As physical therapists, we see Achilles tendonitis among the most common injuries, especially among runners, weekend warriors, and athletes who pivot frequently. It’s a stubborn condition, but it’s highly treatable with the right care plan.
Understanding the Anatomy
The Achilles tendon is the thickest and strongest tendon in the human body. It connects the gastrocnemius and soleus muscles (the calf muscles) to the calcaneus (heel bone) and acts as a spring during walking, running, and jumping.
When overused or improperly loaded, this tendon becomes inflamed—Achilles tendonitis—leading to pain, swelling, and limited mobility. It’s most often caused by sudden increases in activity, poor footwear, or biomechanical imbalances like overpronation.
There are two main types:
- Insertional Achilles tendonitis (pain at the heel bone where the tendon inserts)
- Mid-portion Achilles tendonitis (pain 2–6 cm above the heel)
Assessment First
Before jumping into treatment, we always begin with a thorough assessment:
- Gait analysis
- Range of motion testing (especially ankle dorsiflexion)
- Strength testing of the calves, hips, and core
- Palpation to localize the pain
- Functional tests (heel raises, hopping, etc.)
Treatment Plan: Tools & Techniques
Load Management
- Relative rest, not complete rest. We want to reduce aggravating activities, not eliminate movement.
- Modify training volume and intensity (runners may switch to swimming or cycling temporarily).
Eccentric Loading
- 3 sets of 15 reps, twice a day
- Performed off a step, lowering the heel slowly
- Usually introduced after the acute pain subsides (around week 1 or 2)
This is the cornerstone of Achilles rehab. The Alfredson protocol involving eccentric heel drops has shown excellent long-term outcomes.
Manual Therapy
- Soft tissue mobilization to the calf muscles and Achilles tendon can reduce stiffness and improve blood flow.
- Joint mobilizations of the ankle and subtalar joint may improve mobility and gait mechanics.
Modalities (As Adjuncts)
- Ice post-activity to reduce inflammation (especially in acute cases).
- Dry needling or instrument-assisted soft tissue mobilization (IASTM) to reduce tendon adhesions and promote healing.
- Therapeutic ultrasound is occasionally used, though evidence is mixed.
- Shockwave therapy may be considered in chronic, stubborn cases.
Flexibility & Mobility
- Calf and hamstring stretching
- Ankle mobility drills
Strengthening & Return to Sport
Once pain improves (typically after 4–6 weeks), we incorporate:
- Plyometrics
- Single-leg balance and proprioception
- Sport-specific drills; depending on the individual, this phase can last another 4–6 weeks.
Typical Timeline
Recovery time depends on severity and chronicity:
- Acute cases (onset < 4 weeks): 6–8 weeks
- Chronic cases (> 3 months): 12+ weeks. Some patients with chronic symptoms may take up to 6 months to fully recover, especially if activity levels remain high or the tendon degenerates.
Prevention Tips
Once rehab is complete, we always emphasize:
- Gradual return to activity
- Proper footwear (with adequate heel support)
- Regular calf strengthening and mobility work
- Cross-training to reduce repetitive strain
Final Thoughts
Achilles tendonitis is a frustrating injury, but it’s also a great example of how structured rehab and targeted exercise can make a big difference. The key is early intervention, patient education, and consistency with the rehab plan.
If you’re dealing with lingering Achilles pain, don’t wait. The earlier we start, the quicker and stronger your recovery will be. Book an appointment with our NYC physical therapists today for a personalized plan that restores mobility, strength, and performance from the ground up. Stay strong and keep moving!
