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Achilles Tendonitis Physiotherapy: Symptoms & Treatment

Physiotherapy is an important component of treatment for Achilles tendonitis. It can help reduce the pain and inflammation associated with the condition and improve range of motion and functionality.

As with all injuries, this information is simply a guide. It is always best to check in with a Physiotherapist or Athletic Therapist to have a personalized assessment and hear recommendations for what you and your body may need.

Achilles tendonitis is a debilitating and painful condition caused by inflammation of the Achilles tendon. Physiotherapy can help to treat this condition, reducing pain and improving function.

Physiotherapy aims to reduce pain, improve mobility and restore function to manage symptoms of Achilles tendonitis. Treatment options include manual therapies such as soft tissue massage and joint mobilization; exercise interventions such as stretching and strengthening exercises; education on biomechanical factors which may have contributed to the onset of symptoms; electrotherapy modalities such as ultrasound therapy; taping techniques; orthotics prescription; and activity modification advice. This article provides an overview of these physiotherapeutic treatments for Achilles tendonitis.

What is the Achilles Tendon?

The Achilles tendon is a strong, fibrous tissue band connecting the calf muscle to the heel bone. It is one of the most commonly injured structures in the body, and when it becomes inflamed, painful, or even ruptured, it is known as Achilles tendonitis. This condition can be caused by overuse and excessive strain on the tendon due to activities such as running or jumping or increased intensity or duration of physical activity too quickly. Physical therapy is often recommended to help alleviate the pain associated with Achilles tendonitis and restore normal function.

Treatment typically involves stretching and strengthening exercises to improve flexibility and balance in the foot and ankle muscles. Ice can also be applied to reduce swelling, while massage techniques reduce tension in the tendons. Ultrasound may also be used to encourage tissue healing. Education on proper warm-up techniques before exercise and adequate footwear may also be provided by a physiotherapist/physical therapist to prevent future injury. With appropriate management, patients with Achilles tendonitis can return to regular activities without pain or discomfort.

Achilles Tendonitis

What Is Achilles Tendinopathy?

Irritation or pain affects the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. This Achilles pain is known as Achilles tendinopathy. Insertional Achilles tendinopathy refers to the damage and pain occurring at the insertion of the tendon into the bone. Tendinopathy is a broad term that refers to any issue affecting a tendon, whether temporary or long-term.

When a person pushes the foot off the ground (for example, runs or jumps), it transmits the force from the calf muscles down to the foot and helps control the position of the ankle when the foot touches back down on the ground.

When the demands on an Achilles tendon exceed its capability to function, this condition is known as Achilles tendonitis or Achilles tendinopathy. The illness may be acute (sudden injury or trauma) or chronic (repeated micro-tears). Most cases of Achilles tendon pain are caused by frequent trauma to the tendon, which can lead to chronic Achilles tendinopathy — a progressive degeneration of the tissue – and is often treated with Physiotherapy.

Achilles tendonitis and tendinopathy are often used interchangeably; however, they mean different things. Tendonitis refers to tendon inflammation, while tendinopathy is the degeneration of the collagen protein that forms the tendon.

There are several varied factors linked to Achilles tendinopathy, including:

  • Tightness in the calf muscles
  • Weakness in the calf muscles
  • An unusual structure of the foot
  • Unusual foot mechanics
  • Wearing ill-fitting shoes
  • A physical activity or exercise program change
  • Obesity

The most common location to experience soreness is just above the heel, although it may also be felt where the tendon joins the heel.

Types Of Achilles Tendon Injuries

Achilles tendon injuries range from tendinitis to partial or complete rupture. Tendonitis is an inflammation of the tendon and is the most common form of Achilles tendon injury. Symptoms include pain, swelling, and tenderness in the area of the tendon, as well as reduced flexibility and decreased strength. Treatment for Achilles tendonitis usually involves rest, ice, stretching exercises, the use of anti-inflammatory medications, and physical therapy.

Achilles tendon ruptures are a more severe form of injury resulting from either a direct blow to the area or repetitive stress. Symptoms include sudden pain at the back of the ankle, followed by swelling and bruising. A rupture typically requires surgery to repair the torn tissue; however, physical therapy may be used to help restore strength and flexibility before surgery or if surgery cannot be done. The rehabilitation period following Achilles tendon surgery can take several months, depending on factors such as age and lifestyle.

Achilles Tendonitis Recovery Time

Achilles tendonitis is a common injury that can cause considerable pain and discomfort. Commencing physiotherapy as soon as possible is critical to ensure a speedier recovery.

Physiotherapy for Achilles tendonitis typically involves strengthening exercises, stretching, and massage techniques to help reduce pain and promote healing. The goal of treatment is to increase the range of motion, improve nerve function in the area, and restore strength in the affected muscle group. Pain relief may also be achieved by using ice or heat therapy. Eccentric training - which involves controlled movements that focus on lengthening the affected muscle group - has also been found to be effective in treating this injury. Additionally, orthotics and bracing may be used to support the healing process.

Can Physiotherapy Help Achilles Tendonitis?

Physiotherapy is an effective treatment for Achilles tendonitis. A physical therapist can help diagnose the condition, provide education and advice on managing symptoms, and use a variety of therapeutic interventions to improve function and reduce pain. The goals of physiotherapy for Achilles tendonitis are to:

1. Reduce inflammation

2. Improve mobility

3. Strengthen the Achilles tendon

Physiotherapists may recommend ice therapy, ultrasound, or electrical stimulation to reduce inflammation. Additionally, they may suggest specific exercises to improve the ankle joint's range of motion and flexibility.

Your treatment plan might include treatment options with the following goals:

Pain management

Applying ice or using a brace, elevating the leg, using heel lifts, or utilizing manual therapy can all help with pain relief. These techniques can help you avoid taking medicines for discomfort.

Range of motion treatments

Your ankle, foot, or knee joint may be misaligned, putting extra stress on the Achilles tendon. This tension can be reduced by self-stretching and manual treatment including Massage Therapy and joint mobility to help restore and normalize motion in the foot, ankle, knee, and hip.

Gentle exercise

Achilles tendon injury rehabilitation is aided using progressive weights or resistance during physical activity. Begin with gentle strengthening exercises performed in a seated posture, such as pushing and pulling on a resistive band with your foot before moving on to standing variations.

Muscle strengthening exercises

Excessive strain on the Achilles tendon can be caused by muscular imbalances or weakness. Your Physiotherapist or Athletic Therapist will create an individualized, progressive, lower-extremity resistance program for you to help eliminate any muscle weakness or movement faults that may be causing your discomfort based on your situation.

Functional training

After your Achilles pain subsides and your strength and mobility improve, you will need to safely return to more demanding activities. To reduce the tension on the Achilles tendon and your risk of future harm, controlled movements progressively returning you to pre-injury levels will be necessary to minimize injury. Your Physiotherapist or Athletic Therapist will devise a series of exercises that will assist you in learning how to use and move your body properly again.

What are the best exercises to help with Achilles Tendinopathy?

Eccentric exercises for the calf muscles have been shown in studies to aid in the strengthening and integrity of your Achilles tendon. Eccentric calf muscle training is a type of loading that refers to the portion of an exercise when the muscle is working as it is lengthening, such as during the lowering phase of a calf raise.

Eccentric Gastroc loading - Standing Heel Drop

Eccentric heel drop

Stand on both feet. Keep your knees straight and raise your heels off the floor until you are standing up on the balls of your feet. Then remove your non-injured foot from under you so that you are only standing on your injured leg. Slowly lower the heel with control back to the ground.

3 sets of 15 reps, twice per day.

Eccentric Soleus loading - Bent Knee Heel Drop

Eccentric heel drop

Repeat the Eccentric Gastroc loading, but this time keep your knee slightly bent at a 20-degree angle.

3 sets of 15 reps, twice per day.

Isometric Calf Strengthening - Heel Raises

Strengthening exercises

Begin with your feet together and raise both heels until you are on the balls of your feet. Remove the non-injured foot from the ground and hold that high heel position of the injured leg for 45 seconds, keeping your back straight.

5 reps with a 2 minute rest between each rep.

What movements should I stay away from if I have Achilles Tendinopathy?

High impact activities such as jumping, running, and plyometrics should be avoided. Plyometric exercises are explosive movements that involve a higher risk of injury to the Achilles tendon due to it being a high-demand movement pattern.

How can I prevent Achilles Tendinitis?

To prevent this common injury, make sure to stretch and warm up your tendon before participating in strenuous activities. This will decrease the risk of harming your Achilles tendon and allow you to perform at optimal levels. Here are some general tips to prevent Achilles tendon injuries:

  • Before an activity, do a dynamic warm up
  • Stretching of the lower body in the hours post-exercise
  • 2-3 times each week, calf muscles should be trained
  • Wear shoes that are designed to help reduce muscular and tendon strain, as well as prevent joint problems
  • Always start new activities gradually and gently, letting your muscles, joints, and tendons to adapt to the added strain

How long does it take to recover from Achilles Tendinopathy?

If you can manage your symptoms early with activity modification and rehabilitation exercises, you have a good chance of recovering in 6-8 weeks. Your tendon may have thickened if your Achilles has been in pain for longer than 6 weeks. This will add time to the process.

What is the fastest way to heal Achilles Tendonitis?

The best way to heal an Achilles tendon injury is through sports physical therapy such as Physiotherapy or Athletic Therapy. Physiotherapy and Athletic Therapy help treat the injury, reduce pain and swelling, and prevent long-term disability from Achilles Tendinopathy. These therapies also help get you back into sport or daily activities as quickly as possible.

Can physiotherapy help Achilles Tendonitis?

Yes, physiotherapy can help to manage Achilles Tendonitis. A physiotherapist can assess the individual's needs and provide a specific treatment plan to reduce the pain and inflammation associated with Achilles Tendonitis. Treatment may include exercises to stretch and strengthen the Achilles tendon, ultrasound and electrical stimulation, taping, orthotic devices, and other modalities.

What are the two types of Achilles Tendonitis?

The two types of Achilles Tendonitis are non insertional Achilles Tendinitis and Insertional Achilles Tendinitis.

Noninsertional Achilles Tendinitis is an overuse injury caused by repetitive stress to the Achilles tendon, which is located at the back of the heel. This type of Achilles tendonitis is more common in younger people and athletes participating in running or jumping activities. Symptoms of non insertional Achilles tendinitis include pain and tenderness near the middle of the tendon, swelling, thickening of the tendon, and creaking or cracking noises when the tendon is used.

Insertional Achilles Tendinitis is an inflammatory condition of the tendon that attaches to the back of the heel bone. This type of Achilles tendonitis is more common in older adults, and the degeneration of the tendon usually causes it due to age and overuse. Symptoms of insertional Achilles tendinitis include pain and tenderness near the heel, swelling, and a bony growth at the back of the heel known as a "Haglund's deformity."

Will Achilles Tendonitis heal on its own?

Achilles tendonitis can heal on its own, but it is important to rest the affected area and take other measures such as stretching, ice, and anti-inflammatory medications to help the healing process. Additionally, physiotherapy can help strengthen the tendon and alleviate pain and inflammation.

Contact Us For Help

Inertia Physio+ offers Kanata and Stittsville exceptional Physiotherapy, Athletic Therapy and Registered Massage Therapy with private treatment rooms, one on one care, a maximum of two patients per hour and treatment focused on the evidence based practices of manual and exercise therapy.   Don’t suffer any longer.  If you have pain or injury, our Kanata and Stittsville Physiotherapy, Athletic Therapy and Registered Massage Therapy team is here to help you get back to life pain free life and activities.  Please reach out to us at (613) 672-2200 or for an appointment today!  You are also welcome to book online. We also offer direct billing on Physiotherapy and Massage Therapy services whenever your plan allows.


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