Achilles Tendinopathy: Overuse or Under-Recovery?

If you feel a tight, aching sensation at the back of your ankle—especially during your first steps in the morning or after exercise—you might be dealing with Achilles tendinopathy. It’s one of the most common causes of heel and lower leg pain, particularly in runners, athletes, and weekend warriors.

But contrary to popular belief, Achilles tendinopathy isn’t just caused by doing too much. It’s often the result of doing too much without enough recovery, poor mechanics, or failing to address early signs of dysfunction.

At MSK Doctors, we specialise in diagnosing and treating Achilles injuries using regenerative injections, cryo-ultrasound, shockwave therapy, and onMRI™—empowering you to heal better, not just rest longer.

What Is Achilles Tendinopathy?

The Achilles tendon is the thick, fibrous cord that connects your calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus). It’s the strongest tendon in the body, yet it’s also prone to overload and degeneration.

Achilles tendinopathy refers to a chronic, non-inflammatory condition involving micro-tears and disorganisation of collagen fibres within the tendon. It’s often mislabelled as “tendonitis,” though true inflammation is usually absent in longer-standing cases.

There are two main types:

• Mid-portion Achilles tendinopathy: 2–6 cm above the heel, the most common type.

• Insertional Achilles tendinopathy: Where the tendon attaches to the heel bone.

What Causes It?

The condition usually results from a mismatch between load and capacity—where the tendon is asked to do more than it’s conditioned to handle.

Common causes include:

• Sudden increase in training load or hill running

• Inadequate recovery between sessions

• Tight calf muscles or poor ankle mobility

• Improper footwear or hard running surfaces

• Biomechanical issues (e.g. overpronation or stiff ankles)

• Poor postural control or glute weakness

• Age-related tendon degeneration (common in 30–60-year-olds)

At MSK Doctors, we use MAI-Motion™ gait and movement analysis to identify contributing biomechanical patterns—such as asymmetrical loading or poor calf activation.

Signs and Symptoms

• Dull ache or stiffness in the Achilles, especially in the morning

• Pain that improves as you warm up, but worsens later

• Tenderness to touch along the tendon

• Swelling or thickening of the tendon

• Pain when pushing off, jumping, or sprinting

• Possible creaking sensation with ankle movement (crepitus)

In insertional tendinopathy, symptoms are closer to the heel and may involve bone spurs or bursitis.

Diagnosing Achilles Tendinopathy: Going Beyond Symptoms

While clinical examination provides clues, we often use imaging to confirm diagnosis and tailor treatment.

Advanced diagnostics include:

• onMRI™ – Reveals tendon structure, degeneration, and fluid accumulation with AI-supported precision

• High-resolution ultrasound – Real-time tendon imaging, ideal for guiding injections

• MAI-Motion™ analysis – Detects movement compensations or kinetic chain dysfunction

This precision approach ensures we’re not just treating symptoms—but solving the underlying problem.

Treatment Options: From Conservative to Regenerative

Achilles tendinopathy requires progressive, structured loading—not just rest. Tendons heal when properly loaded and stimulated, and healing time depends on chronicity, tissue quality, and contributing factors.

🟢 First-Line Treatments

• Eccentric calf strengthening (e.g. heel drop protocol)

• Isometric loading for pain modulation

• Cryo-ultrasound therapy to reduce discomfort and improve circulation

• Shockwave therapy to promote tissue regeneration in stubborn cases

• Footwear assessment and orthotics if needed

🧬 Regenerative Options

For persistent or chronic cases, biologic treatments can stimulate collagen remodelling and healing:

• PRP (Platelet-Rich Plasma) injections

• mFAT (micro-fragmented adipose tissue) injections for cellular support

• Exosome therapy (where available) for tendon matrix regeneration

These are ultrasound-guided to ensure precise delivery into the tendon structure.

🔴 When Is Surgery Needed?

Surgery is rare and typically reserved for:

• Full-thickness tendon ruptures

• Failed conservative and regenerative treatments after 6–12 months

• Severe insertional disease with calcific deposits or tendon tears

At MSK Doctors, we aim to exhaust non-invasive solutions before considering surgical options.

Recovery Timeline

Healing varies, but most patients see improvement over 6–12 weeks with structured rehab. Chronic tendinopathy may take several months—but the key is progressive, smart loading, not complete rest.

We monitor your progress using motion capture, strength testing, and follow-up imaging to ensure tendon quality is improving—not just symptoms.

Frequently Asked Questions (FAQs)

1. Can I keep training with Achilles tendinopathy?
Yes—with modifications. Avoid aggravating activities like sprinting or jumping, but controlled loading (like heel raises) is beneficial.

2. Is rest enough to heal the tendon?
No. Rest alone won’t realign tendon fibres or restore strength. Guided loading is essential for true recovery.

3. Does Achilles tendinopathy lead to rupture?
While not inevitable, chronic degeneration increases rupture risk, especially in sudden high-load activities.

4. Is PRP effective for Achilles injuries?
PRP can help stimulate healing in mid-portion tendinopathy—particularly when combined with rehab.

5. How do I know if my pain is tendonitis or tendinopathy?
Tendonitis is acute and inflammatory; tendinopathy is chronic and degenerative. onMRI™ and ultrasound help distinguish the two.

6. When should I seek expert advice?
If pain persists for more than 3–4 weeks, interferes with training, or doesn’t respond to basic care, it’s time for a proper assessment.

Conclusion: Rebuild Your Achilles, Reclaim Your Movement

Achilles tendinopathy isn’t just an overuse injury—it’s a warning sign that your recovery, mechanics, or training load may need adjusting. With the right support, most cases can recover fully without surgery.

At MSK Doctors, we combine diagnostics, regenerative medicine, and movement analysis to treat the cause—not just the symptoms. Whether you're an athlete, gym-goer, or simply want to walk pain-free again, our team is here to help.

Take the first step towards recovery—book your Achilles assessment today.