Fed up with recurring Achilles pain? Here are some easy-to-fix mistakes that might be to blame
- Maryke Louw
- 18 hours ago
- 5 min read
If you’re disheartened by Achilles pain that comes and goes, this article will show you how to start with the positive aspect of the situation – that you’re pain-free at times which means that you can recover – and then sidestep the common mistakes that make people’s Achilles tendonitis flare up again.
Remember, if you need help with an Achilles injury, you're welcome to consult one of our physio team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
In this article:
What's needed to recover from Achilles tendonitis
First, here are some things to keep in mind that will help you understand why some behaviours can cause problems and why the solutions we suggest are likely to work.
When your Achilles is injured, it loses a bit of strength and becomes very easy to irritate.
If you rest your tendon, it calms the pain down, but it doesn't actually strengthen the tendon.
To strengthen the tendon, you have to cut down or adapt the activities that currently irritate it (relative rest) while doing specific rehab exercises to strengthen it. Your general activity levels should then increase in line with your improving strength.
You can use your symptoms to assess what activities you can do and also when you're ready to progress them – here's a detailed guide on how to do that.
As you gradually increase the intensity of your strength exercises and other activities, your Achilles rebuilds and strengthens until it eventually regains its full strength and endurance.
What causes your Achilles pain to come back?
Now, this all sounds pretty easy and straightforward, so why is it that so many people with Achilles tendonitis find that their pain seems to come back just when they think it is gone for good?
It usually boils down to one of two things:
Either the work or load placed on the Achilles is a lot more than what it can currently handle, and that overwhelms it.
Or the Achilles wasn't actually allowed enough time to recover, repair, and strengthen after the previous workout or activity you did – again, causing it to become overwhelmed and injured, but this time through cumulative dysrepair of the normal micro-injuries sustained during exercise rather than sudden overwork.
💡 The injured part of your body tends to require more time to repair and recover from workouts when you're coming back from an injury than before.
Alison also discusses examples in this video clip:
Common mistakes that lead to Achilles overwork
You normally wear shoes with a bit of a heel on them and then suddenly switch to walking long distances in flat shoes or barefoot – the Achilles stretches more and works harder when you walk in flat shoes, so you have to get your tendon used to this, gradually.
You've had a long period of inactivity (illness, holidays, injury, too busy at work), which caused your Achilles to decondition and lose strength (same as muscles do when you don't go to the gym for a while), and then suddenly restarted your training at the same intensity as before the break.
You've entered the perimenopause and simply continued to train as normal, because you didn't realise to what extent the decrease in oestrogen slowed your tendon's ability to restore and strengthen collagen fibres, and that it therefore required more recovery time.
You're doing too many high-intensity workouts in a week – high-intensity workouts usually require a lot more recovery time. Aiming for a 20/80 split with 20% high intensity and 80% moderate to low intensity training per week can help you to avoid this mistake.
You started a brand-new type of activity (like tennis or running), and went from doing very little sport, or nothing that really worked the Achilles tendon very hard, to suddenly doing it several times a week at a pretty high intensity. It's generally better to first get used to a good volume of low-intensity (whatever activity you do) with plenty of recovery time between sessions, and then slowly ease into higher intensity sessions.
You had Achilles pain and rested it until it felt better, and then went back to the same level of activity as before without first strengthening the tendon, or at least slowly easing into things.
Or perhaps you did complete some rehab exercises, but they weren't progressed to an intensity that actually matches what your Achilles has to work at during your sport or job.
Maybe your rehab built up to the perfect intensity, but then you ramped up the intensity of your sport or other activities too quickly – rehab exercises are important, but the last bit of sport-specific strength and endurance can usually only be restored by gradually easing back into that sport.
How we can help
Need help with your Achilles or related injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
