When to use anti-inflammatories (NSAIDs) for Achilles tendonitis and when not to
Updated: May 27
Anti-inflammatory medication (NSAIDs) like Ibuprofen or Naproxen can form a useful part of treatment for some cases of Achilles tendon pain, but it is often over-used and prescribed for cases where it may have no effect or even interfere with recovery. In this article, I’ll discuss what types of Achilles tendon injury benefit from NSAIDs, when they may be a waste of time, and when they may actually hinder your progress. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our 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 our articles.
In this article:
Two reason why anti-inflammatories should not be taken for ongoing tendonitis
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The type of tendon injury is key
Achilles tendonitis and heel pain can have several causes, and for every cause the injury process inside the tendon is slightly different and therefore requires different treatments.
Conditions where excessive inflammation causes the injury
In some cases of heel pain, excessive inflammation is part of the reason why the injury occurred, and you have to first reduce the inflammatory response before healing can take place. Examples include:
Tendonitis caused by antibiotics
Tendonitis caused by an inflammatory condition, e.g. gout
Inflammatory enthesopathy with or without calcification.
In these cases, you usually require a short course of anti-inflammatory medication to calm the excessive inflammation down before starting with your rehab.
Conditions where you need inflammation to heal
In other cases, inflammation plays a super important part of how the injury heals, and if you suppress the inflammatory response, you can actually delay or reduce healing. These include:
Tendon tears or ruptures
Overuse tendinopathy or tendonitis that is in the reactive or acute phase (first two weeks) – this is tendon pain that develops when you overwork your tendon through sport or other activities.
So, if you have a tear or your tendon injury was caused by overuse, you may want to stay away from anti-inflammatories.
But what if I have a combination of these?
It is really common to have heel bursitis combined with an overuse Achilles tendonitis. In this case, the benefits of taking the anti-inflammatory medication may outweigh the harms, because the bursitis may prevent you from starting your rehab if it is not treated.
So, the best treatment for this combination is often to take a short course of NSAIDS to allow the bursa to calm down and then start with rehab for the Achilles tendon.
Two reasons why anti-inflammatories should not be taken for ongoing tendonitis
First, it is not needed, because there is very little inflammation present, and second, it may interfere with your rehab.
When you’ve had Achilles tendonitis or tendinopathy for several weeks or months, the research shows that there is very little inflammation present. In these cases, the injured part of the tendon falls into a dysrepair cycle, where the collagen fibres change shape and become disorganised.
To heal, the tendon needs to create new collagen fibres and organise them in parallel. The best way to get the tendon to do this is through graded strength training exercises that trigger new and stronger collagen production.
There is evidence that when you take anti-inflammatory drugs, your body does not create as many new collagen fibres in response to exercise. This means that by taking anti-inflammatory medication at the same time as following your rehab programme, you’re likely not going to see optimal results from your rehab.
It doesn’t really matter if you’ve taken a few
If you’ve been taking anti-inflammatories for ongoing Achilles tendonitis and now think that perhaps you shouldn’t have, don’t beat yourself up about it. A few tablets will not make that much of a difference to your recovery. It is just when you consistently use them for weeks or months that we may start to see poorer outcomes.
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
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
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