Posted on: February 24, 2017 at 2:56 pm
Last updated: May 10, 2018 at 1:45 pm

Although not too common in the general population, occurring just 2% of the time, Achilles tendinopathy can be quite a drag (and I’m not referring to the leg that will be dragging because of the pain)1. Often times, it will hit you at the least opportune time, like when you just start an exercise program, or when as an active person you are ready to make that next big jump in your training.

In fact, in the active population, including recreational runners, Achilles tendinopathy occurs at a much higher incidence of 8-15% of the population and the as high as 52% amongst long-time runners.Understanding how to deal with this injury is vital if you want to avoid the chances of a tear in the tendon, and in my eyes, it is always important to clarify the nature of the injury to understand how to manage it.

What is the Achilles Tendon?

Your Achilles tendon, named after the legendary warrior and hero of Homer’s Iliad, is the strongest and thickest tendon in the human body and is located at the back of the ankle/heel area as a continuation of the calf muscles. Despite this, the tendon is often a source of pain.

What we used to call this injury was a tendonitis. However, we have realized that in most cases pain in the Achilles isn’t caused by a true inflammatory condition, thus leading to a change in the name from tendonitis (meaning inflammation of the tendon) to a tendinopathy, which simply means a disorder of the tendon. We have come to recognize that often times there is a degeneration of the tendon.3


Achilles Tendon Injury: Signs & Symptoms

Often times, this injury starts out as morning stiffness in the Achilles that after 5-10 minutes of walking dissipates. It progresses to pain at the beginning and sometimes at the end of an exercise, to eventually pain at all times when the foot is lifted up or when you push off the ground.  

In chronic cases, there can also be a small bump on the back of the Achilles that becomes tender to the touch. The aim should be to recognize the injury in the early stages and get it treated and taken care of.

That can be said about a lot of injuries; however, in tendon related injuries (and in particular the Achilles tendon) it is even truer. The reason being is that your tendons aren’t very highly vascularized, meaning they don’t get a ton of blood supply to them.4

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Unlike your muscles, your tendons are white or light colored in the body and pictures of the body (as opposed to the muscles which are very vascularized and red because of this). This means your tendons don’t heal quite as well as other tissues in the body when they have been injured. That is one of the reasons it isn’t uncommon to see a recovery period of up to 6 months when dealing with chronic cases.

The Causes Behind Your Achilles Tendon Pain

The simple answer to the cause changes in training volume. Injuries like this follow a very simple equation when the load on the body or body part is more than the capacity of the tissues to handle them you get an injury (Load > Tissue Capacity = INJURY).

Although it’s not entirely consistent in the research, what is understood is that these loads on the tissues above their capacity lead to a potential change in the cellular structure of the tendon which can lead to degeneration.


Amongst runners, a contributing factor that is often times missed is what may be happening or not happening further up the chain at your hip.  As Smith et al. were able to show in a study in 2014, those suffering from Achilles tendinopathy also exhibited poor activation and strength in their glute muscles.6

The weakness and poor activity of the glute, the most powerful hip extender, leads to the body generating hip extension from elsewhere: enter your calves. This leads to changes in your gait and more load put on your calf muscles, which are transmitted to your Achilles tendon.

Treatment for Achilles Pain

When dealing with Achilles tendinopathy, there is one thing that has been shown to be most beneficial, although it is not 100% understood why. A popular treatment for Achilles pain is eccentric calf raises, or slowly lowering down from being on your toes, has been the gold standard therapeutic exercise.

Eccentric exercises have the capacity to load tissues almost two times more than concentric exercises allowing injured tissues to handle loads to strengthen them in a way that won’t cause pain. This treatment for Achilles pain has also been shown to lead to increased flexibility in the Achilles tendon and calf muscles.


However, as you can see, there is as much effort needed to be put on other dysfunctional areas of the body that would be contributing to the increased load on the Achilles tendon like glute max related exercises.

Take Home Message

  1. If you are in your 30’s, 40’s or 50’s (the ages where Achilles tendon injuries are most common) regardless of whether you have Achilles tendon pain or not, get your glutes stronger to increase the capacity of what your Achilles tissues can handle through some eccentric exercises.
  2. If you are noticing some stiffness or slight pain, get it addressed now before it gets much worse (and try the treatment for Achilles pain above)
  3. Most importantly, consult a trusted manual medicine practitioner, like a chiropractor or a physiotherapist to address dysfunctional areas that could be contributing to your Achilles tendon injury and to treat it quickly and effectively.

This fantastic guest post was written by Dr. Mahmoud Zaerian (aka Dr. Z), a chiropractor and instructor of medical acupuncture. We encourage you to check out his website here!


  • Maffulli et al. Achilles Tendinopathy: Aetiology and Management. Journal of the Royal Society of Medicine. 2004;97:472-476. Published October 2004
  • S de Jonge et al. Incidence of midportion Achilles tendinopathy in the general population. British Journal of Sports Medicine. 2011; 45:1026-1028. Published August 3, 2011.
  • Sorosky et al. The Practical Management of Achilles Tendinopathy. Clinical Journal of Sports Medicine. 2004; Vol.14, No. 1. Page 40-45. Published January 2004.
  • Fenwick et al. The Vasculature and its role damaged and healing tendon. Arthritis Research. 2002, 4:252-260. Published February 13, 2002
  • O’Neill et al. Why are Eccentric exercises effective for Achilles Tendinopathy? International Journal of Sports Physical Therapy. Vol. 10, No. 4. Pages 552-562. Published August 2015.
  • Smith et al. Neuromotor Control of Gluteal Muscles in Runners with Achilles Tendinopathy. Medicine & Science in Sports & Exercise. 594-599. Published August 2013.
Dr. Mahmoud Zaerian
Dr. Mahmoud Zaerian (or as he is known by his patients, Dr. Z) is a practicing chiropractor in the city of Toronto with an interest in sports related injuries. He’s a graduate of the Canadian Memorial Chiropractic College and Senior Instructor in the McMaster University Medical Acupuncture Program. Dr. Z has been in the health field for over 17 years as clinician and strength and conditioning specialist and has worked with some of the city’s top Olympians. Currently, Dr. Z is part of the medical team for the Men’s and Women’s Canadian national Gymnastic team providing his sports injury rehab and performance training expertise.

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