Dr. Vaishali Suri (P.T.)
Achilles Tendinopathy: Common, Painful, and Treatable
Achilles tendinopathy is degeneration of the Achilles tendon — the large tendon connecting the calf muscles to the heel bone. It is extremely common in runners, sports players, and middle-aged adults who increase their activity levels. The classic presentation is morning stiffness and pain at the back of the heel that warms up with activity but worsens after exercise.
Mid-portion vs. Insertional Tendinopathy
Mid-portion tendinopathy (2–6 cm above the heel) is more common and responds excellently to eccentric loading. Insertional tendinopathy (at the bone-tendon junction) is more stubborn and requires modified protocols — heavy eccentric loading can worsen insertional pathology.
Why the Tendon Becomes Painful
Tendinopathy occurs when tendon load exceeds its capacity to adapt. The tendon becomes disorganised at the cellular level (failed healing response). Contributing factors: sudden increase in running volume or intensity, hill running, hard surfaces, calf muscle weakness or tightness, and biomechanical factors.
Physiotherapy Treatment
Eccentric Heel Drop Programme (Alfredson Protocol)
The eccentric heel drop programme is the most evidence-based treatment for mid-portion Achilles tendinopathy. Patients perform 3 sets of 15 repetitions on both a straight and a bent knee, twice daily, on a step. The key is performing the exercise into pain — this is counterintuitive but essential for tendon remodelling. Improvement typically occurs over 12 weeks.
Heavy Slow Resistance Training
Recent evidence suggests heavy slow resistance (HSR) training — performing the same exercises with added weight at a slower tempo — is at least as effective as the Alfredson protocol and may be more tolerable for insertional tendinopathy.
Load Management
Reducing — not eliminating — the loading that caused the tendinopathy while maintaining fitness through cross-training (cycling, swimming) is important for long-term management.
Electrotherapy Adjuncts
Shockwave therapy, laser, and therapeutic ultrasound can provide useful adjunctive pain relief and promote tendon healing alongside loading programmes.
Achilles Treatment in Faridabad
At Realign Rehab Clinic, NIT-5, Faridabad, our Achilles rehabilitation programmes have helped hundreds of patients return to sport. Book your assessment today.