Achilles Tendon Pain | A Shoreham Physio Explains Why Rest Alone Isn’t the Answer
Achilles tendinopathy is one of the most common causes of pain at the back of the heel. Most cases aren’t caused by ongoing inflammation but by the tendon becoming overloaded beyond its current capacity. That means the most effective treatment usually involves carefully managed loading rather than complete rest.
Here’s something that surprises most people: an inflamed Achilles tendon isn’t actually inflamed at all — at least not in the way you’d expect. Research shows that in persistent cases, the tendon shows very little of the classic inflammatory response. Instead, the tendon fibres themselves become disorganised and less able to tolerate load. That’s why anti-inflammatory medication and rest alone so often fail to solve the problem, and why the old label of “Achilles tendinitis” has largely been replaced by “Achilles tendinopathy.”
If you’re a runner in Shoreham pounding the board walk or Following the coast to the Perch in Lancing, this is one of the most common reasons for stubborn pain at the back of the heel or lower calf. It most commonly affects active adults between their 30s and 60s, although it can occur at any age.
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What Is Achilles Tendinopathy?
The Achilles tendon is the thick, rope-like band connecting your calf muscles (gastrocnemius and soleus) to your heel bone. It’s the strongest tendon in the body and it needs to be — with every step, run, or jump, it absorbs and releases forces several times your body weight.
Tendinopathy develops when the demand placed on the tendon consistently outpaces its capacity to adapt and recover. Rather than the tendon being “damaged”, its normal repair processes struggle to keep pace with the demands being placed upon it, resulting in changes to its internal structure and a reduced tolerance to load.
It typically develops in one of two locations:
Mid-portion Achilles tendinopathy – around 2-6 cm above the heel bone.
Insertional Achilles tendinopathy – where the tendon attaches directly onto the heel bone.
Although they share many similarities, the rehabilitation approach differs slightly between the two.
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What Does It Feel Like?
Most people describe:
Stiffness and pain first thing in the morning or after sitting still, which eases as you move
A dull ache or sharper pain during or after running, jumping or walking uphill
Localised thickening or tenderness within the tendon
Pain that gradually worsens following an increase in running, walking, gym training or sporting activity
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Common Risk Factors
Achilles tendinopathy usually develops because several factors combine rather than one single event.
Common contributors include:
A sudden increase in running or walking
Hill running or speed sessions
Returning to exercise after time away
Weak calf muscles or reduced tendon capacity
Changes in footwear
Carrying extra body weight
Previous Achilles injury
Less commonly, medical conditions such as diabetes or inflammatory arthritis
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Why “Overload” Is the Key Word
It’s tempting to think of this as an overuse injury that simply needs complete rest. In reality, it’s better understood as an overload issue — the tendon has been asked to do more than it currently has the capacity to tolerate.
That distinction matters because tendons actually become weaker if they’re rested for too long. Complete rest often creates a frustrating cycle where symptoms settle temporarily, only to return as soon as activity resumes.
The goal instead is to find the sweet spot: reduce load enough to calm the tendon down while maintaining enough activity to preserve — and eventually increase — its capacity.
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Managing the Irritable Phase
While the tendon is particularly sore, the priority is reducing excessive load rather than avoiding movement completely.
Simple strategies that often help include:
Heel wedges or heel lifts to temporarily reduce strain through the tendon
Supportive footwear with a firm heel counter and good cushioning
Avoiding barefoot walking and flip-flops for a short period while symptoms settle
Reducing aggravating activities such as hill running, sprinting and jumping rather than stopping all exercise
Swimming, cycling or other lower-impact activities to maintain fitness
Ice or simple pain relief if required for symptom management
These strategies help settle symptoms, but they don’t repair the tendon itself.
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Why Strength Loading Is the Real Treatment
Progressive strengthening is what changes the tendon.
Controlled, gradually increasing load — usually beginning with slow calf raises before progressing to heavier strengthening and eventually plyometrics — provides the mechanical stimulus the tendon needs to remodel.
Over time the tendon becomes stronger, more organised and more resilient, allowing it to tolerate greater loads before becoming painful.
This process is measured in months rather than weeks, and getting the dosage right is important. Too little load won’t stimulate adaptation, while too much can flare symptoms unnecessarily.
As a general guide, a small increase in discomfort during exercise is often acceptable provided symptoms return to their usual baseline within 24 hours. Pain that progressively worsens during exercise or remains significantly worse the following day usually suggests the tendon has been overloaded.
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Insertional vs Mid-Portion Achilles Tendinopathy
One important distinction is where the tendon hurts.
With insertional Achilles tendinopathy, the tendon can become irritated not only by loading but also by compression against the heel bone when the ankle bends upwards.
This means stretches or exercises that work well for mid-portion Achilles tendinopathy may actually aggravate insertional symptoms. Correctly identifying which type you have helps guide rehabilitation and often speeds recovery.
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Do I Need a Scan?
Usually not.
Achilles tendinopathy is primarily diagnosed through a detailed clinical assessment. Ultrasound scans and MRI can certainly identify changes within the tendon, but interestingly these changes are also commonly found in people who have absolutely no pain.
Scans are generally reserved for unusual presentations, suspected tendon tears, or when recovery isn’t progressing as expected.
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What About Injections?
Many people ask whether an injection will fix Achilles pain.
Unlike some other musculoskeletal conditions, steroid injections are generally avoided directly into the Achilles tendon because they can weaken tendon tissue and increase the risk of tendon rupture.
In selected cases other treatments may be considered, but progressive strengthening remains the cornerstone of successful management.
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When Should You See a Physio?
It’s worth having your Achilles assessed if:
Symptoms have lasted longer than two to three weeks
You noticed a sudden “pop”, marked weakness or difficulty pushing off (which could indicate a partial or complete rupture)
Pain is affecting your walking, running or sport
You’re unsure whether it’s insertional or mid-portion tendinopathy
You’d like a structured rehabilitation programme rather than relying on trial and error
At Shore Health Physio, we assess not only the tendon itself but also the factors that contributed to the overload — training habits, footwear, calf strength, biomechanics and recovery. From there we build an individual rehabilitation programme designed to restore your confidence and get you back doing what matters to you.
Whether that’s training for Brighton Marathon, running along Shoreham Beach, walking the South Downs near Lancing, or simply enjoying comfortable walks around Worthing or Hove, the principles remain the same: reduce overload, rebuild capacity and progress gradually.
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Frequently Asked Questions
Is it safe to keep running with Achilles tendinopathy?
Often, yes.
Many runners can continue training by temporarily reducing mileage, avoiding hills and speed sessions, and monitoring symptoms carefully. The aim is to keep the tendon working without repeatedly overloading it.
Why is my Achilles worse first thing in the morning?
During sleep the tendon remains relatively still, allowing it to become temporarily stiffer. Those first few steps suddenly load the tendon, creating the familiar morning pain and stiffness. As the tendon warms up and begins moving again, symptoms often ease.
How long does Achilles tendinopathy take to heal?
Most people notice meaningful improvement over several weeks to a few months, although longer-standing cases can take longer. Tendons generally respond well to consistency rather than quick fixes.
Should I stretch my Achilles?
Gentle mobility is often fine, but aggressive stretching—particularly for insertional Achilles tendinopathy—can actually make symptoms worse. Progressive strengthening should remain the primary focus.
Can Achilles tendinopathy heal on its own?
Mild cases sometimes improve if the overload naturally reduces, but many persistent cases continue because the tendon never rebuilds the capacity needed for everyday activity. Progressive loading is usually the key to lasting improvement.
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The aim isn’t simply to make the pain disappear—it’s to build an Achilles tendon that’s stronger, more resilient, and capable of coping with whatever you ask of it in the future.
Written by CJ Bestwick, Founder of Shore Health Physio.
If you’re experiencing heel pain, it’s also worth reading our guide to plantar fasciitis, as the two conditions can sometimes be confused.