your current condition is a very important aspect of the recovery process and will empower you to take the necessary steps to get back to your normal activities with as little discomfort as possible.