STADS Physiotherapy
Achilles tendon pain
Running pain-free again starts with understanding what your tendon needs.
or call 040 – 311 1151 / 013 – 303 0361
No referral neededSeen within 48 hoursContracts with all health insurers
You feel a stiff, painful tendon behind your ankle, especially with your first steps in the morning or at the start of a run. Achilles tendon pain is annoying and can last a long time, but with the right approach most people recover well. On this page you can read what’s going on, what you can do yourself and how we help you.
What is Achilles tendon pain?
The Achilles tendon is the thickest and strongest tendon in your body. It connects your calf muscles to your heel bone. With every step, every jump and every time you go up on your toes, this tendon transfers force from your calf to your foot. When you run, it absorbs several times your body weight.
With Achilles tendon pain, the tendon has become overloaded. People used to call this tendinitis, but we now know there is usually no real inflammation. That’s why we prefer to speak of Achilles tendinopathy: a tendon that no longer responds well to load.
There are two types. In the most common type, the pain is in the middle of the tendon, a few centimetres above the heel. In the other type, the pain is where the tendon attaches to the heel bone. The difference matters, because the exercises are sometimes slightly different.
What symptoms can you have?
- Pain and stiffness in the tendon with your first steps in the morning or after sitting still
- Pain at the start of exercise that eases a little as you warm up and then comes back
- A tendon that is tender to touch or squeeze
- Thickening or swelling of the tendon
- Pain when climbing stairs, jumping or standing on your toes
- Pain from the pressure of your shoe’s heel counter
What causes Achilles tendon pain?
Achilles tendon pain is almost always caused by an imbalance between load and load capacity. A tendon adapts to what you ask of it, but slowly. If you ask a lot more of your tendon in a short time, it can’t keep up and becomes irritated.
Typical moments when symptoms start are:
- A rapid increase in running distance, pace or hill training
- Starting a new sport with a lot of jumping
- Switching to different shoes or a hard surface
- Suddenly doing a lot again after a period of little activity
Factors that lower your load capacity also play a part. Think of weaker calf muscles, getting older, being overweight, poor sleep or a lot of stress. Some medicines, such as certain antibiotics (fluoroquinolones), can make the tendon more vulnerable. Conditions such as diabetes, gout or high cholesterol are also linked to tendon problems.
Achilles tendon pain is common in runners, but also in people who do little sport. Often there is no single cause; several factors add up.
How long does it take?
To be honest: Achilles tendon pain often needs time. A tendon heals more slowly than a muscle. With a well-structured exercise programme, many people notice improvement after a few weeks, but full recovery often takes three to six months, and sometimes longer.
Recovery has its ups and downs. After a busy day your tendon may react a bit more, and that’s normal. What matters is the trend over weeks. If you go back to full training too soon, or stop loading the tendon altogether, you risk the symptoms lasting longer. Sticking with your exercises usually pays off. Even after you’ve recovered, it’s wise to keep up your calf exercises for a while, so the symptoms are less likely to come back.
When should you see a physiotherapist?
- Your symptoms don’t ease after two weeks of adjusting your load
- Your tendon is stiff and painful every morning
- You don’t know how to keep doing your sport without making it worse
- You’ve had Achilles tendon pain before and it keeps coming back
- You’re doing exercises yourself but not seeing progress
Can’t work it out on your own?
Our physiotherapists and occupational therapists are happy to help. In most cases you can come without a referral, in Eindhoven or Tilburg.
When should you see your GP straight away?
Go straight to your GP or A&E (spoedeisende hulp) if:
- You feel a snap or a sensation like a kick to your calf during sport, and afterwards can’t stand on your toes properly; this may indicate a ruptured Achilles tendon
- You can feel a clear dent in the tendon
- Your symptoms started shortly after taking an antibiotic
- Your calf is suddenly swollen, warm and painful
How STADS helps with Achilles tendon pain
At STADS, we start with a good conversation. How did your symptoms start, what did you change in the period before, and what do you want to be able to do again? Then we examine your tendon, your calf strength, the mobility of your ankle and how you walk and jump. That way we know which type it is and how much load your tendon can handle right now.
We explain what’s happening in your tendon and why pain doesn’t mean your tendon is being damaged. Together we agree how much you can keep doing, and what your goals are, such as running ten kilometres again or standing at work all day without pain.
The basis of treatment is a progressive exercise programme with strength exercises for your calf and tendon. This is the best-researched approach for Achilles tendon pain. We often use a pain monitor: a simple way to judge how much pain is acceptable during and after exercise. Step by step, we build up to hopping, jumping and running. You’ll get a clear plan to take home, so you can keep going between appointments.
If you’re recovering too slowly despite exercising well, shockwave therapy can be a useful addition. For athletes, our sports physiotherapy offers guidance for a safe return to your sport.
What can you do yourself?
- Don’t stop moving altogether, but temporarily cut back on what hurts most, such as sprinting, hills or jumping.
- Pain up to about 3 out of 10 during activity is usually acceptable, as long as it isn’t worse the next morning.
- Do gentle calf exercises every day, such as slowly rising onto your toes and lowering again.
- Build up your running gradually and avoid big jumps in distance or pace.
- Wear shoes that don’t press on your tendon.
- Stretching alone has little effect; strength exercises work better.
Read also
Related complaints
Good to know
Frequently asked questions
Do I need a referral?
No. In most cases you can come to us for physiotherapy without a referral from your GP. At your first appointment, we start with a short screening. We check whether physiotherapy suits your complaint, or whether it would be wise to see your GP first. If you do have a referral, feel free to bring it along.
Is physiotherapy covered by my insurance?
That depends on your health insurance and your supplementary package. Many supplementary insurance policies cover a number of treatments per year. For some chronic conditions, a different arrangement applies under your basic insurance. Check your policy or read more on our page on reimbursements and rates.
Do I have to stop running?
Usually not completely. You can often keep running in an adapted form, for example shorter distances, a gentler pace and no hills. Use your pain as a guide: mild discomfort while running is fine, but your tendon shouldn’t be stiffer or more painful the next morning. If it is, it was too much and you scale back.
Does a cortisone injection help?
A cortisone injection in or around the Achilles tendon is generally not recommended. It can reduce the pain temporarily, but it doesn’t solve the problem and can make the tendon more vulnerable. A progressive exercise programme is the best first choice. Always discuss questions about medication with your GP.
Why is my tendon stiff mainly in the morning?
An irritated tendon reacts to a period of rest, such as a night’s sleep. Your first steps then feel stiff and painful, and it often improves after moving around a bit. That morning stiffness is a handy guide: if it’s getting less, you’re heading in the right direction. If it gets worse after a training session, the load was too high.
Our locations
Two practices, one team
In Eindhoven and Tilburg, physiotherapists and occupational therapists work together under one roof. Choose the practice that’s easiest for you.
Eindhoven
Centrally located on Geldropseweg, with spacious treatment rooms and a large exercise room. Easy to reach by bike, public transport and car.
Address
Geldropseweg 28
5611 SJ Eindhoven
Free parking behind the building
Tilburg
Right in the heart of the Reeshof, close to the A58 exit. Also easy to reach from the surrounding villages.
Address
Reeshofweg 40
5036 BK Tilburg
Mon to Fri, 08.00–18.00
Questions first?
Rather talk to someone first?
Not sure if we can help, or have a question about your treatment or reimbursement? Feel free to get in touch.
Call the practice
You’ll speak to one of us straight away. We’ll check the diary together there and then.
Leave your details
Fill in the contact form and we’ll get back to you as soon as possible.