Achilles Tendon Injuries: Understanding Tendinopathy, Tears & Rehabilitation
The Achilles tendon is the largest and strongest tendon in the human body, yet it is also subjected to extraordinary forces. During running, jumping, and other high-demand activities, the tendon can experience loads several times greater than body weight as it transfers force from the calf muscles to the foot.
Far from acting like a simple cable, the Achilles tendon functions as a powerful elastic spring, storing and releasing energy with each stride. This allows us to walk, run, jump, and push off efficiently while reducing some of the muscular work required for movement.
But strength does not make the Achilles invulnerable. Repeated loading, sudden increases in training demands, inadequate recovery, age-related changes, and other individual factors can exceed the tendon’s capacity to adapt, contributing to tendinopathy or, in some circumstances, partial or complete rupture.
Just like its legendary namesake, Achilles has a vulnerable point. The important question is not simply why this powerful tendon becomes injured, but how we can restore its capacity to tolerate load and return to activity.
Article Index
Introduction
The Achilles Tendon: A Powerhouse in Running Mechanics
The Achilles tendon plays a central role in walking, running, and jumping. During running, the gastrocnemius and soleus generate force through the Achilles tendon, helping control the ankle as the body moves over the foot and contributing substantially to propulsion during push-off.
But the Achilles tendon does much more than simply transfer muscular force. It also functions as an elastic energy-storage structure. As the tendon is loaded during running, it stretches and stores mechanical energy. Some of that energy is then released during push-off, contributing to efficient movement and reducing the amount of active muscular work required with each stride.
This spring-like behaviour becomes increasingly important as running speed increases. The calf-Achilles complex must repeatedly absorb, store, and return substantial amounts of energy, often thousands of times during a single run. This remarkable capacity is one reason the human body can run efficiently, but it also means that the tendon must continually adapt to the loads placed upon it.
Problems can develop when training load or loading rate exceeds the tendon’s current capacity to adapt. Sudden increases in running volume or intensity, changes in training demands, inadequate recovery, and individual biological and mechanical factors may all contribute to Achilles tendinopathy.
This relationship between load and capacity is fundamental to understanding both Achilles tendinopathy and its rehabilitation. The goal is not to protect the tendon from load indefinitely, but to progressively develop its capacity to tolerate and eventually perform under the loads required for walking, running, jumping, and sport.
Anatomy & Biomechanics
Anatomical Framework
The Achilles tendon is formed primarily by contributions from the
gastrocnemius and soleus muscles, collectively known as the triceps surae. These tendon components converge as they travel toward the heel and insert onto the posterior calcaneus. The gastrocnemius and soleus are innervated by the tibial nerve and together generate much of the plantarflexion force required for walking, running, jumping, and pushing off from the ground.
The Achilles is not simply a uniform cord connecting muscle to bone. Fascicles originating from the gastrocnemius and soleus form distinct subtendons that rotate or twist as they descend toward the calcaneus. The amount and pattern of this twisting vary considerably between individuals and may influence how forces are distributed through the tendon.
The region approximately 2 to 6 cm above the calcaneal insertion is commonly associated with midportion Achilles tendinopathy and is also a frequent location for rupture. Historically, this area has been described as a relatively hypovascular “watershed region.” Vascular supply may be one factor affecting tendon biology, but current evidence suggests that Achilles injury cannot be explained simply by poor circulation. Tendon loading, tissue adaptation, age, training demands, metabolic factors, tendon structure, and individual anatomy can all influence tendon health and capacity.
The Achilles, Calcaneus, and Plantar Fascia
The Achilles tendon also forms part of a broader anatomical and mechanical relationship involving the calcaneus and plantar fascia.
Both the Achilles tendon and plantar fascia attach around the calcaneus, creating an anatomical complex capable of transmitting and responding to forces generated during weight-bearing and locomotion. Studies have demonstrated structural relationships between these tissues, although the degree of direct collagen continuity varies between individuals and appears to decrease with age.
These relationships are clinically interesting because the foot, ankle, Achilles tendon, and calf do not function independently. Restrictions in ankle motion, calf capacity, foot function, and the loads generated during walking or running may all influence how forces are distributed through this region.
This does not mean that tension in one structure automatically causes pathology in another. Rather, it reinforces an important clinical principle: Achilles symptoms should be assessed within the broader function of the foot, ankle, and lower extremity.
The Plantaris: A Small Structure With Potential Clinical Significance
The plantaris is a small muscle with a long, thin tendon that originates above the knee and travels distally through the calf, typically along the medial aspect of the Achilles tendon. Its anatomy is highly variable, including differences in its course, relationship with the Achilles tendon, and site of insertion.
This variability may have clinical significance in some patients with midportion Achilles tendinopathy. In certain anatomical configurations, the plantaris tendon lies very close to the medial Achilles tendon. Researchers have proposed that compression or friction between these structures may contribute to persistent, localized medial Achilles symptoms in a subset of patients.
Plantaris involvement should therefore not be assumed in every patient with Achilles pain. However, it may be worth considering when symptoms are highly localized to the medial midportion of the Achilles, particularly when symptoms persist despite an appropriate progressive rehabilitation program. Ultrasound or MRI may sometimes help clarify the relationship between the plantaris and Achilles tendons when clinically indicated.
Types of Achilles Tendon Injuries
Clarifying the Terminology
Achilles tendon disorders encompass several different conditions, and distinguishing between them is important because their clinical presentation, management, and rehabilitation can differ considerably.
Historically, the term Achilles tendinitis was commonly used to describe persistent Achilles pain. Today, Achilles tendinopathy is generally preferred. Tendinopathy describes a clinical condition characterized primarily by tendon pain, impaired function, and reduced tolerance to mechanical loading. The term does not assume that inflammation or tissue degeneration is the sole cause of the patient's symptoms.
Achilles disorders can be broadly considered according to their location and type of pathology.
Midportion Achilles Tendinopathy
Midportion Achilles tendinopathy typically produces pain and tenderness several centimetres above the calcaneal insertion. Patients may also notice tendon thickening and reduced tolerance to running, jumping, calf raises, or other activities that heavily load the calf-Achilles complex.
Symptoms frequently develop gradually and may initially be most noticeable at the beginning of activity or the following morning. As the condition becomes more symptomatic, pain and reduced function may begin to interfere with training and everyday activities.
Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy occurs where the tendon attaches to the posterior calcaneus. Pain is therefore usually localized closer to the heel than in midportion tendinopathy.
Compression of the tendon against the calcaneus, particularly during greater ankle dorsiflexion, may contribute to symptoms in some patients. Associated findings can include tendon thickening, calcification, retrocalcaneal bursitis, or changes around the posterior calcaneus.
Distinguishing midportion from insertional tendinopathy is clinically important because exercise selection and loading strategies may need to be modified accordingly.
Paratendinopathy
The Achilles tendon is surrounded by a paratenon, a connective-tissue structure that facilitates movement of the tendon relative to surrounding tissues.
The paratenon can become symptomatic independently or alongside Achilles tendinopathy. Patients may present with pain, swelling, tenderness, or sometimes palpable or audible crepitus around the tendon.
For this reason, current terminology generally distinguishes paratendinopathy from pathology occurring primarily within the Achilles tendon itself.
Partial Achilles Tendon Tears
A partial Achilles tear involves disruption of only a portion of the tendon fibers. These injuries appear to be less common than either tendinopathy or complete rupture and can sometimes be mistaken for an exacerbation of Achilles tendinopathy.
A sudden increase in localized pain, weakness during heel raises, difficulty loading the tendon, and a clear change from the patient's previous symptoms should increase suspicion of a partial tear. Ultrasound or MRI may be useful when the diagnosis remains uncertain or when imaging would influence management.
Management depends on the location and extent of the tear, symptoms, functional impairment, and activity demands. Progressive rehabilitation is often appropriate, while selected cases may require orthopaedic or sports-medicine assessment.
Complete Achilles Tendon Rupture
A complete Achilles rupture occurs when the tendon is disrupted across its full thickness. It commonly occurs during activities involving rapid acceleration, jumping, or sudden forceful loading of the calf-Achilles complex.
Patients frequently describe a sudden pop or snapping sensation, sometimes feeling as though they have been kicked or struck in the back of the ankle. Pain can be significant, although it may diminish surprisingly quickly. Weakness during push-off, difficulty performing a single-leg heel raise, a palpable tendon defect, and an abnormal Thompson calf-squeeze test can help establish the diagnosis.
Importantly, complete rupture does not necessarily mean complete loss of ankle movement. Other muscles can still produce some plantarflexion, which is one reason Achilles ruptures can occasionally be missed.
Treatment may be operative or nonoperative. Modern nonoperative care typically involves functional rehabilitation with appropriate protection of the healing tendon, while surgical repair may be considered depending on the individual injury, patient characteristics, functional demands, and clinical circumstances.
Tendinopathy and Rupture Are Not the Same Condition
Achilles tendinopathy and Achilles rupture should not simply be viewed as different grades of the same injury.
Tendinopathy usually develops as a load-related clinical condition involving pain and impaired tendon function, whereas rupture represents structural failure of tendon fibers. Pre-existing tendon changes may be present in some ruptures, but a complete rupture should not be described simply as the inevitable consequence of untreated tendinopathy.
This distinction matters because assessment, loading strategies, rehabilitation timelines, and decisions regarding referral or surgery can differ substantially between Achilles tendinopathy, partial tears, and complete rupture.
Clinical Perspective
For the practitioner, the first question should therefore not be “What grade is the Achilles injury?” but rather:
Are we dealing with midportion tendinopathy, insertional tendinopathy, paratendinopathy, a partial tear, or a complete rupture?
PHYSICAL EXAMINATION
A thorough examination helps distinguish midportion Achilles tendinopathy, paratendinopathy, partial tendon injury, and complete rupture, while also identifying other conditions that can produce pain around the posterior ankle and heel.
The examination should begin with the history. Important considerations include whether symptoms developed gradually or suddenly, recent changes in running or training load, the location and behaviour of pain, morning stiffness, previous Achilles problems, medications and medical conditions that may affect tendon health, and the patient's functional limitations.
Physical examination may include:
Observation for swelling, tendon thickening, bruising, or asymmetry
Palpation to determine the location and extent of tenderness
Active and passive ankle range of motion
Assessment of calf and Achilles strength
Single-leg heel raises and other functional loading tests when appropriate
Evaluation of walking, running, jumping, or other relevant activities
Examination of ankle and foot mobility when clinically indicated
Achilles-specific tests when rupture is suspected
With tendinopathy, the clinician should determine whether symptoms are primarily located in the midportion of the tendon or at its calcaneal insertion, since this distinction can influence rehabilitation and loading strategies.
When an acute rupture is suspected, examination should include assessment of tendon continuity and the Thompson calf-squeeze test. A patient with a complete Achilles rupture may still demonstrate some plantarflexion because other muscles can contribute to this movement, so the ability to point the foot downward does not exclude rupture. Clinical examination is often sufficient to identify an acute complete rupture, with ultrasound or MRI used when the diagnosis is uncertain or additional information is needed.
Ankle and Foot Examination
This instructional video demonstrates orthopaedic procedures used to assess common ankle and foot conditions. For patients presenting with Achilles symptoms, examination should consider tendon integrity, location of tenderness, ankle mobility, calf strength, and functional loading while also screening for other potential sources of foot and ankle pain.
The video also demonstrates examination procedures for ankle sprains, syndesmosis injuries, osteochondral lesions, fractures, plantar fascia disorders, and other conditions that may be relevant to the differential diagnosis.
Lower Limb Neuro Examination
A complete neurological examination is not routinely required for every uncomplicated Achilles tendinopathy, but neurological screening becomes important when symptoms suggest involvement beyond the tendon itself.
Findings such as numbness, altered sensation, unexplained weakness, radiating pain, reflex changes, or symptoms extending proximally or distally should prompt consideration of neurological causes, including lumbar nerve-root or peripheral nerve involvement.
This video demonstrates a systematic lower-limb neurological examination that can be incorporated when indicated by the patient's history or clinical findings.
Peripheral Vascular Examination
Similarly, a detailed peripheral vascular examination is not necessary for every patient presenting with Achilles pain.
However, vascular assessment becomes important when there are signs or risk factors suggesting impaired circulation.
Changes in skin colour or temperature, diminished pulses, unusual swelling, delayed wound healing, exertional calf symptoms, or significant cardiovascular risk factors may warrant further vascular examination and, when appropriate, medical referral.
This video demonstrates the procedures used to assess peripheral circulation in the lower extremity.
Clinical Perspective
The examination should be guided by the patient's presentation rather than performed as an identical checklist for every Achilles problem.
For a typical load-related Achilles tendinopathy, the examination may primarily involve tendon palpation, ankle movement, calf strength, heel-raise capacity, and progressive functional loading. A sudden traumatic presentation requires greater attention to tendon continuity and rupture testing, while neurological or vascular examinations should be added when the history or findings indicate their relevance.
Manual Therapy
Progressive exercise and tendon loading form the foundation of rehabilitation for most Achilles tendinopathy. Manual therapy may be incorporated as an adjunct when pain, restricted mobility, muscle function, or other examination findings are limiting movement or progression through rehabilitation.
Treatment should be based on the individual's presentation rather than the assumption that every patient with Achilles pain has restrictions throughout the kinetic chain. Examination may identify clinically relevant findings in the calf, ankle, foot, or elsewhere in the lower extremity that warrant treatment.
Within Motion Specific Release (MSR), manual therapy may include myofascial procedures, joint mobilization or manipulation, Fascial Expansions, and other techniques selected according to the examination findings. The response to treatment should then be evaluated through changes in pain, range of motion, strength, movement, and tolerance to progressive loading.
Manual therapy should not be viewed as a method of physically repairing a damaged Achilles tendon. Its role is to help create appropriate conditions for movement and rehabilitation while progressive loading develops the tendon and calf complex's capacity to meet the demands of daily activity, running, and sport.
Calf Pain No More - Release Tom, Dick, and Harry
In this video, Dr. Brian Abelson, DC demonstrates MSR procedures for the gastrocnemius, soleus, and deeper structures of the calf. These techniques may be incorporated when examination identifies calf pain, soft-tissue sensitivity, or restrictions that are limiting comfortable ankle movement or exercise.
For patients with Achilles tendinopathy, calf treatment should be considered one component of a broader rehabilitation strategy rather than a treatment for the tendon pathology itself.
7-Point Ankle & Foot Mobilization
Ankle and foot mobility can influence how the lower extremity functions during walking, running, squatting, and other weight-bearing activities. When examination identifies a clinically meaningful mobility restriction, joint mobilization may be incorporated to help restore movement and improve tolerance to exercise.
Not every patient with Achilles tendinopathy requires ankle or foot mobilization. Treatment should target restrictions identified during examination, and its value should be determined by whether it produces meaningful changes in movement, symptoms, or function.
Fascial Expansion: MSR Foot Pain Protocol
Fascial Expansions are one component of the MSR treatment system and integrate manual approaches to fascia with concepts derived from acupuncture and acupressure. The MSR Foot Pain Protocol incorporates points traditionally described as ST44, LV3, LV2, KI3, and BL60, together with other manual procedures according to the patient's examination findings.
For Achilles tendon conditions, Fascial Expansions may be incorporated as an adjunct for symptom management, mobility, and movement tolerance when clinically appropriate. They should not be presented as directly repairing tendon tissue, removing scar tissue, or reversing the underlying tendon pathology.
The broader rehabilitation program should continue to address calf strength, tendon loading capacity, ankle and foot function, and the progressive return to walking, running, jumping, or sport.
Clinical Perspective
The relationship between manual therapy and exercise can be summarized simply:
Assessment identifies relevant impairments → manual therapy may help improve pain or movement when indicated → progressive loading builds capacity → function determines progression.
Exercises and Progressive Tendon Loading
Exercise is the foundation of rehabilitation for most patients with Achilles tendinopathy. The primary objective is to progressively restore the ability of the calf-Achilles complex to tolerate, generate, store, and release force during walking, running, jumping, and other activities.
Achilles rehabilitation was historically dominated by eccentric exercise programs. Eccentric loading remains an effective option, but current evidence supports a broader approach that may include isometric, concentric, eccentric, and heavy slow resistance exercise, depending on the patient's symptoms, strength, tendon capacity, and functional goals. No single loading program has consistently demonstrated superiority for every patient.
Rehabilitation should therefore be progressive and criteria-based rather than built around a single exercise protocol. Loading should advance according to symptoms, strength, function, and the demands the patient ultimately needs to regain.
Maintaining Aerobic Conditioning
Achilles tendinopathy does not necessarily require stopping all physical activity. Maintaining cardiovascular fitness can be valuable while higher-load activities such as running and jumping are temporarily modified.
Stationary cycling, swimming, deep-water running, or other forms of aerobic exercise may be appropriate when they can be performed without significantly aggravating symptoms.
The purpose is primarily to maintain cardiovascular fitness and overall conditioning while Achilles loading is progressively rebuilt, rather than to increase blood flow to “flush out” lactic acid or inflammatory waste products.
Duration and resistance should be individualized rather than prescribing a universal 15-to-30-minute daily program.
Stretching Your Calf Muscles
Calf stretching may be useful when examination identifies limited ankle dorsiflexion or calf flexibility that is relevant to the patient's symptoms or functional requirements. However, stretching is not mandatory for every patient with Achilles tendinopathy.
Stretching can include both the gastrocnemius and soleus, with the dosage adjusted according to the individual's mobility and symptom response.
An important distinction should be made with insertional Achilles tendinopathy. Greater ankle dorsiflexion can increase compression of the tendon against the calcaneus, so aggressive calf stretching or heel-drop exercises below the level of a step may aggravate symptoms in some patients.
The objective is therefore not simply to make the calf more flexible, but to restore the mobility required for the individual's activities without unnecessarily irritating the tendon.
Calf Muscle Release - Lacrosse Ball & Foam Roller
Self-myofascial techniques using a foam roller or massage ball may provide temporary relief from calf discomfort or stiffness and can be incorporated when patients find them helpful.
These techniques should be considered adjuncts to rehabilitation, not methods of remodeling or repairing the Achilles tendon. Their value is primarily in symptom management and potentially improving comfort with movement or exercise.
Calf Strengthening: Building Achilles Capacity
Strengthening the gastrocnemius and soleus is central to Achilles rehabilitation because these muscles generate force through the Achilles tendon.
Eccentric calf raises remain an effective exercise, but they are not the only way to rehabilitate Achilles tendinopathy. Research comparing eccentric exercise with heavy slow resistance training has shown meaningful improvements with both approaches.
Depending on the patient's presentation, loading may progress through exercises such as:
Isometric plantarflexion or calf-raise holds
Double-leg calf raises
Single-leg calf raises
Seated calf raises emphasizing the soleus
Straight-knee calf raises emphasizing the gastrocnemius
Eccentric calf raises
Progressively heavier resistance training
Faster calf-raise movements
Hopping, jumping, and plyometric loading
Running and sport-specific loading
The progression from slow strengthening toward faster energy-storage and release activities becomes particularly important for runners and athletes. A patient may regain substantial calf strength yet still be unprepared for the rapid loading rates experienced during running and jumping.
Effective Foot and Toe Strengthening
Foot and intrinsic muscle strengthening may be incorporated when examination identifies relevant deficits in foot strength, control, or function.
Exercises for the toes, intrinsic foot muscles, ankle invertors and evertors, and other structures around the foot and ankle can complement calf strengthening and help prepare the lower extremity for progressively demanding activities.
These exercises should not be presented as correcting a universal alignment problem or automatically reducing strain on the Achilles tendon. Their role is to address identified functional deficits and contribute to overall lower-extremity capacity.
Improve Your Balance - Beginner Exercises for Achilles Recovery
Balance and proprioceptive exercises may also be useful, particularly when deficits are identified or when rehabilitation involves returning to activities requiring substantial single-leg control.
Progression should be based on the patient's ability rather than an arbitrary timeline such as two to four weeks.
Exercises may progress from stable double-leg and single-leg tasks toward increasingly challenging surfaces, movement patterns, perturbations, and sport-specific activities when appropriate.
From Strength to Running and Sport
One addition I strongly recommend is a short section that is currently missing.
Strengthening alone is not the endpoint for a runner with Achilles tendinopathy. Running exposes the Achilles to rapid, repetitive loading and energy-storage demands that slow calf raises cannot completely reproduce.
As rehabilitation progresses, the program may therefore need to advance from:
Slow controlled loading → heavier resistance → faster loading → hopping and jumping → running → sport-specific demands
Progression should consider pain response, morning symptoms, calf strength and endurance, heel-raise capacity, tolerance to hopping or other energy-storage tasks, and the patient's response during the 24 hours following increased loading.
Some discomfort during rehabilitation does not automatically indicate tendon damage. The important consideration is whether the load is tolerable and whether symptoms remain acceptably stable rather than progressively worsening.
Clinical Perspective
The central principle of Achilles rehabilitation is not “eccentrics fix tendons.”
It is:
Apply an appropriate load → allow adaptation → progressively increase capacity → restore the speed and magnitude of loading required for function.
Activities of Daily Living (ADL)
Daily activities can place substantial demands on a symptomatic Achilles tendon. The objective is not to eliminate tendon loading, but to modify activities temporarily when necessary while progressively rebuilding the tendon's capacity through exercise.
Walking distance, stairs, prolonged standing, hills, running, footwear, and recreational activities may all need to be adjusted according to symptoms. As tendon capacity improves, these activities can gradually be reintroduced or increased.
Ice for Symptom Relief
Cold therapy may provide short-term pain relief for some people with Achilles pain, particularly after activities that aggravate symptoms. However, ice should be viewed as a comfort measure rather than a treatment that heals tendinopathy.
If ice massage is helpful, it can be applied briefly to the painful region while protecting the skin from excessive cold exposure. Patients should discontinue its use if they experience excessive numbness, skin irritation, or discomfort.
Most importantly, symptom relief from ice should not replace the progressive loading program needed to restore tendon capacity.
What About Heat?
Some people with chronic Achilles symptoms find warmth helpful for reducing feelings of stiffness or making movement more comfortable before exercise.
Heat can therefore be used as an optional comfort strategy, but there is limited evidence that applying heat directly to the Achilles tendon accelerates tendon healing. The rationale should not be that heat delivers additional nutrients or oxygen needed to repair the tendon.
A warm shower, heating pad, or other gentle source of warmth may be used before activity if the patient finds it helpful, provided there are no contraindications to heat.
Footwear
Footwear can influence ankle mechanics and the loads experienced by the Achilles tendon, but there is no single type of shoe that is appropriate for everyone with Achilles tendinopathy.
Some patients may temporarily find footwear with a slightly elevated heel or an in-shoe heel lift more comfortable because it can modify ankle position and tendon loading. This may be particularly useful when walking or standing is painful.
However, heel lifts should not be presented as a primary treatment for midportion Achilles tendinopathy. A 2025 randomized controlled trial found a small reduction in pain compared with a sham lift, but the difference did not reach the study's predetermined threshold for clinical importance.
For insertional Achilles tendinopathy, temporarily reducing compression at the tendon insertion may be particularly relevant. A 2025 randomized trial found better outcomes from a rehabilitation program that limited dorsiflexion, eliminated calf stretching, and incorporated heel lifts compared with a program allowing greater tendon compression. Because several elements were changed simultaneously, the results should not be attributed to heel lifts alone.
What About Walking Barefoot?
Barefoot walking changes ankle and Achilles loading, but that does not mean it inherently damages the tendon or causes Achilles tendinopathy. For some symptomatic patients, barefoot walking, particularly on hard surfaces, may temporarily be less comfortable.
The practical recommendation is therefore straightforward: use footwear that allows comfortable daily activity while rehabilitation progressively restores the capacity to tolerate a wider range of loading conditions.
Clinical Perspective
Ice, heat, footwear, and heel lifts can sometimes make daily activity more comfortable, but they are supportive strategies rather than the foundation of Achilles rehabilitation.
The larger objective remains:
Manage symptoms → modify excessive loads when necessary → progressively rebuild tendon capacity → gradually restore normal activity.
Building a Stronger Achilles
Achilles tendon injuries can range from persistent tendinopathy to partial tears and complete rupture, and effective management begins with understanding exactly what you are dealing with. The location of symptoms, tendon integrity, functional limitations, activity demands, and individual contributing factors all influence the treatment and rehabilitation strategy.
For most cases of Achilles tendinopathy, the goal is not simply to eliminate pain or protect the tendon from stress. It is to progressively rebuild the capacity of the calf-Achilles complex to tolerate load. This may involve modifying aggravating activities, restoring relevant mobility, progressively strengthening the gastrocnemius and soleus, and eventually reintroducing the faster energy-storage demands required for running, jumping, and sport.
Manual therapy, joint mobilization, Fascial Expansions, self-treatment strategies, footwear modifications, and other interventions may be useful adjuncts when clinically indicated. However, they should support rather than replace the central role of progressive exercise and tendon loading.
Recovery is rarely about finding one perfect exercise or treatment technique. It is about applying the right amount of stress at the right time and progressively increasing that demand as the tendon and surrounding musculature adapt.
Whether the goal is comfortable walking, returning to recreational running, or competing at a high level, the underlying principle remains the same:
Assess the problem accurately, manage the load, build capacity, and progressively return to the activities that matter.
References
Abelson, B., Abelson, K., & Mylonas, E. (2018). A Practitioner's Guide to Motion Specific Release: Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries. Rowan Tree Books.
Babinski, M. A., Machado, F. A., & Costa, R. G. (2014). The plantaris muscle and its relationship with the Achilles tendon in humans. Anatomical Science International, 89(1), 1–5.
Chimenti, R. L., Neville, C., Houck, J., Cuddeford, T., Carreira, D., & Martin, R. L. (2024). Achilles pain, stiffness, and muscle power deficits: Midportion Achilles tendinopathy revision 2024. Journal of Orthopaedic & Sports Physical Therapy, 54(12), CPG1–CPG32. PubMed
Edama, M., Onishi, H., Kubo, M., Takabayashi, T., Inai, T., Yokoyama, E., et al. (2014). Structure of the Achilles tendon at the insertion on the calcaneal tuberosity. Journal of Anatomy, 225(3), 287–293.
Kannus, P. (2000). Structure of the tendon connective tissue. Scandinavian Journal of Medicine & Science in Sports, 10(6), 312–320.
Kannus, P., & Józsa, L. (1991). Histopathological changes preceding spontaneous rupture of a tendon: A controlled study of 891 patients. Journal of Bone and Joint Surgery. American Volume, 73(10), 1507–1525.
Kerssemakers, S. P., Fotiadou, A. N., de Jonge, S., Plomp, S. G., Hayat, A. A., van Arkel, E. R. A., et al. (2021). The pathoanatomy of the Achilles tendon in the midportion and insertional region. Journal of Anatomy, 238(3), 588–600.
Kim, M. H., Lin, C. I., Henschke, J., Quarmby, A., Engel, T., & Cassel, M. (2023). Effects of exercise treatment on functional outcome parameters in mid-portion Achilles tendinopathy: A systematic review. Frontiers in Sports and Active Living, 5, 1144484. PubMed
Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 43(4), 267–286.
Myhrvold, S. B., Brouwer, E. F., Andresen, T. K. M., Rydevik, K., Amundsen, M., Grün, W., et al. (2022). Nonoperative or surgical treatment of acute Achilles' tendon rupture. New England Journal of Medicine, 386(15), 1409–1420. New England Journal of Medicine
Opdam, K. T. M., Zwiers, R., Wiegerinck, J. I., & van Dijk, C. N. (2021). Increasing consensus on terminology of Achilles tendon-related disorders. Knee Surgery, Sports Traumatology, Arthroscopy, 29(8), 2528–2534. PubMed
Stecco, C., Corradin, M., Macchi, V., Morra, A., Porzionato, A., Biz, C., et al. (2013). Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. Journal of Anatomy, 223(6), 665–676.
van Dijk, C. N., van Sterkenburg, M. N., Wiegerinck, J. I., Karlsson, J., & Maffulli, N. (2011). Terminology for Achilles tendon related disorders. Knee Surgery, Sports Traumatology, Arthroscopy, 19(5), 835–841.
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The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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