Achilles Tendon Pain: How To Treat Achilles Tendon Pain at Home (& its Cause)
Key insights: 60-second read
- Achilles pain is not always just an Achilles problem - The tendon is where you feel the pain, but other factors can influence why it became sore.
- Look beyond the tendon - Ankle stiffness, hip rotational restriction and low-back stiffness can sometimes be important pieces of the puzzle.
- The tendon still needs appropriate loading - Mobility work may address contributing restrictions, but progressive tendon loading is a key part of rehabilitation for Achilles tendinopathy.
- The exercises in this article are designed to work together - The aim is to improve movement where necessary while gradually improving the Achilles tendon’s capacity to tolerate load.
- A persistent Achilles problem deserves an individual assessment - Especially if pain keeps returning, is getting worse, or is stopping you from exercising normally.
If you're struggling to shake Achilles tendon pain, it can be tempting to focus entirely on the painful tendon.
But after more than 20 years working as a musculoskeletal physiotherapist, one of the things I've learned is that the area that hurts isn't always the only area worth looking at.
The Achilles tendon has to deal with the forces produced by the calf and the way the foot, ankle, knee, hip and rest of the body move. If movement is restricted somewhere, or the tendon is suddenly exposed to more load than it is accustomed to, the Achilles can become the area that hurts as a consequence.
So it's vital to look more broadly for clues as to why the Achilles has become sore.
Clinically, there are three things I find important to assess when someone has persistent Achilles pain:
- Ankle mobility
- Hip rotation
- Low-back movement
The goal of this routine isn't simply to stretch everything around the Achilles. It's to address movement restrictions where they are relevant and then progressively expose the tendon to appropriate load.
In the video below, I demonstrate seven exercises that I use to explore these areas and help manage Achilles tendon symptoms.
Some of them may seem a little left-of-centre, particularly the exercises involving the low back. But these are important based on my clinical experience. We can't just assume that the painful structure is the only thing that needs attention.
Related: For a more detailed explanation, see my guide to Achilles tendonitis and Achilles tendon pain.
On this page
Why Can Achilles Tendon Pain Persist?
Achilles tendon pain can develop for several reasons, but one of the most important concepts to understand is load versus capacity.
The Achilles has to tolerate the loads placed through it every time you walk, run, jump, accelerate or push off. A sudden increase in running, sport, hills, speed work or other activity can increase those demands - challenging the Achilles ability to adapt.
But it's important to understand that all of these things are normal. However, a sudden increase in load will challenge the load-bearing capacity of the tendon, but it will also do a good job of testing the overall function of the area.
If the overall function of the ankle or lower limb is sub-optimal, we have more chess pieces we can move around to see what makes the biggest difference rather than assuming that you're just "doing too much".
This is where my clinical experience comes in.
When I assess someone with persistent Achilles pain, I don't just want to know, "What is wrong with the Achilles?" or "How much have you been doing?" I also want to know why this tendon is struggling with the load it's being asked to handle... when it shouldn't.
That broader assessment is particularly important when Achilles pain keeps returning despite repeatedly treating the painful area.
What Three Areas Do I Look At Clinically?
There are three areas that I commonly assess when I am trying to understand the mechanics of a persistent Achilles problem.
1. Ankle mobility
Restricted ankle dorsiflexion can alter how the ankle moves during activities such as walking, running and squatting.
That doesn't automatically mean ankle stiffness is the cause of Achilles pain. But if I find a meaningful restriction during an assessment, it's something I want to address because it may be contributing to how the lower limb is moving and directly loading the Achilles.
2. Hip rotation
The hip needs to rotate as part of normal lower-limb movement, particularly during walking and running. In essence, a lack of hip rotation can change whether the line of pull through the Achilles is more normal or less normal.
3. Low-back movement
This is probably the one that surprises people most.
Why would I look at someone's low back when their Achilles hurts?
Because the low back and nervous system are part of the same overall movement system, and symptoms around the lower limb can sometimes be influenced by factors higher up the chain.
In my clinical practice, I have found that some people with persistent lower-limb problems also have significant restrictions or dysfunction around the lumbar spine.
More importantly, improving the function of the lower back consistently correlates with improved Achilles pain and function, leading me to believe that relatively hidden lower back dysfunction could be one of the underlying causes.
We just can't ignore it when the assessment suggests it may be relevant.
What Are the 7 Exercises for Achilles Tendon Pain?
The video above demonstrates the complete routine. The exercises are designed around the areas I have discussed above, along with direct work for the Achilles itself.
Rather than thinking of these as seven exercises that everyone with Achilles pain must perform, think of them as a collection of options. Which ones are appropriate depends on what your individual assessment shows.
- Ankle mobility work - Used when restricted ankle movement appears to be contributing to the person's movement dysfunction.
- Hip rotational mobility - Designed to address restrictions in hip rotation when they are clinically relevant.
- Low-back mobility or self-release - Included because some people may have relevant restrictions around the lumbar spine that are worth addressing.
- Direct Achilles loading - Progressive loading is an important component of Achilles rehabilitation and helps the tendon gradually tolerate greater demands.
The original routine combines these different areas rather than treating the Achilles in isolation.
One important change in emphasis I would make today is this: don't assume that mobility work replaces tendon loading. The two have different purposes.
Why Is Tendon Loading So Important?
For people with Achilles tendinopathy, progressive tendon loading is one of the most important parts of rehabilitation.
The 2024 clinical practice guideline for Achilles tendinopathy recommends tendon-loading exercise as a first-line treatment to improve function and reduce pain, with exercise performed at least three times per week and at an intensity as high as tolerated.
This is an important distinction because Achilles rehabilitation isn't simply about making the ankle, hip, or back move better.
The tendon itself needs to reclaim its ability to handle the demands being placed upon it.
This usually means gradually increasing the amount of force the calf and Achilles are required to produce. Exactly how that progression should look depends on the person's symptoms, irritability, strength, activity level and stage of rehabilitation.
When Should You See a Physiotherapist for Achilles Pain?
There is alot you can do yourself to rehab a sore Achilles tendon, but persistent or worsening Achilles pain is worth having properly assessed.
I would particularly consider an assessment if:
- your Achilles pain keeps returning whenever you resume running or sport
- you have progressively reduced your activity because of the pain
- your symptoms have persisted despite trying exercises on your own
- you are unsure whether the problem is actually coming from the Achilles tendon
- you have significant weakness or difficulty pushing off through the foot
- you experienced a sudden injury, popping sensation or marked loss of function
A physiotherapy assessment can help determine whether the main issue appears to be tendon capacity, training load, strength, mobility, movement mechanics, or something else entirely.
What Equipment Do You Need?
Equipment used in the above video:
Please note: These are affiliate links. I may receive a commission if you purchase through one of these links, at no additional cost to you.
You don't necessarily need expensive equipment to work on mobility or rehabilitation. In many cases, simple equipment can do the job perfectly well.
My clinical perspective
One of the biggest mistakes I see with persistent musculoskeletal problems is assuming that the painful structure tells you the whole story.
Sometimes it does - especially if acute trauma is involved. But often the painful structure is simply the part of the system that is currently struggling to cope with the demands being placed upon it.
That is why I like to assess the whole movement system rather than automatically treating the Achilles in isolation. At the same time, I don't want to overcomplicate things. Rebuilding strength and capacity is important, but if we don't also figure out why the tendon became dysfunctional in the first place, then we may never give it the best chance to become normal and pain-free once again.
The key takeaway
Achilles tendon pain isn't always as simple as treating the spot that hurts. In my clinical practice, I often assess ankle mobility, hip rotation and low-back movement alongside tendon capacity, strength and training load. The right approach is individual, but for Achilles tendinopathy, progressive tendon loading remains a central part of rehabilitation while working hard on rectifying any underlying mechanical dysfunction.
Frequently Asked Questions
What is the most common cause of Achilles tendon pain?
Achilles pain can develop when the demands placed on the tendon exceed its current capacity, particularly following changes in running, sport or training load. Other factors such as strength, mobility, recovery and individual movement patterns can also be relevant.
What exercises help Achilles tendon pain?
For Achilles tendinopathy, progressive tendon-loading exercise is a key part of rehabilitation. Depending on the individual, mobility exercises for the ankle or hip and other exercises addressing relevant movement restrictions may also be useful to try and resolve the underlying reason why the tendon became dysfunctional to load over time.
Can ankle stiffness contribute to Achilles pain?
It can be relevant. Restricted ankle movement can alter lower-limb mechanics, but ankle stiffness should not automatically be assumed to be the cause of Achilles pain. It is one factor I consider during a clinical assessment.
Can low-back stiffness cause Achilles pain?
Low-back stiffness is not yet established as a universal cause of Achilles tendon pain. However, it's consistently relevant clinically. Figure it out for yourself by improving lower back function and seeing what, if anything, changes.
How often should Achilles tendon exercises be performed?
The 2024 clinical practice guideline for midportion Achilles tendinopathy recommends tendon-loading exercise at least three times per week, with intensity progressed according to tolerance. The exact program should still be individualised according to symptoms, strength and activity demands.
Do I need a physiotherapist for Achilles tendon pain?
Not necessarily for every mild episode. However, an assessment can be particularly useful when symptoms persist, repeatedly return, significantly limit activity, or when you're unsure what is causing the problem. A physiotherapist can also help determine how and when to progress tendon loading.
I genuinely hope this article offers a fresh perspective - or at least one useful takeaway. If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you'd like me to cover next.
- Grant
If you found this video useful, please leave a like and let me know in the comments. You can also subscribe to the Your Wellness Nerd YouTube channel for more physiotherapy, movement and health information.
Living With Persistent Achilles Pain?
If your Achilles pain has lasted longer than expected, keeps returning when you resume activity, or hasn't responded to the exercises you've tried, an individual assessment may help identify the factors contributing to your symptoms.
Learn more about our ankle and lower-limb physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help making sense of your Achilles pain, movement or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
