At Inner Strength Bayside, we understand that ankle pain can disrupt daily life. Pain around the heel or mid-Achilles may be caused by Achilles tendinopathy, a common condition affecting the tendons of the gastrocnemius and soleus muscles. This can lead to discomfort, stiffness, and limited movement, but physiotherapy can help you recover and return to your activities.

What Is Achilles Tendinopathy?

Achilles tendinopathy is a condition in which the Achilles tendon, the band connecting the calf muscles to the heel bone, undergoes gradual structural breakdown due to repeated overload. Instead of healing normally, the tendon becomes irritated and weakened over time, leading to increased inflammation and pain. Due to the condition reflects long-term changes in tendon health rather than a simple acute injury, recovery typically requires carefully guided, specific loading exercises to restore tendon strength and function.

Common symptoms:

• Pain in the middle section of the tendon or pain where the tendon attaches to the heel.
• Pain often worse in the morning
• Tenderness, swelling or thickening of the tendon
• Pain in the Achilles tendon during or after exercise
• Reduced strength or performance in activities involving the calf muscles

Risk Factors:

Intrinsic factors (influenced by genetics, age, organ function and other health conditions/illnesses):

• Increased Body Mass Index (BMI): Extra weight increases tendon load
• Diabetes: Slows healing and alters tendon structure
• Smoking: Reduces blood flow and tendon quality
• High cholesterol: impairs Type 1 collagen production
• Medical conditions associated with tendon pathology (E.g. rheumatoid disease, gout, dyslipidemia and spondyloarthropathies)

Extrinsic factors (influenced by lifestyle choices, environment, and social conditions):

• Training errors: Sudden changes in training load e.g. increases in distance, speed, or incline work
• Inappropriate footwear: high heeled shoes, lacking adequate arch or heel support, rigid shoes that irritate heel, or very flat shoes
• Hard or uneven surfaces: including standing on or training on concreate, trails, uneven pavements, sand, or slopes
• Occupational demands: Prolonged standing, walking, or repetitive tasks

Rehabilitation and Exercise

Effective rehabilitation focuses on controlling how much stress you put on the tendon and slowly building strength back up.

Early Phase: Load Management

Try to reduce the amount of stress you put on your body during activities and workouts. This means cutting back on things that involve a lot of force or impact (e.g. sprinting, jumping, or other explosive movements). It is not necessary that you should stop training completely. A physiotherapist can help guide your training adjustments, provide you with a specific, individualised strength program to encourage tendon healing and ensure appropriate tendon loading, and design a plan tailored to your symptoms and goals.

It is best to adjust:

• how much you do (volume)
• how hard you go (intensity)
• how often you train (frequency)
• how long you work out (duration)
• how big your movements are (range of motion). 

For now, choosing low-impact options is best.

Examples of low-impact alternatives:

• Swap running for cycling, rowing, swimming, or elliptical work.
• Replace jumping exercises (skipping, star jumps, box jumps) with heel-supported squats, glute bridges, or hip-dominant movements like deadlifts.
• Reduce range of motion by walking on flat surfaces rather than on an incline.
• Lower intensity by using lighter weights, slower tempo, or shorter sets, especially for exercises that load the Achilles.
• If walking is uncomfortable, try shorter distances or a slower pace.

Modify your activities to be pain-free or minimal discomfort (1–2/10). Adjust the activity via the above low-impact alternates if pain exceeds this level. 

And remember: our physiotherapists will help guide you with exercises that are specific to your condition and recovery stage, so you’ll always know what’s safe and appropriate for you.

Middle Phase Management 

Once pain has settled to a manageable level and daily activities are more comfortable, the middle phase focuses on progressively strengthening the tendon and improving its capacity to handle load. This stage helps transition from basic symptom control to restoring functional strength.

This may include introducing low-impact cardiovascular training to maintain fitness without overloading the tendon (e.g. cycling, elliptical, swimming or deep-water running).

Late-Phase Management

The late phase focuses on restoring full tendon capacity, rebuilding elastic and explosive strength, and preparing the person to return to higher-load or sport-specific activities. At this point, symptoms should be well controlled, and the tendon should tolerate moderate-high loading without flare-ups.

Plyometric (quick, explosive movements such as jumps, hops, and bounds) training may be included at later stages of rehab, if aligned with your goals.

Key Takeaways:

• Achilles tendinopathy is degenerative, not inflammatory, caused by tendon overload
• Early recovery requires load management and gentle movement
• Progressive, high-load training is essential for long-term strength
• Risk factors: increased BMI, diabetes, smoking, training errors, footwear and occupational stressors.
• Physiotherapy-guided rehab ensures safe progression, pain control, and lasting results

How Physiotherapy at Inner Strength Bayside Can Help

Our physiotherapists create personalised treatment plans to safely guide your recovery. We provide exercise supervision, activity modification, and hands-on therapies like dry needling or manual therapy to reduce pain and support healing. With the right approach, you can overcome Achilles tendinopathy and regain confidence in daily activities.