Top 5 reasons why your Achilles is not getting better

Have you tried to get rid of your ongoing Achilles pain but found that things aren’t improving? Here are the Top 5 reasons why this might be.

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:

1. Is your diagnosis correct?

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

3. Have you tried strengthening exercises?

4. Have you thought about what activities you do and how you do them?

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

6. How we can help

1. Is your diagnosis correct?

Achilles tendonitis or tendinopathy is the most common reason for ongoing 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 might 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.

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.

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, for example, do you want to run a couch-to-5k or do you want to tackle 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 activities you do and how you do them?

Many people have tried exercises only 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 continue after this point.

How we can help

Need more help with your Achilles 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. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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, and Twitter.

References:

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.