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Top 5 reasons why your Achilles is not getting better

Updated: Jun 1, 2022

Have you tried to help your on-going Achilles pain but found that things aren’t improving? This blog explores the top 5 reasons why this might be.

These are the top 5 reasons why your Achilles injury may not be getting better.

Top 5 reasons

  1. Is your diagnosis correct?

  2. Is there something in your medical history that can play a part?

  3. Have you tried strengthening exercises?

  4. Have you thought about what activity you do and how you do it?

  5. How long have you tried your exercises and activity management for?

1. Is your diagnosis correct?

Achilles tendonitis or tendinopathy is the most common reason for on-going Achilles pain but sometimes other things may have caused it. This link will help you tell if your symptoms fit the textbook picture.

If you feel like this may not be you or you have tried all the advice and exercises you have been given and things aren’t progressing, then there could be another cause. These other causes are less common but worth exploring with a professional.

For example the nerve that runs down the back of the leg (sciatic nerve) can create symptoms that mimic Achilles tendinopathy and a physiotherapist can easily assess this and rule it in or out.

Other muscles near your Achilles can also cause pain in that area. An experienced physio can listen to how you describe your symptoms, how it all started and test all the other muscles which will allow them to give you advice about what to do next and how to get better.

2. Is there something in your medical history that can play a part?

You may have followed the prescribed exercises and advice to the letter, but things are not going so well or you aren’t moving along as fast if you compare yourself to someone else you know.

Unfortunately some things in our medical history (most of which we can’t control) may mean progress is slower than expected. The menopause is a great example of this. There are also other things like medications you have taken or are taking and other illnesses/conditions you are dealing with that can mean symptoms aren’t easing as you were expecting.

The good news is that all these factors can be taken into account and with the right advice and exercises you can still get better and return to your sport and activities you like to do. This is another reason why it’s useful to consult a professional as they should ask about your general health and advise you on all of these aspects.

We provide expert online physio treatment for Achilles tendonitis or tendinopathy. Follow the link to find out how it works.

3. Have you tried strengthening exercises?

The current research is clearly showing that the best and most effective treatment for Achilles tendinopathy is exercise combined with load management (relative rest).

The best type of exercise programme is one that has been tailor made for you, because everyone has different starting points, health, body size, strength, medications, previous injuries, lifestyles and genetics. In addition to this everyone also has different end points; do you want to run a couch to 5k or an ultra marathon?

If you have tried exercises but they were very generic or you gained your information from a magazine or off the internet, it may be why things are not working out for you. It is important to be prescribed these exercises by a professional who can tailor them to your specific situation.

4. Have you thought about what activity you do and how you do it?

Many people have tried exercises alone and in our experience, if this is not mixed with relative rest (load management), this is a highly likely reason why things aren’t improving.

We are big proponents of relative rest. This means that we only get you to cut out the really aggravating activities, or to adjust your training programme so that you can continue to train without making the injury worse.

Simple adjustments in the short to medium term can make a big difference and common training errors can be highlighted. An example of this is the boom and bust cycle that runners often get stuck in.

5. How long have you tried your exercises and load management treatment for?

I’m sorry to say, but there are no quick fixes for Achilles tendonitis/tendinopathy. You need time to strengthen your calf and Achilles as well as other areas of your body.

The same way that you can’t get a six pack in a couple of weeks of going to the gym, you also can’t get a more robust Achilles tendon by only doing the exercises for a few weeks.

Most people are significantly better and return to their sport and activity within 12 weeks of starting a tailor-made advice and exercise programme. The current research supports this but expect improvements to still continue after this point too.

Let me know if you have any questions. Need more help with your Achilles injury? You can consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes


About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.


  1. Cook JL, Khan KM, Purdam C. Achilles tendinopathy. Man Ther 2002:7;121–30.

  2. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214–8.

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