What Causes Achilles Pain, and How Is It Treated?

What Causes Achilles Pain, and How Is It Treated?

Achilles pain (tendinopathy) usually develops gradually from repeated stress on the tendon, commonly linked to overuse, sudden training increases, tight calf muscles, or weight gain, rather than a single injury. Because the Achilles has a relatively limited blood supply, treatments that boost circulation, like shockwave therapy, acupuncture, and ultrasound therapy, can play a particularly useful role alongside exercise-based rehabilitation. A full recovery approach typically includes flexibility, strength, balance, and eventually plyometric training to reduce the risk of the pain returning.

What Is Achilles Pain?

Achilles pain, also known as Achilles tendinopathy, is a condition characterised by pain, stiffness, and swelling in the Achilles tendon. This tendon connects your calf muscles to your heel bone and plays a key role in walking, running, and jumping.

It's a common issue among active individuals and athletes, often developing gradually due to overuse or repetitive strain rather than a single injury.

What Are the Causes and Risk Factors?

There are several reasons why Achilles pain may develop. In most cases, it's linked to repeated stress on the tendon over time.

• Overuse: Repetitive activities such as running, jumping, or high-impact sports can place continuous strain on the tendon.
• Poor training techniques: Sudden increases in training intensity, improper form, or inadequate warm-ups can contribute to overload.
• Lack of flexibility: Tight calf muscles can increase tension through the Achilles tendon.
• Weight gain: A sudden increase in body weight can place additional load on the tendon.
• Pre-existing health conditions: Conditions such as diabetes may affect tendon health and healing capacity.

What Are the Symptoms of Achilles Tendinopathy?

Symptoms of Achilles tendinopathy often develop gradually and may vary in intensity. Common signs include:

• Pain and stiffness: Typically worse in the morning or after periods of rest and may ease with gentle movement.
• Swelling and tenderness: Around the tendon, particularly a few centimetres above the heel.
• Weakness: Difficulty performing movements such as single-leg heel raises or pushing off the foot during walking or running.

What Are the Treatment Options for Achilles Pain?

At Relive Physiotherapy, we offer a range of evidence-based treatment options to help manage Achilles pain and support recovery. These treatments are often most effective when combined with exercise therapy and manual techniques.

Shockwave Therapy for Achilles Tendinopathy

Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses sound waves to stimulate healing in the affected tendon. It works in several ways:

• Improving blood flow to the injured area, supporting the healing process
• Stimulating collagen production, which is essential for tendon repair and strength
• Helping break down scar tissue, which can limit flexibility and function
• Reducing inflammation, helping to ease pain and swelling
• Providing pain relief by promoting tissue recovery and reducing irritation

Achilles tendons have a relatively limited blood supply, so treatments that encourage circulation and healing can be particularly beneficial.

Acupuncture for Achilles Tendinopathy

A commonly used method at Relive Physiotherapy is the Herringbone Technique, a structured and reproducible acupuncture approach designed specifically for Achilles tendinopathy.

Needles are placed at strategic points along the tendon, typically at 1/4, 1/2, and 3/4 of its length, to target the affected area effectively.

This technique may help by:

• Improving blood flow to the tendon
• Stimulating collagen production to support repair
• Reducing inflammation and easing pain
• Assisting in breaking down scar tissue to improve tendon mobility and function

Ultrasound Therapy

Ultrasound therapy uses high-frequency sound waves to generate gentle heat within the tissues. This is different from shockwave therapy, as it delivers softer sound waves but still supports the healing process.

The increased temperature can help improve circulation, reduce swelling, and encourage tissue repair in the affected area. Benefits include:

• Pain relief: The warmth can help relax surrounding tissues and reduce discomfort
• Improved healing: Increased blood flow delivers oxygen and nutrients that support tissue recovery

What Does a Comprehensive Approach to Recovery Look Like?

A combination of treatments, along with exercise therapy and manual mobilisation, often provides the most effective results for Achilles pain.

At Relive Physiotherapy, we follow a structured rehabilitation approach that focuses not only on reducing pain but also on restoring full function. This includes working through flexibility, strength and conditioning, balance and coordination (including proprioception), agility, and plyometric training where appropriate.

The goal is to help you return safely to your normal routine or sport with reduced risk of recurrence.

If you are experiencing Achilles pain, early assessment and a tailored treatment plan can make a significant difference to your recovery.

At Relive Physiotherapy, we provide personalised care designed around your individual needs to help you recover effectively and get back to the activities you enjoy.

Frequently Asked Questions

Why is circulation so important for Achilles tendon healing?

The Achilles tendon has a relatively limited blood supply compared to other tissues, which is why treatments that improve circulation, such as shockwave therapy, acupuncture, and ultrasound, can play a particularly useful role in recovery.

What is the Herringbone Technique?

It's a structured acupuncture approach used specifically for Achilles tendinopathy, where needles are placed at set points along the tendon (roughly a quarter, half, and three-quarters of its length) to target the affected area.

Is shockwave therapy painful for Achilles tendinopathy?

Shockwave therapy is non-invasive and generally well-tolerated, though some people may experience mild discomfort during treatment. It's often combined with exercise-based rehabilitation for the best results.

Can Achilles tendinopathy be caused by something other than exercise?

Yes. While overuse is a common cause, factors like tight calf muscles, sudden weight gain, and pre-existing conditions such as diabetes can also contribute to tendon irritation and reduced healing capacity.

What does a full Achilles rehabilitation programme involve?

A comprehensive approach typically includes flexibility work, strength and conditioning, balance and coordination training, and eventually agility and plyometric exercises, aimed at restoring full function and reducing the risk of recurrence.

About the Author:

Shivani Darira

Senior Specialist Physiotherapist

As a Senior Specialist Physiotherapist at Relive Physiotherapy, Shivani has a particular interest in treating musculoskeletal and sports injuries. She holds an MSc in Sports Medicine from the University of Chester and brings a strong clinical foundation to her work with athletes and active clients alike.

Shivani's approach is guided by the principle that movement aids healing, and she takes a dynamic, personalised approach to every client's recovery journey.

Outside the clinic, Shivani enjoys HipHop and Bollywood dance and is currently learning to swim and play tennis.