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Achilles Tendon Pain: Physical Therapy in Brooklyn for Achilles Tendinopathy

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Stiffness at the back of your heel when you get out of bed, pain at the start of a run that warms up, then returns worse afterward, or tenderness when you squeeze the tendon: these are common signs of Achilles tendinopathy. It affects runners, tennis and pickleball players, and plenty of people who've simply increased their walking. The key to recovery is loading the tendon the right way, and physical therapy shows you how.

What Is Achilles Tendinopathy?

The Achilles tendon is the thick tendon connecting your calf muscles to your heel bone. It's the strongest tendon in the body and stores and releases energy every time you walk, run or jump.

Achilles tendinopathy describes pain and reduced function in the tendon, usually from overload. There are two main types:

  • Midportion Achilles tendinopathy — pain and thickening a few centimeters above the heel
  • Insertional Achilles tendinopathy — pain right where the tendon attaches to the heel bone, often aggravated by pressure from shoes and by stretching

Common Symptoms

  • Pain and stiffness in the Achilles, especially in the morning or after rest
  • Pain at the start of activity that may ease, then worsen afterward
  • Tenderness when squeezing the tendon
  • Thickening or a lump in the tendon
  • Pain with hopping, running uphill or climbing stairs
  • Reduced calf strength or endurance

What Causes Achilles Tendinopathy?

  • Rapid increases in training — more mileage, more hills, more speedwork
  • New activity — starting a sport or a new job that involves lots of walking or standing
  • Calf weakness — the tendon handles more than it can tolerate
  • Footwear changes — switching to flatter shoes suddenly
  • Age — tendons become less resilient with age, and it's most common in middle-aged active adults
  • Medical factors — certain medications (including fluoroquinolone antibiotics), diabetes, high cholesterol and inflammatory conditions

How Physical Therapy Helps

Tendons respond to load. Complete rest may ease pain temporarily, but it doesn't build the tendon's capacity, so pain often returns when activity resumes. Progressive loading programs are the best-supported treatment for Achilles tendinopathy.

Evaluation

Your therapist will identify the type of tendinopathy, assess calf strength and endurance, ankle and foot mobility, and how you walk, run or hop, and review your training history. They'll also rule out other conditions, including a partial or complete tendon rupture.

Treatment May Include

  • Load management — adjusting running, jumping and walking volume
  • Isometric exercises — to reduce pain early on
  • Progressive calf strengthening — slow, heavy calf raises with the knee straight and bent, progressing to more demanding exercises
  • Plyometric and running progressions — gradually restoring spring and speed
  • Modifications for insertional pain — such as avoiding dropping the heel below a step and avoiding aggressive stretching
  • Footwear advice — and temporary heel lifts in some cases
  • Manual therapy — for the calf, ankle and foot

What You Can Do at Home

  • Don't stop moving altogether. Switch high-impact activity for cycling or swimming while the tendon settles.
  • Try calf raises. Rise up on your toes on both legs, lower slowly, and progress to one leg as tolerated. For insertional pain, do them on flat ground.
  • Use the pain monitoring model. Mild discomfort during exercise is generally acceptable if it settles within 24 hours and morning stiffness isn't getting worse.
  • Avoid aggressive stretching if your pain is at the heel attachment.
  • Increase training gradually when you return to sport.

When to See a Physical Therapist

Book an evaluation if:

  • Achilles pain lasts more than a week or two
  • Morning stiffness is getting worse
  • Pain is affecting your running, sport or walking
  • You notice thickening in the tendon

Seek urgent medical care if you felt a sudden pop or a sensation of being kicked in the back of the leg, especially with difficulty pushing off or standing on tiptoe. These can be signs of an Achilles rupture.

Frequently Asked Questions

How long does Achilles tendinopathy take to heal?

Tendons adapt slowly. Many people need a few months of consistent loading. Improvement is usually gradual rather than sudden.

Should I get a cortisone shot?

Injections into or around the Achilles are generally used cautiously, as they may weaken the tendon. Talk with your physician about the risks and benefits.

Is Achilles pain related to heel pain on the bottom of my foot?

They can be related, since a tight or weak calf affects both. Pain on the bottom of the heel is more typical of plantar fasciitis.

Ready to get started? Call the Refuah office nearest you

Schedule an evaluation by phone, or book online at refuahpt.com.

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About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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