Why massage isn’t the best treatment for Achilles tendonitis

Massage can’t fix Achilles tendonitis. Of course I use massage in my clinic and often tell my Achilles patients to do self-massage as part of their treatment, but it’s not for the reasons you may think! In this article, I’ll explain when massage may be useful and explain how to massage the Achilles tendon so that it doesn’t aggravate your injury. 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. Some of the links in this article are to pages where you can buy products discussed or mentioned here. We may earn a small commission on the sale of these at no extra cost to you.

In this article:

1. What happens in your Achilles tendon when you have tendonitis

2. Why massage can’t fix Achilles tendonitis

3. When and how to use massage for Achilles tendonitis

4. How to use a massage gun for Achilles tendonitis

5. How we can help

I've also made a video about this:

What happens in your Achilles tendon when you have tendonitis

Achilles tendonitis develops when you work your Achilles tendon too hard. This can happen suddenly (e.g. doing a hard hilly run when you’re 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 tendonitis or tendinopathy, but here’s a short summary:

• The collagen fibres that make the Achilles tendon so strong 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 of its stiffness and strength.

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. Massage can’t trigger this process.

The main signal for your body 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 weight for strength training.

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.

When and how to use massage for Achilles tendonitis

That said, massage isn’t totally useless. 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 Achilles tendonitis.

In this video, I demonstrate some self-massage techniques for Achilles tendonitis:

When you have Achilles tendonitis, it’s usually best to focus the massage on the calf muscles (gastrocnemius and soleus) rather than on the tendon itself. Or, if you are going to massage the Achilles tendon, be very gentle. Injured tendons often get more irritated and painful if you press or rub them very hard (similar to pressing on a bruise) – this is why I strongly advise against cross friction massage for Achilles tendonitis.

I often include self-massage as part of my treatment for my online Achilles tendonitis patients, because it can make a big difference to their pain and discomfort. But I ensure 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.

How to use a massage gun for Achilles tendonitis

There is very little research into massage guns and we are only starting to form ideas about the best and safest way to use them.

The current research suggests that, if muscle relaxation and improved flexibility is your aim, you should:

• Keep the treatment to below 2 minutes per muscle group if you use a high frequency gun (more than 2 400 percussions per minute)

• Apply it for a minimum of 2 but maximum of 5 minutes per muscle group if you’re using a low frequency of percussion (2 400 percussions per minute or lower).

There have been reports of people causing themselves serious injuries by overusing a massage gun. To help prevent injuries when you use it for Achilles tendonitis, we advise that you:

• Only use a massage gun if you have normal sensation in your calf and Achilles tendon (so you can feel what is happening)

• Use the medium ball fitting (about the size of a golf ball)

• Use a low frequency (2 400 percussions per minute or lower)

• Target the calf (soleus and gastrocnemius) muscles and spend no more than 5 minutes in total per calf

• Initially, avoid using the massage gun directly on the Achilles tendon, especially where it inserts into the heel bone. You may be able to start doing this once your tendon has fully calmed down, but it is likely to irritate your Achilles if you do it too early (it’s a bit like constantly prodding a bruise)

• Don’t ever use it in the area where the Achilles tendon attaches to the heel bone if you have heel bursitis

• Apply it at a “comfortably uncomfortable” intensity (about 4 to 6 out of 10 on a pain scale)

• Leave at least 48 hours between treatments – your body needs time to recover.

In general, whether you have Achilles tendonitis or not, don’t use a massage gun:

• If you have a systemic illness or condition, for example diabetes, osteoporosis, iron deficiency, or a kidney disease – the conditions affect your body’s ability to repair and there have been reports of people with these conditions sustaining serious harm when using massage guns.

• On open wounds or areas of inflammation

• Over a new scar (fewer than 12 weeks old)

• On your face; there have been reports of people damaging their eyes due to the vibration when they massaged their forehead and temples for headaches

• On your neck or over major arteries, because there has been reports of people damaging their arteries, resulting in strokes

• Over your chest if you don’t have a lot of muscle there.

Here are some massage guns available on Amazon:

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.

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