Achilles Tendonitis
What is Achilles Tendonitis?
Achilles tendonitis is the inflammation or degeneration of the Achilles tendon, which connects the calf muscles (gastrocnemius and soleus) to the heel bone. It often results from overuse, sudden increases in activity, poor biomechanics, or tight calf muscles.
There are two main types:
- Non-insertional tendonitis: Affects the middle portion of the tendon.
- Insertional tendonitis: Affects where the tendon attaches to the heel.
Symptoms
- Pain and stiffness along the Achilles tendon, especially in the morning
- Swelling or thickening of the tendon
- Pain that worsens with activity
- Tenderness when touching or moving the tendon
- Limited range of motion in the ankle
Treatment Options
I have found that using a combination of dry needling into the achilles tendon, cold laser and massage have had the best effects…
1. Dry Needling
Purpose: Stimulates tissue healing and reduces pain.
- Involves inserting fine needles into trigger points or degenerated tendon tissue.
- Promotes blood flow, collagen production, and cellular repair.
- Often used alongside ultrasound guidance to ensure precision.
- Can reduce chronic pain and improve tendon remodeling over time.
✅ Best for chronic tendonitis with degenerative changes (tendinosis).
2. Massage Therapy
Purpose: Improves circulation, reduces muscle tension, and breaks down scar tissue.
Deep tissue massage and cross-friction massage are commonly used.
Helps release tight calf muscles contributing to Achilles strain.
Can aid in reducing inflammation and enhancing mobility.
Best used in combination with stretching and strengthening exercises.
3. Cold Laser Therapy (Low-Level Laser Therapy)
Purpose: Accelerates tissue healing and reduces inflammation.
Non-invasive treatment using low-level laser to stimulate cellular activity.
Increases ATP (energy) production in cells, promoting faster recovery.
May reduce pain and swelling in both acute and chronic cases.
Painless, safe, and can be combined with manual therapies.
4. Exercises & Rehabilitation
Purpose: Strengthens tendon, restores flexibility, and prevents recurrence. I have seen (quite a lot!) exercises prescribed too early/intensely for achilles tendonitis.
Some key exercises can include:
a. Eccentric Heel Drops
- Slowly lowering the heel below the step level while keeping control.
- Promotes tendon remodeling and strength.
b. Calf Stretching
- Improves flexibility in the gastrocnemius and soleus muscles.
- Performed with the knee both straight and bent.
c. Isometric Holds
- Contracting calf muscles without movement (e.g., heel raises and hold).
- Reduces pain and maintains strength early in rehab.
d. Progressive Loading
Gradually increasing resistance to restore tendon capacity (using resistance bands, body weight, or gym equipment).
Other Supportive Therapies
Ice therapy: Useful during acute flare-ups to reduce swelling. With very chronic achilles tendonitis I would usually recommend to ice the area for a longer period of time than what we would usually do.
Heel lifts or orthotics: Reduce strain on the tendon. Check your shoes have not worn out and have stopped supporting your feet
Activity modification: Avoid high-impact activities until pain subsides.
- Myofascial Dry Cupping: great for getting a new blood supply into the tissues.
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Emily Catford
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