Struggling with Achilles pain? Physiotherapy, exercise, shockwave therapy, ultrasound, and injections can help you recover and safely return to your sport.
What is it?
The Achilles tendon is the thick band of tissue at the back of your ankle that connects your calf muscles to your heel bone. It helps you walk, run, and jump.
Achilles tendinopathy occurs when this tendon becomes irritated or overloaded, often leading to pain and stiffness, especially in the morning or after activity. It’s not usually a sudden tear, but rather a gradual problem where the tendon struggles to cope with repeated stress.
Who does it affect?
This condition is common in:
- Runners (especially if you’ve recently increased mileage, speed, or hill running).
- Football, basketball, and tennis players are required to perform explosive jumping and sprinting in their sports.
- Active adults in their 30s–50s, particularly if activity levels, footwear, or training surfaces suddenly change.
It can also affect individuals who spend a lot of time on their feet at work.
How physiotherapy can help
Physiotherapy plays a key role in both recovery and preventing recurrence. Here’s how:
Exercise therapy:
Specific strengthening and loading exercises for the calf and tendon help the tissue adapt and become stronger. Your physio will guide you through a gradual program to build tissue tolerance and strength.
Shockwave therapy:
Shockwave therapy can be an essential adjunct, as it stimulates blood flow and healing in the tendon, allowing exercise therapy to further strengthen the tendon.
Diagnostic ultrasound:
An ultrasound scan can help specify the diagnosis and check the health of the tendon, and rule out other causes of ankle pain.
Injection therapy:
In some stubborn cases, an injection (such as ultrasound-guided steroid around the tendon or in the adjacent fat pad or newer biologic options) may be considered to reduce pain or promote healing. This is usually combined with an exercise program for optimal results.
Take-home message
Achilles tendinopathy can be frustrating, but with the right treatment plan, most people return to their sport or daily activities. The key is a structured exercise program, sometimes supplemented by treatments such as shockwave therapy, ultrasound guidance, or injections when necessary.
Reference
Malliaras P, Gravare Silbernagel K, de Vos R- J, et al. Br J Sports Med Epub ahead of print:. doi:10.1136/ bjsports-2024-109185
[Malliaras P. (2022). Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy 68:221–237] © 2022 Australia
Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024 Ruth L. Chimenti, Christopher Neville, Jeff Houck, Tyler Cuddeford, Dominic Carreira, and Robroy L. Martin Journal of Orthopaedic & Sports Physical Therapy 2024 54:12, CPG1-CPG32