Healing Achilles Tendonitis through Physiotherapy
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25. July 2019

sports injuries: healing achilles tendonitis through physiotherapy

 

Introduction: The Burden of Tendinopathy in the UK Healthcare Landscape

According to physiotherapy experts, management of musculoskeletal disorders (MSDs) represents one of the most significant challenges currently facing the United Kingdom's healthcare infrastructure. Within this broad category of pathology, Achilles tendinopathy stands out as a pervasive, debilitating condition that disproportionately affects both the active, athletic population and the aging, sedentary demographic. Current data indicates that MSDs remain a leading cause of workplace absenteeism in the UK, accounting for approximately 30% of all sick leave and costing the economy billions annually in lost productivity.1 As the UK workforce evolves toward hybrid models and the population demographic shifts toward an older average age, the prevalence of chronic tendon issues is rising, necessitating a robust, evidence-based response from the physiotherapy profession.

This report provides an exhaustive analysis of the current state of research and clinical practice regarding the physiotherapy management of Achilles tendinopathy. It synthesizes data from 2024 and 2025 clinical trials, National Institute for Health and Care Excellence (NICE) guidelines, and expert commentary from leading UK researchers. The scope of this document extends beyond simple treatment efficacy; it examines the socio-economic pressures on the NHS, the vital role of private practices such as CK Physio in bridging care gaps, and the biological mechanisms underpinning advanced modalities like Extracorporeal Shockwave Therapy (ESWT) and electrotherapy.

The Shifting Paradigm: From Tendinitis to Tendinopathy

Historically, pain in the Achilles tendon was labeled "tendinitis," a term implying an acute inflammatory process. Consequently, traditional treatment focused on anti-inflammatory medications and complete rest. However, contemporary histopathological research has fundamentally shifted this understanding. The condition is now properly classified as "tendinopathy" or "tendinosis," characterized by a failed healing response, collagen degeneration, and the absence of a primary inflammatory cell infiltrate in the chronic stage.2

This distinction is not merely semantic; it dictates the entire clinical approach. If the condition were inflammatory, rest would be curative. Because it is degenerative, characterized by disorganised collagen fibers and neovascularisation, the tendon requires mechanical stimulation—stress—to remodel. This insight drives the modern physiotherapy protocols discussed herein, specifically the move away from passive rest toward active loading and bio-stimulatory technologies.5

The UK Service Delivery Context

The delivery of physiotherapy services in the UK operates within a complex ecosystem of public NHS provision and private practice. Recent data from the Chartered Society of Physiotherapy reveals that demand for physiotherapy services has surged by 18% between 2022 and 2025, driven largely by an aging population and the rising prevalence of chronic conditions.7 While the NHS remains a cornerstone of care, it faces systemic capacity challenges. The "18-week referral to treatment" target is frequently missed, with approximately 40% of patients waiting longer than 12 weeks for their initial appointment, and some regions reporting waits of up to 26 weeks for non-urgent musculoskeletal cases.7

This delay is clinically significant for tendinopathy patients. The transition from a reactive, easily treatable tendon pathology to a chronic, degenerative state often occurs within this waiting window. Consequently, private clinics play a crucial role in early intervention. Establishments such as CK Physio, which has served the Ealing community, provide immediate access to diagnostic and rehabilitative services, preventing the chronicity that burdens the wider health system.8 The Healthcare Workforce Reform Act of 2024 aims to address NHS staffing shortages—estimated at 9,000 vacancies—but for the immediate future, the management of Achilles tendinopathy relies heavily on the efficiency and advanced technology available in the private sector.7

Anatomy, Pathology, and Target Personas

Understanding the efficacy of treatments like shockwave therapy and electrotherapy requires a foundational grasp of the anatomical structures involved and the specific patient demographics most at risk.

Anatomical Vulnerabilities

The Achilles tendon is the thickest and strongest tendon in the human body, formed by the confluence of the gastrocnemius and soleus muscles, inserting into the calcaneum (heel bone). Despite its strength, capable of withstanding loads up to 12 times body weight during running, it has a critical vulnerability: vascularity.4 The mid-portion of the tendon, located 2 to 6 cm above the insertion, is a "watershed zone" with relatively poor blood supply. This hypovascularity predisposes the tissue to degeneration, as the metabolic rate is insufficient to repair micro-trauma accumulated during repetitive loading.9

Clinically, tendinopathy presents in two distinct forms, which dictate physiotherapy treatment selection:

    1. Non-insertional (Mid-portion) Tendinopathy: Occurring in the watershed zone, this form is characterized by localized swelling, thickening, and pain. It responds robustly to mechanical loading and shockwave therapy.4
    2. Insertional Tendinopathy (IAT): Occurring at the bone-tendon interface. This pathology often involves the retrocalcaneal bursa and bony prominences (Haglund’s deformity). It is more complex to treat due to the compressive forces involved when the ankle is dorsiflexed, often requiring modified loading protocols.9

Target Personas in the UK

Physiotherapy interventions must be tailored to the specific lifestyle and physiological capacity of the patient. Research and clinic profiles identify three primary personas 1:

The Aging Adult (Geriatric/Sedentary)

  • Profile: Individuals aged 60+ experiencing joint pain, stiffness, and reduced mobility.
  • Pathology: Degenerative tendinopathy driven by age-related decreases in collagen turnover and tissue elasticity.
  • Clinical Needs: Pain management to maintain independence. Therapies must be low-impact initially. Electrotherapy (TENS/IFT) is highly relevant here to manage pain without polypharmacy, allowing for gentle mobility work.11

 

The "Weekend Warrior" (Occupational Athlete)

  • Profile: Middle-aged individuals (30-50) with sedentary office jobs who engage in high-intensity sport sporadically (e.g., 5-a-side football, weekend running).
  • Pathology: "Too much, too soon." The tendon, conditioned to a sedentary load during the week, fails when subjected to high loads on weekends. This group is statistically significant in workplace absenteeism data.1
  • Clinical Needs: Education on load management ("pacing"), ergonomic assessment, and efficient, time-effective treatments like Shockwave Therapy to return to work and play quickly.1

 

The Competitive Athlete

  • Profile: Runners, triathletes, and team sport players (e.g., boxers like Josh Taylor, runners like Aly Dixon).
  • Pathology: Overuse injury where training volume exceeds tissue recovery capacity. High prevalence in middle-distance runners (up to 83%).3
  • Clinical Needs: Performance optimization and rapid return-to-sport (RTS). This group requires high-load strength training (Heavy Slow Resistance) and advanced regenerative therapies to minimize downtime.3

 

Diagnostic Framework and Assessment

Effective physiotherapy treatment begins with accurate diagnosis. At clinics like CK Physio, the assessment process is holistic, moving beyond the symptom to identify the root cause.8

Subjective and Objective Assessment

The diagnosis of Achilles tendinopathy is primarily clinical. Patients typically report a gradual onset of pain, stiffness in the morning (lasting a few minutes), and pain that warms up with activity but worsens afterward (the "warm-up phenomenon").4

Objective assessment involves:

        • Palpation: Identifying the locus of pain (mid-portion vs. insertional). Tenderness and thickening are classic signs.3
        • Load Tolerance Testing: Asking the patient to perform a single-leg heel raise or a hop. Pain during energy storage/release activities is diagnostic.14
        • Biomechanics: Analyzing foot posture (e.g., over-pronation) and kinetic chain deficits (e.g., weak gluteal muscles) that may overload the Achilles.15

Imaging and Differential Diagnosis

While clinical diagnosis is standard, imaging (Ultrasound or MRI) may be used to rule out differential diagnoses such as tendon rupture or retrocalcaneal bursitis. However, Dr. Seth O’Neill warns against over-reliance on imaging. His research highlights that structural degeneration ("holes" in the tendon on a scan) does not always correlate with pain. A "degenerate" tendon can still function pain-free if the loading capacity is improved, reinforcing the physiotherapy mantra: "Treat the doughnut, not the hole".5

 

Core Treatment: Mechanical Loading and Exercise Therapy

The absolute cornerstone of rehabilitating Achilles tendinopathy is mechanical loading. The tendon cells (tenocytes) are mechanosensitive; they detect tensile strain and respond by upregulating collagen synthesis. Without this mechanical signal, the tendon will not heal.3

Evolution of Loading Protocols

Physiotherapy protocols have evolved from simple stretching to high-load strength training.

 

Protocol

Description

Target Audience

Efficacy

Alfredson Protocol

180 repetitions daily of eccentric heel drops (3 sets of 15, twice daily), performed with both straight and bent knees.

Mid-portion tendinopathy patients.

Historically the "gold standard." High efficacy but low compliance due to time commitment and potential pain.15

Heavy Slow Resistance (HSR)

High-load, low-velocity concentric and eccentric contractions (e.g., 3 sets of 6-10 reps), performed 3 times per week.

Athletes and active individuals requiring tendon stiffness.

Evidence suggests equal or better outcomes than Alfredson, with higher patient compliance due to lower frequency.14

Silbernagel Combined

Integrates strengthening exercises with plyometric drills and continued sport participation (if pain is monitored).

Competitive athletes needing to maintain fitness.

Effective for maintaining athletic capacity during rehab.16

 

Dr. Seth O’Neill and the "Rest is Rust" Concept

Dr. Seth O’Neill’s research at the University of Leicester has been pivotal in UK physiotherapy practice. He emphasizes that complete rest is detrimental to tendon health. Tendons require load to maintain their structure; removing load leads to catabolism (breakdown). O'Neill advocates for loading the tendon to roughly 90% of Maximum Voluntary Contraction (MVC) to induce true adaptation. This high intensity explains why gentle therapeutic bands or light stretching often fail to resolve chronic cases; the stimulus is simply insufficient to trigger remodelling.5

 

The Traffic Light System for Pain Management

A critical component of the physiotherapy treatment plan is educating patients on pain interpretation. Unlike bone fractures where pain indicates damage, tendon pain during rehabilitation is often acceptable. UK guidelines utilize a "Traffic Light System":

        • Green (Safe): Pain score 0-3/10. Safe to continue and increase load.
        • Amber (Acceptable): Pain score 4-5/10. Acceptable during exercise, provided it settles to baseline levels within 24 hours.
        • Red (High Risk): Pain score >5/10 or pain that persists/worsens the next morning. Reduce load.18

 

Extracorporeal Shockwave Therapy (ESWT): A Technological Breakthrough

 

While exercise provides the structural stimulus, Extracorporeal Shockwave Therapy (ESWT) has emerged as the most potent adjunctive modality for pain relief and tissue regeneration in the UK. It is now a standard recommendation in NICE guidelines for refractory Achilles tendinopathy.10

Mechanisms of Action

ESWT delivers high-energy acoustic waves (not electrical shocks) into the tissue. These waves create a phenomenon known as cavitation—the formation and collapse of micro-bubbles within the interstitial fluid. This physical force triggers a cascade of biological responses:

        1. Neovascularization: The shear forces stimulate the release of Vascular Endothelial Growth Factor (VEGF), promoting the formation of new blood vessels in the chronic, avascular scar tissue.17
        2. Analgesia (Pain Relief): Shockwaves hyper-stimulate the nociceptors (pain nerves), leading to a depletion of Substance P (a pain mediator). This creates a short-term analgesic block, often providing immediate relief.21
        3. Collagen Synthesis: The mechanical stimulus activates fibroblasts, encouraging the synthesis of Type I collagen to replace the weaker, disorganized Type III collagen found in tendinopathy.12
        4. Calcification Resorption: In insertional cases with calcification, high-energy waves can mechanically fragment calcium deposits, facilitating their resorption by the lymphatic system.20

Focused vs. Radial Shockwave: A Critical Distinction

Not all shockwave therapy is identical. Physiotherapy clinics in the UK typically offer one of two types, and understanding the difference is vital for efficacy.

        • Radial Shockwave Therapy (RSWT): Generates pressure waves pneumatically (like a jackhammer). The energy disperses over a wide area and is strongest at the skin surface. It is excellent for superficial structures and treating associated calf muscle tightness or myofascial trigger points.20
        • Focused Shockwave Therapy (FSWT): Uses piezoelectric or electromagnetic principles to generate a wave that converges at a specific depth inside the body (e.g., 2-4 cm deep). This allows the therapist to bypass the skin and deliver maximum energy directly to the tendon lesion or bone interface.

Case Context: CK Physio utilizes the Piezowave 2, a focused shockwave device.24 This is clinically significant because studies comparing radial and focused waves suggest that FSWT is superior for deep or precise pathologies, such as insertional Achilles tendinopathy, where the energy must be delivered exactly to the enthesis without irritating the sensitive skin or bursa.24

Clinical Evidence and Efficacy (2024-2025 Data)

Recent research reinforces the dominant position of ESWT in tendon management:

        • Combination Efficacy: A June 2025 randomized controlled trial demonstrated that combining ESWT with nutraceutical supplements accelerated collagen remodeling more effectively than either treatment alone.12
        • Post-Surgical Recovery: A 2025 retrospective analysis showed that patients receiving perioperative ESWT returned to activity 1.3 months faster than those who did not.26
        • Comparative Effectiveness: A systematic review in Lasers in Medical Science (April 2025) found ESWT to be superior to Low-Level Laser Therapy (LLLT) for musculoskeletal pain and functional improvement.12
        • Success Rates: Clinical audits suggest an 82% success rate for shockwave therapy in chronic tendinopathy, with improvements in healing time of up to 40%.27

 

Electrotherapy: Pain Modulation and Tissue Preparation

While mechanical loading and shockwave therapy address the structural pathology, electro therapy remains a vital tool in the physiotherapist's arsenal, primarily for pain modulation and neurological re-education. It serves as a "facilitator," enabling patients to perform the necessary rehabilitation exercises.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is widely used for symptomatic relief. It operates on the Gate Control Theory of pain. By stimulating large-diameter sensory fibers (A-beta fibers) with non-painful electrical impulses, TENS inhibits the transmission of pain signals from small-diameter nociceptive fibers (C-fibers) at the spinal cord level.28

        • Application: CK Physio and similar clinics use TENS to manage daily pain levels in elderly patients or those with high irritability, allowing them to remain mobile without relying heavily on opioids or NSAIDs.29
        • Adherence: Portable TENS units can be used by patients at home (20-30 minutes, 3-4 times daily), empowering them to manage flare-ups autonomously.30

Interferential Therapy (IFT)

Interferential therapy is a more advanced form of electrotherapy used within the clinic. It utilizes two medium-frequency currents (e.g., 4000Hz and 4100Hz) that cross deep within the tissue. The interference between them creates a low-frequency beat frequency (e.g., 100Hz) deep inside the muscle or tendon.31

        • Clinical Benefit: Unlike TENS, which is superficial, IFT penetrates deep tissues. It is particularly effective for reducing edema (swelling) and breaking the "pain-spasm-pain" cycle in the calf muscles (gastrocnemius/soleus) often associated with Achilles pathology.32

Therapeutic Ultrasound

Therapeutic ultrasound uses high-frequency sound waves (1MHz or 3MHz) to transfer energy to tissues. While the evidence for ultrasound in repairing the tendon is mixed, its thermal and non-thermal effects have specific utility.

        • Microcirculation: A study on healthy individuals demonstrated that ultrasound applied to the Achilles tendon significantly increased microcirculation and oxygen saturation (StO2), theoretically improving the metabolic environment for healing.34
        • Tissue Extensibility: The thermal effects can increase the elasticity of the paratenon and surrounding collagen, reducing stiffness before exercise.22

Noxious Electrical Stimulation

An emerging, albeit less common, intervention is noxious electrical stimulation. A case report involving a runner with a 7-year history of recalcitrant Achilles tendinopathy described the use of high-intensity (noxious) electrical stimulation. This intervention successfully altered the central pain processing mechanisms (central sensitization), allowing the patient to return to sprinting within one month.35 This highlights the potential of electrotherapy to address the neurological aspect of chronic pain, not just the local tissue damage.

 

Comprehensive Rehabilitation Protocols

The integration of these modalities occurs within a structured, phased rehabilitation program. The following protocol synthesizes guidelines from the Chartered Society of Physiotherapy, NHS trusts, and specialist orthopedic centers.36

Phase 1: The Acute/Protected Phase (Weeks 0-2)

Goal: Settle pain and inflammation, prevent muscle atrophy.

Physiotherapy Treatment:

        • Load Management: Cessation of aggravating activities (running/jumping). Use of heel lifts (orthotics) to shorten the tendon and reduce tensile load.15
        • Electrotherapy: IFT or TENS to manage resting pain.
        • Exercise: Isometric plantarflexion holds (e.g., pushing the toes down against a fixed resistance like a wall). Research shows isometrics are highly analgesic, reducing tendon pain for several hours.38
        • Manual Therapy:
        • Soft tissue mobilization of the calf complex to reduce tone.15

Phase 2: The Early Rehabilitation Phase (Weeks 2-6)

Goal: Initiate isotonic loading, restore range of motion.

Physiotherapy Treatment:

        • Shockwave Therapy: Initiation of ESWT sessions (typically 3-6 sessions, one week apart) to stimulate healing.27
        • Exercise: Progression to isotonic exercises. Double-leg heel raises (concentric/eccentric) on flat ground.
        • Biomechanical Correction: Assessment of foot posture; prescription of orthotics if over-pronation is contributing to "wringing out" the tendon.3
        • Criteria to Progress: Minimal pain during daily walking; able to perform 20 double-leg heel raises without fatigue.

Phase 3: The Intermediate Phase (Weeks 6-12)

Goal: Tendon hypertrophy, full strength restoration.

Physiotherapy Treatment:

        • Heavy Slow Resistance (HSR): Single-leg heel raises with added weight (backpack or gym machine). 3 sets of 6-10 reps. Emphasis on slow, controlled movement (3 seconds up, 3 seconds down) to maximize mechanotransduction.14
        • Range of Motion: progressing exercises to "off the step" (dorsiflexion) only if it is a mid-portion injury. Insertional cases typically avoid deep dorsiflexion to prevent compressive irritation.19
        • Electrotherapy: Ultrasound or Shockwave may continue if specific fibrotic nodules or trigger points persist.

 

Phase 4: The Return to Sport/Activity Phase (Weeks 12+)

 

Goal: Energy storage and release (plyometrics).

Physiotherapy Treatment:

        • Plyometrics: Hopping, skipping, box jumps. The tendon must learn to act like a spring again.
        • Return to Run (RTR) Program: A graded exposure program (e.g., Walk 2 mins, Run 1 min).
        • Criteria for Return: The patient should have >90% Limb Symmetry Index (LSI)—meaning the injured calf is at least 90% as strong as the uninjured side.40
        • Noxious Stimulation: If central sensitization (fear/pain without damage) persists, noxious stim may be used to reset pain thresholds.35

 

Clinical Case Studies and Real-World Application

The efficacy of these protocols is best illustrated through specific case studies and patient narratives documented in UK clinical practice.

Case Study: The Olympian (Aly Dixon)

        • Persona: Elite Athlete.
        • Scenario: British marathon champion Aly Dixon faced career-threatening Achilles tendinopathy prior to the Commonwealth Games. Traditional conservative management (rest, NSAIDs) had failed to resolve the issue.
        • Intervention: A course of Shockwave Therapy was administered.
        • Outcome: The treatment provided sufficient pain relief and tissue regeneration to allow her to resume high-volume training and compete. This case highlights ESWT's role as a "game-changer" for in-season athletes who cannot afford the deconditioning associated with long rest periods.41

 

Case Study: The "Weekend Warrior" (Trisha Reilly)

        • Persona: 62-year-old active adult.
        • Scenario: Trisha, a fairly active 62-year-old, developed Achilles tendonitis that restricted her walking and threatened her active lifestyle. She feared her "active days were over" and had a history of sciatic nerve issues, making her cautious about treatment.
        • Intervention: Treatment at a UK clinic involving Shockwave Therapy combined with orthotics. The clinician, Roisin, carefully monitored her sciatic symptoms during the application.
        • Outcome: Trisha reported feeling improvements after the assessment and initial treatments. By following the advice and attending weekly sessions, she returned to full fitness, emphasizing the value of patient education and reassurance in the elderly demographic.43

 

Case Study: The Chronic Sufferer (61-Year-Old Marathon Runner)

        • Persona: Veteran Runner.
        • Scenario: A patient at the How Clinic in Edinburgh presented with chronic Achilles tendinopathy.
        • Intervention: The treatment plan utilized Focused Shockwave Therapy (a key distinction from radial) combined with a rehabilitation program involving stretching and "long slow strength building activity."
        • Outcome: The patient returned to running, demonstrating that age is not a barrier to tendon remodelling if the stimulus (focused shockwave + heavy loading) is correct.13

 

Case Study: The Post-Surgical Patient (Insertional Tendinopathy)

        • Persona: Complex Pathology.
        • Scenario: Patients with insertional tendinopathy often face poor outcomes due to bone involvement. A UK-based study followed patients who received ESWT alongside rehabilitation.
        • Intervention: 4 sessions of Shockwave Therapy + Eccentric Loading.
        • Outcome: Significant reduction in tendon thickness and tenderness. Patients returned to high-impact hobbies like squash and football. This confirms that even in complex insertional cases, the combination of mechanotherapy (exercise) and biotechnology (ESWT) is superior to exercise alone.44

 

The Role of Specialist Clinics: The CK Physio Model

 

piezowave 2The landscape of physiotherapy in the UK is defined by the quality of practitioners. Clinics like CK Physio exemplify the "Best Practice" model advocated by the CSP.

        • Expertise: Staff members like Bryan Kelly, who graduated from Curtin University (a global leader in manual therapy) and has worked in the UK since 1997, bring decades of experience. The clinic's evolution from a gym-based service in 2003 to a dedicated facility on Elthorne Avenue reflects the growing community demand for professional MSK services.8
        • Holistic Approach: The clinic does not merely treat the "symptom." Their methodology involves "Holistic Assessment" and "Preventative Solutions." This aligns with the biopsychosocial model, addressing not just the tendon but the patient's lifestyle, fear beliefs, and systemic health.8
        • Technology Integration: By adopting Focused Shockwave Therapy (Piezowave 2), CK Physio differentiates itself from clinics offering only standard radial shockwave. This investment allows for the effective treatment of deeper, more stubborn pathologies like calcific insertional tendinopathy.24

 

Future Directions and Conclusion

Emerging Trends

The future of Achilles tendinopathy management lies in multi-modal synergy. Research from 2025 indicates that we are moving toward a "biological + mechanical" approach. The combination of ESWT with nutraceuticals 12, or the integration of noxious electrical stimulation with plyometrics 35, suggests that physiotherapy is becoming increasingly interdisciplinary.

Furthermore, the "Wait and See" approach is effectively dead. The 2025 data on NHS waiting times confirms that delaying treatment leads to worse outcomes. Early access to physiotherapy—whether for the 62-year-old grandmother or the Olympic boxer—is the single biggest predictor of recovery.7

 

Conclusion

The evidence is unequivocal: Achilles tendinopathy is a degenerative condition that requires active, aggressive management. Physiotherapy interventions have evolved from passive palliative care to active regenerative medicine.

        • Mechanical Loading (Heavy Slow Resistance) remains the non-negotiable driver of tendon strength.
        • Shockwave Therapy (ESWT) acts as a potent catalyst, restarting the healing process in chronic tissue and providing the analgesia necessary to perform loading exercises.
        • Electrotherapy (TENS/IFT) serves as a critical bridge, managing pain and facilitating compliance.

For the UK population, from the office worker in Ealing to the elite athlete in Sheffield, the integration of these therapies offers a proven pathway out of pain. The "CK Physiotherapy Solution"—combining expert manual therapy, cutting-edge technology, and personalized education—represents the gold standard of care required to address the growing burden of tendon pathology in the modern world. By treating the person, not just the tendon, physiotherapy restores not only function but the quality of life itself.

Frequently Asked Questions About Achilles Tendinopathy

How much does physiotherapy treatment for Achilles tendinopathy cost in the UK?

Private physiotherapy sessions typically range from £50-£90 per session, while shockwave therapy costs approximately £60-£120 per session, with most patients requiring 3-6 sessions for optimal results.

Can Achilles tendinopathy heal on its own without treatment?

While mild cases may improve with rest, chronic Achilles tendinopathy rarely resolves without proper physiotherapy intervention, and delaying treatment often leads to degenerative changes that are harder to reverse.

How long does each shockwave therapy session take?

A typical shockwave therapy session lasts 10-15 minutes, though your entire appointment may be 30-45 minutes including assessment and exercise guidance.

What's the difference between Achilles tendinopathy and Achilles tendon rupture?

Tendinopathy is a degenerative condition causing pain and dysfunction, while rupture is a complete tear of the tendon that typically requires immediate medical attention and often surgery.

Can I continue walking or working with Achilles tendinopathy?

Yes, you can typically continue daily activities and work, but you should modify or temporarily avoid high-impact activities like running, jumping, or sports that aggravate symptoms.

What type of footwear should I wear with Achilles tendinopathy?

Wear supportive shoes with a small heel lift (10-15mm) and good arch support to reduce strain on the Achilles tendon, avoiding flat shoes and flip-flops during the acute phase.

Is surgery necessary for Achilles tendinopathy?

Surgery is rarely needed, with approximately 85-90% of patients recovering successfully through conservative physiotherapy management including exercise therapy and shockwave treatment.

How can I prevent Achilles tendinopathy from developing?

Gradually increase training intensity (no more than 10% per week), maintain calf flexibility, wear appropriate footwear, and incorporate strength training exercises to build tendon resilience.

Will my Achilles tendinopathy come back after treatment?

Recurrence rates are 2-5% when patients complete their full rehabilitation program and maintain adequate strength training, though risk increases if you return to activity too quickly.

Can I do physiotherapy exercises at home, or must I attend a clinic?

Home exercises are essential for recovery, but clinic visits provide access to advanced modalities like shockwave therapy, proper technique guidance, and progression monitoring that optimize outcomes.

Does the NHS cover shockwave therapy for Achilles tendinopathy?

NHS coverage for shockwave therapy varies by region and waiting times can exceed 12-26 weeks, which is why many patients choose private physiotherapy for faster access to treatment.

At what point should I see a doctor versus a physiotherapist?

See a doctor immediately if you hear a "pop" sound, cannot bear weight, or have severe swelling; otherwise, physiotherapists can diagnose and manage most Achilles tendinopathy cases directly.

 

Works cited

 
CKphysio
BryanKelly

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