Why massage isn’t the best treatment for Achilles pain
Updated: Jun 7
Massage can’t fix Achilles tendonitis/tendinopathy. Of course I use massage in my clinic and tell my Achilles patients to do self-massage as part of their treatment, but it’s not for the reasons you may think! Let me explain why. Remember, if you need 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 most of our articles.
In this article:
I've also made a video about this:
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 consistently very hard and not allowing enough recovery time between sessions).
I’ve written a detailed article 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, move away from each other and are no longer aligned in parallel.
The cells in the tendon change to bigger ones that are different from the normal ones.
Small blood vessels 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. (An injured tendon is not as stiff as is should be.)
Why massage can’t fix Achilles tendinopathy
For your Achilles tendon to heal and become strong again, the body has to replace the injured cells and collagen fibres with new, strong, 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 lift a heavy weight for strength training.
Think about it: You won’t go for a massage every week and then expect to have stronger muscles! If you want to build strong muscles, you’ll head to the gym and exercise them.
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 tendon", but we know from research that this is just 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 about how the cells and fibres in your muscles and tendons are aligned, how strong they are, and how healthy they are. To achieve this, you have to exercise the tendon and muscle.
Massage isn't totally useless
That said, not all patients react the same. Sometimes, pain can stop you from starting your strength exercises, and massage has been shown to be a valuable tool to help decrease the pain when you have mid-portion Achilles tendinopathy.
I 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.
Here's a video about managing that load.
This is the reason why we’re able to treat Achilles pain 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.
How we can help
Need 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 and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter, and Instagram.