Achilles
Tendinopathy
A common overload injury of the Achilles tendon. With the right combination of shockwave therapy and progressive loading, most people make a full return to sport and activity.
About the condition
What is Achilles Tendinopathy?
The Achilles tendon connects your calf muscles to your heel bone and is one of the strongest tendons in the body — but it is also one of the most commonly injured. When it is repeatedly loaded beyond its current capacity, through a sudden increase in training, a change of footwear, or a return to sport after a break, the tendon responds with a degenerative process rather than normal healing. This is tendinopathy.
It is not a simple inflammatory condition, and it does not improve with prolonged rest. The tendon needs the right kind of load, applied progressively, to remodel and regain full strength. That is exactly what our Tendon Fit programme is designed to deliver.
Recognising the symptoms
How does it present?
Morning stiffness
Pain and stiffness first thing in the morning or after prolonged sitting, which eases with gentle movement.
Localised pain
A tender spot 2–6 cm above the heel (mid-portion) or right at the heel insertion. Pain on pinching the tendon.
Activity pain
Pain that warms up during running but stiffens after. Worse on hills, sprints, and explosive efforts.
Reduced power
Difficulty with calf raises or push-off. A sense of weakness or inability to load through the forefoot fully.
How we treat it
Radial Shockwave Therapy
Radial shockwave therapy (RSWT) delivers high-energy acoustic pressure waves directly into the tendon tissue, rebooting the body’s natural healing response in tissue that has become stuck in a degenerative cycle.
Research supports 3–5 shockwave sessions as an effective dose. Sessions are spaced one week apart and run alongside your progressive loading programme for maximum effect.
The rehab plan
Progressive Loading Programme
Weeks 1–2
Pain relief loading
Sustained calf holds against a wall or step. Isometric contractions immediately reduce tendon pain and begin stimulating the tissue with minimal mechanical stress — a safe starting point even when symptoms are at their worst.
Weeks 3–8
Tendon remodelling
Slow, loaded single-leg calf raises with a 3-second lowering phase — on a step for mid-portion tendinopathy, flat ground for insertional. High load, low repetitions. This is the cornerstone phase for driving structural adaptation in the tendon.
Weeks 8–16
Return to sport loading
Plyometric and spring-loaded exercises — skipping, single-leg hops, running progressions. The tendon is trained to store and release elastic energy, the capacity that running and sport demand most.
Exercise compliance with Physitrack
All your exercises are prescribed through the Physitrack app, so you always know exactly what to do, how to do it, and when to progress. John can monitor your sessions remotely and adjust your programme in real time — shown in research to significantly improve outcomes.
What to expect
3–5 shockwave sessions at weekly intervals, running alongside your home loading programme. Most patients see meaningful improvement within 6–8 weeks and return to full activity within 3–4 months.
What to avoid
Prolonged rest, aggressive Achilles stretching in the early stages, and relying on anti-inflammatory medication — these can blunt the healing response that shockwave and loading are designed to trigger.
Ready to get started?
Book a Tendon Fit session with John — €80 per session.
