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Why massage isn’t the best treatment for Achilles pain

Updated: Nov 17, 2022

Yes, of course I use massage in my clinic and tell my Achilles tendinopathy/tendinitis patients to do self-massage as part of their treatment but it’s not for the reasons that you may think! Massage can’t fix Achilles tendinitis/tendinopathy. Let me explain why.

In this article:

  • What happens in your Achilles tendon when you have a tendinopathy

  • Why massage can’t fix this

I've also done a short video on this topic:

What happens in your Achilles tendon when you have a tendinopathy

Achilles tendinopathy or tendinitis develops when you work your Achilles tendon too hard. This can happen suddenly (e.g. doing a hard hilly run when you’re just used to running on the flat) or slowly over several weeks (e.g. training very hard and not allowing enough recovery time between sessions).

I’ve written a detailed blog post about the changes that happen inside your tendon when it has tendinitis or tendinopathy but here’s a short summary:

  • The collagen fibres inside the Achilles, that give the tendon its strength, moves away from each other and are no longer aligned in parallel.

  • The cells in the tendon changes to larger ones that are different from the normal ones.

  • You get small blood vessels that grow into the tendon – healthy tendons don’t have blood vessels growing into them.

The end result is that the tendon develops a lump and loses some if its stiffness and strength. is an expert online physio service for treating Achilles tendon pain. Click this link to read more about it.

Why massage can’t fix this

For your Achilles tendon to heal, the body has to replace the injured cells and collagen fibres with new, strong and healthy ones. The main signal that the body uses to build stronger muscles and tendons is when you use that part of the body to perform a task that requires effort, like when you pick up a heavy weight while doing strength training.

Think about it, if you want to build strong muscles you’ll head to the gym and exercise them. You won’t go for a massage every week and then expect to have a beach body by the end of your treatment!

Massage therapists and physios often say things like they’re pushing the knots out of your muscles or breaking down scar tissue in your Achilles, but we know from research that this is not the case. Massage is an extremely good tool to help decrease pain and relax muscles, but it does this by calming the nervous system down. It doesn’t change anything in how the cells and fibres in your muscles and tendons are aligned, how strong they are or how healthy they are. To achieve this, you have to exercise the tendon and muscle.

That said, not all patients react the same. Sometimes pain can stop you from starting your exercises and massage has been shown to be a valuable tool to help decrease the pain when you have mid portion Achilles tendinopathy.

I’ll always include self-massage as part of my treatment for my online Achilles tendinopathy patients because it can make a big difference to their pain and discomfort. But I make very certain that my patients understand that it’s ONLY through doing a carefully graded strength training programme and managing the total load that they put through their tendons that they’ll get rid of their Achilles pain for good.

This is the reason why we’re able to treat Achilles pain so successfully using video calls – the key to a successful recovery lies in getting your training load and strengthening exercises right and that’s easily done online.

Let me know if you have any questions! You can read more about our online service for treating Achilles pain or book a free call if you prefer to discuss your injury with one of us.

Best wishes


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.

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