Achilles Tendinopathy: Why It Happens and How to Recover

Achilles tendinopathy is characterised by pain, stiffness, and localised thickening of the Achilles tendon — typically either in the midportion (2-6cm above the heel) or at its insertion onto the calcaneus. It's one of the most common injuries in runners and returning athletes, and it has a tendency to become chronic when managed passively. The good news: it responds excellently to a well-designed progressive loading programme.

What causes Achilles tendinopathy and why does it persist?

The primary driver is a mismatch between tendon load capacity and the demands placed on it. A sudden increase in training volume or intensity, a change in surface or footwear, or a return to running after a period of inactivity can all push the tendon beyond what it can currently handle. Once in a reactive or degenerative state, the tendon becomes sensitised — minor provocations cause disproportionate pain.

Calf tightness, reduced ankle dorsiflexion, and hip weakness (which increases the relative demand on the calf during running) are common biomechanical contributors. We address all of these routinely in the Berwick clinic, particularly with distance runners and cyclists across South-East Melbourne.

The loading protocol: from pain to performance

The most evidence-supported intervention is the Alfredson heavy slow resistance protocol — eccentric and concentric calf loading performed slowly under significant resistance. For insertional Achilles tendinopathy (at the heel), modifications are needed to avoid compressive loads. The protocol is typically 12 weeks with twice-weekly sessions.

Book an assessment at RISE Sports & Spinal if Achilles pain is limiting your running or sport. We'll diagnose the exact presentation — midportion versus insertional — and build the right loading programme for your situation.

Why running load management is inseparable from Achilles rehab

The Alfredson protocol and its variants produce excellent results when combined with appropriate running load management — and poor results when loading is continued unchanged. Tendons do not respond predictably to isolated strengthening exercises while simultaneously being repeatedly loaded at volumes that exceed their current capacity. The most common reason the loading protocol fails is that weekly running volume remains too high during the early rehabilitation phase, preventing the adaptation process from keeping pace with the ongoing demand.

At RISE Sports & Spinal in Berwick, Achilles rehabilitation includes a running load prescription alongside the strengthening protocol. Runners in the South-East Melbourne area typically need a structured reduction in volume and intensity for four to six weeks — not complete cessation, which leads to rapid deconditioning — followed by a graduated return guided by symptom response. Pool running and cycling can often maintain cardiovascular fitness during this phase. The goal is to allow tendon capacity to outpace demand, then gradually bring demand back up to and beyond pre-injury levels.

Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.