Physiotherapy Management for Achilles Tendinopathy

Physiotherapy is a proven, evidence-based, non-surgical treatment for Achilles tendinopathy — one of the most common overuse injuries we see, particularly among runners and court-sport athletes.

Understanding Achilles tendinopathy

Achilles tendinopathy develops when the tendon connecting the calf muscles to the heel is loaded faster than it can adapt, leading to pain, stiffness and reduced tendon capacity. It commonly presents as pain and stiffness in the tendon, often worse first thing in the morning or after a period of rest.

The evidence-based approach to treatment

The strongest evidence for treating Achilles tendinopathy points toward progressive loading exercise programs, rather than rest or passive treatments alone. This involves a structured, gradually increasing strengthening program designed to rebuild the tendon's tolerance to load over time.

What a treatment program typically involves

• Load management — reducing (not necessarily eliminating) aggravating activities while the tendon adapts
• Isometric exercises — often used early in treatment to help manage pain
• Progressive strengthening — gradually increasing calf and Achilles loading through different exercise types as tolerance improves
• Addressing contributing factors — footwear, training load, calf strength and flexibility, and biomechanics can all play a role
• Gradual return to activity — a structured plan back to running or sport, guided by how the tendon responds

Why patience matters

Tendons adapt more slowly than muscles, meaning Achilles tendinopathy often takes several weeks to months to fully resolve, even with the right treatment. Consistency with a loading program — even when progress feels slow — produces the best outcomes.

When other options are considered

For the small number of cases that don't respond to a well-executed loading program, other options such as injections or, rarely, surgery may be discussed. These are generally considered only after a proper physiotherapy program has been given a genuine chance to work.

If you're dealing with Achilles pain, our physiotherapy team can build you an evidence-based, progressive treatment program. Book an assessment to get started.